Evaluating Intervention Components

For the VCT component, VCT team leaders assessed counselors’ adherence and skill levels in 10 essential component areas, including (1) general counselor skills in keeping with the client-centered, personalized risk reduction model recommended by the U.S. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO)[15] and (2) adherence to counseling strategy. Each of these component areas were then assessed via approximately 10 required activity or skill criteria. General counselor skills included empathy, being non-judgmental, maintaining appropriate boundaries, and relaying the objectives of the VCT session. As with CM and PTSS, counseling staff were required to review component or session protocols, session checklists, and any other relevant information in advance of each session. From a diplomatic perspective, QAC procedures (1) helped to ensure that project staff completed the VCT process in a non-threatening and sensitive fashion and (2) in accordance with the expected international standards for the delivery of HIV counseling and testing.

For the CM component, CM team leaders assessed outreach workers’ adherence and skill levels for 10 essential areas of community interaction and 6 areas of community referral and follow-up. These included (1) basic interaction skills, (2) provision of accurate information, and (3) referrals to further care. Interaction skills included empathy, being non-judgmental, maintaining appropriate boundaries, and maintaining session cohesion. In addition to adherence to manualized guidelines, CM activities were also rated, using the same scales, on the skill with which the staff member delivered the session. In particular, community mobilization staff were assessed on their success in adapting related activities to observe local social, cultural and religious norms,[16] thereby ensuring that the Project Accept intervention was delivered to recipient communities and individuals with appropriate attention to diplomatic considerations.

For PTSS, team leaders assessed facilitators’ adherence and skill levels in individual crisis counseling, group information sessions, coping effectiveness training, and stigma reduction training (each with approximately 12 activity or skills criteria). Staff were evaluated on (1) basic support service delivery skills, (2) skills in guiding goal-setting, and (3) adherence to the PTSS curriculum. PTSS activities were evaluated and scored separately. As with CM and VCT assessment procedures, PTSS staff and service delivery was assessed with reference to acceptable standards of service delivery from the diplomatic perspective, including the provision of long-term, sustainable and effective coping strategies for patients diagnosed with HIV.