The Government of Kenya, with other stakeholders, developed a national HIV/ AIDS strategic plan (1) that identifies strategies to alleviate the spread of HIV/AIDS whose prevalence is estimated at 6.7%. (2) One of the key strategies since 2001 has been the establishment of voluntary counselling and testing (VCT) services, which have spread rapidly throughout the country. (3,4) Early in 2001 a common national VCT data collection form was piloted by stakeholders and adopted for national usage. (5)
VCT sites are all registered with the national AIDS and sexually transmitted infection (STI) control programme (NASCOP) and supervised annually, during which time the quality of the on-site laboratory and counselling room records are assessed. Registered sites, whether governmental or nongovernmental, are issued with a unique site code, based on both province and district. (4,5) MI sites make monthly returns to their district AIDS and STI coordinator (DASCO), and are issued with free test kits from the government in return for data. In theory the returns are passed up a chain for final collation at NASCOP. At the time of this exercise, there were 332 registered sites.
Many of the donor-supported sites follow a parallel reporting system where data are channelled through their internal mechanism to their main offices. Key among the donor sites are the Centers for Disease Control and the Liverpool VCT (an independent nongovernmental organization in Kenya), which represent fewer than 30% of the sites but around 90% of their data are available in NASCOP.
In Kenya, the national VCT programme uses four models that are integrated, stand-alone, community-based and mobile. (3,5) The integrated sites are located within the grounds of a health facility, whereas stand-alone sites are usually not associated with medical institutions. VCTs in the community-based approach are integrated into other social services or are implemented as the core activity, whereas the mobile approach provides outreach to remote or hard-to-reach areas.
A comprehensive national database is crucial for government planning and budgeting purposes, including the sourcing of test kits, training of VCT counsellors and counsellor supervisors, and the planning of treatment programmes. VCTs have a potential to integrate family planning and other services as well as to provide a point of entry into the health-care system for people who are found to be HIV positive. Owing to the rapid increase of VCT sites in Kenya, there has been a challenge with regard to data collection and management. NASCOP has not been able to receive proper and up-to-date data about the client flow at these sites, posing a challenge to the national VCT database. We therefore set out to determine the completeness of the on-site records, follow up missing data for the national VCT database and determine the barriers to the flow of data in VCT sites in Kenya.
In this exercise, we used an evaluative operations research approach that was non-experimental. In our sample, all registered sites were surveyed quarterly for missing data. We adopted a record-based quantitative survey and a semi-structured interview of key informants to explore opinions about the causes of delays in data handling. All registered sites were surveyed for missing data. Interviews were conducted with key informants, such as counsellors, DASCOs and provincial AIDS and STI coordinators (PASCOs) at sites where delays in data submission were identified.
Two teams of four members were selected and worked simultaneously in different provinces collecting data between 5 September 2004 and 15 October 2004. There was a short training session for data collectors before the start of the exercise; this included how to survey the opinions of key informants with regard to delayed submission of reports, completion of the quarterly reports and the new data collection tool. …