Increasing HIV Testing and Counseling through Improved Health Commodities Management: Kwale County, Kenya

{Photo credit: Mark Tuschman}Photo credit: Mark Tuschman

HIV testing and counseling is central to HIV and AIDS prevention and control as well as improving the quality of patients’ lives. Individuals learn their HIV status and receive personalized risk-reduction counseling to help prevent acquiring or further transmitting of HIV while those found positive are enrolled for support, care, and treatment.

Until 2014, only 46 percent of inpatients at Msambweni Sub-County Hospital in Kwale County were tested for HIV. This changed in 2015 when a team from the hospital set out to increase the number of inpatients tested for HIV.

To initiate the process, the team, with support from the Management Sciences for Health-led Health Commodities and Services Management (HCSM) project, funded by the US Agency for International Development (USAID), conducted an assessment to determine the factors impeding HIV testing and counseling for inpatients at the hospital.

Obstacles included: limited access to test kits due to poor health commodities management practices, including poor documentation of the number of clients tested for HIV at the various testing points; lack of accountability for HIV test kits; a lacking relationship between quantities issued and numbers tested; lack of appropriate skills and knowledge among staff; failure to aggregate consumption data leading to stock-outs in the facility; lack of documentation of stock status at handover when changing shifts; and locking up of test kits.

[Msambweni hospital staff during Continuous Medical Education on health commodities management.] {Photo credit: HCSM}Msambweni hospital staff during Continuous Medical Education on health commodities management.Photo credit: HCSMThe Msambweni team used the results of the assessment to design measures to improve commodities management. As a first step, the team built the capacity of staff at service delivery points in management of health commodities covering topics on inventory management, accurate and timely reporting, proper documentation, use of management information systems tools, and proper storage.

Using their newly acquired skills, the staff adopted proper documentation, with stock status at change of work shifts properly documented; secure storage with controlled access and introduced an easy to understand in-house template to address reporting challenges, and aid the testing sites in preparing accurate monthly reports.

These interventions resulted in improved availability of test kits, leading to a tremendous increase in the number of inpatients testing for HIV—from 46 percent in 2014 to 74 percent in 2015. Some service points, like the female ward, achieved close to 100 percent testing of all inpatients as a result of round-the-clock testing due to increased access to test kits. Moreover, accountability for the test kits improved, resulting in reduced losses.

“Initially, staff in charge of test kits used to lock them up because of lack of accountability by those who use them. This limited access to the testing kits, hence limiting the number of HIV tests conducted,” said John Munyi, assistant laboratory manager at Msambweni Sub-County Hospital:

However, after training on commodity management and adoption of proper management practices, accountability improved. As such, test kits were not locked up any more, making them available round the clock to health workers at all services' points to conduct tests.