Meeting the demand for HIV testing and counselling (HTC) services at Gulu Regional Referral Hospital

Like other regional referral hospitals (RRHs), Gulu RRH is a high-volume healthcare facility with a shortage of service providers. Clients arrive as early as 7:00am and often wait for 2-3 hours before they are attended to by clinicians. As one walks through the hospital gate, the queue of patients at the main Out-Patients Department waiting area is striking. Long queues like this one are a familiar sight at other Out-patient clinics within the hospital as the day unfolds. Early risers manage to get seats on the wooden benches while the rest lean against the metal poles for support or sit across the verandas as they wait their turn to be attended to.Clients line up for HIV testing and counselling services

Although the queues persist, healthcare providers make better use of the time by offering complementary client-focused services. This started in July 2014 during a joint USAID/SUSTAIN and Ministry of Health five-day mentoring/support supervision exercise on scaling up access to HTC using a Provider Initiated Testing and Counselling (PITC) approach. In all Out-patient clinics, HIV testing services are given to clients during the early hours while they (clients) wait for other healthcare services.

Clients at the Gulu RRH Out-patient hypertension clinic line up for HIV testing services after sensitization by nurses @URC 2014 USAID/SUSTAIN project /Julian Natukunda

I have lost two daughters to AIDS. When they fell sick, I nursed them without taking any safety precautions. Now that there is an opportunity for HIV testing, I would like to know my status,” said Ajuleta, a patient attending the Gulu Hypertension Clinic.

To meet the increased demand for HTC services arising out of these changes, staff have divided and clarified roles: nurses conduct health education sessions on a rotational basis; one staff member registers clients and completes HTC client cards; and volunteers, counsellors and nurses share responsibility for conducting HIV testing, counselling and distribution of results. Hospital staff also agreed to begin offering HIV testing services as early as 8:00am on each day of work. The hospital management and leadership teams have supported the initiative by participating in giving health education talks; allowed re-design of client flow within various units; and ensuring that there are enough HIV test kits. In addition, they participated in mentoring staff on how to conduct health education talks.

Senior Principal Nursing Incharge giving health education at the Out-patients department, Gulu RRHWhen patients come, let it be a song that we sing every time we interact with them; tell them the Ministry of Health cares, the Government cares, Gulu cares and that we all care about their health. Knowing one’s HIV status is a key to a healthy future,” said Sister Piloya Okot -   Senior Principal Nursing Officer, as she coached departmental staff. In only three days after beginning the PITC initiative, the hospital’s 23 units with HIV testing services had tested 573 clients and linked 19 HIV-positive clients to care, physically escorting them to the Anti-retroviral Clinic. Pleased with their results, the hospital teams set daily targets for each unit to test clients for HIV and established a quality improvement team to support scaling up of PITC services to all healthcare service delivery units.

Sr. Piloya Okot, Senior Principal Nursing Officer, conducts health education on benefits of HIV testing to clients at the main Out-patient department, female section @URC 2014 USAID/SUSTAIN project /Julian Natukunda


 Written by; Julian Natukunda, Communications Specialist; Rosemary Nasaba, HTC Program Advisor, Kellen Baguma, HTC Program Officer with contributions from Jessica Ziegler, Knowledge Management Specialist at URC