Evaluation database

Evaluation report

2003 BH: Voluntary Confidential Counselling and Testing Project Evaluation

Author: Homans, H.

Executive summary

Background:

The UNICEF-supported, one-year pilot project implemented by the International Forum of Solidarity (IFS) on voluntary confidential counselling and testing (VCCT) for HIV started on June 2002, at a cost of approximately US$ 43,000 for the year. During May 2003, the project was formally evaluated by an international consultant for the United Nations Inter Agency Group (IAG) on Youth Friendly Services (YFS).

Purpose/Objective:

The aim of the evaluation was to assess the extent to which the voluntary confidential counselling and testing (VCCT) for HIV had achieved its objectives and to make recommendations for the continuation of the project, and going-to-scale with specific activities and increased coverage.

Methodology:

The evaluation was conducted through interviews with key project staff from the International Forum of Solidarity (4 counsellors, 4 outreach workers, 11 volunteers, 2 contacts/gatekeepers and beneficiaries), as well as a representative of the Cantonal health authority in Tuzla and 4 doctors working on the project in both sites - Tuzla and Zenica. The UNICEF Programme Officer and Assistant Project Officer were also interviewed. TA review of background documents was also included in the evaluation.

Findings and Conclusions:

In July 2002, the two IFS centres started testing for HIV and, to-date, 409 people have been tested - all test results were negative for HIV. Over 90% returned to the center for their results. In Zenica, they recommend that all people tested for HIV return for another test after three to six months. About 5% have already returned for a second test.

The NGO IFS is a local Youth NGO that managed to access risk groups' members through peer approach. The evaluation looked specifically at the participation of youth in the VCCT and found that the young people are actively involved in the design, implementation and monitoring of the VCCT project. The outreach workers are predominantly young people and all the volunteers are young people (either students or project beneficiaries).

The evaluation shows that the project had clearly met its targets and had developed a workable system of providing VCCT services to especially vulnerable young people (EVYP) in Tuzla and Zenica cantons through innovative cooperation between an NGO (IFS), the local health authority and an international donor (UNICEF). In one canton (Tuzla), health workers are supporting the project through working on a voluntary basis to take blood samples in their own free time; that is, outside official working hours and without payment. The project is an exemplary model of using outreach workers to identify EVYP and informing them of the risk of HIV, a peer counsellor for pre- and post-test counselling, and health workers to provide the blood testing and diagnostic facilities. Beneficiaries of the project expressed satisfaction with the services received.

IFS project staff and volunteers made the following observations on the lessons learnt during the first year of project implementation:

• Need to improve the media campaign to present the project better, but this is expensive
• "Our previous attempts were amateurish."
• Everything is focused on the 1st December and there is nothing much in between
• More training is needed on sex and sexuality to work with groups where the main mode of HIV transmission is sexual
• There is a need for more information for EVYP on STIs and they would welcome a video and illustrated leaflets on this
• Focus is only on counselling and testing for EVYP - it should be broader and not only focus on those people coming for testing; for example, some school children do not have information on HIV/AIDS
• Should have more information on interactive methods for young people to gain more information and develop skills
• Need to make linkages between HIV prevention and STI prevention and contraception
• The importance of the contribution of cantonal and municipal officials to young people's health and development, and the need to include all relevant sectors/ministries
  
  Recommendations:

Given the successful first year of project implementation, it is recommended that the UNICEF-supported VCCT project goes to scale within the existing project oblasts/cantons of Tuzla and Zenica. First, it is proposed that UNICEF provides further support to:

• Expand the range of EVYP covered by the project to include sex workers as well as IDUs and MSM
• Expand the range of services offered to EVYP (IDUs, MSM and SWS) to include testing for Hepatitis B and C, and diagnosis and treatment for STIs
• Increase IFS capacity in basic counselling and issues of sex and sexuality
• Increase IFS capacity in counselling for behaviour change (safer sex and harm reduction)
• Extend the geographical coverage of the project to all sites where EVYP inject drugs or sell sex within the oblast/canton.

Before going-to-scale, it is recommended that a more detailed mapping is done of the existing and proposed sites for the VCCT intervention with the three main groups of EVYO (IDUs, MSM, SWs). This should include regular visits to the sites, and estimates of the number of EVYP at the sites and their at-risk behaviours. At the moment, outreach workers only have information on the number of materials distributed. In order to do this thoroughly, it may be necessary to involve more representatives of EVYP (IDUs, MSM and SWs) as outreach workers.

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