Pangani district council tested 106,232 people between 2016 and 2020. Out of tested people, 69, 460 (65.39%) were tested at five health facility through Amref supported program. A total of 36,772 (34.61%) of the total people tested for HIV were tested from 18 facilities that did not get support from Amref. Program supported facilities seems to perform higher than non-supported facilities. This is likely to have been caused by regular training on HIV testing, regular supportive supervision, data quality assessment conducted by program officers and motivation. HIV testing models can do nothing without good plans, monitoring and evaluation, allocation of adequate resources, training of key implementers as well regular supportive supervision [4].
Implementation of HIV testing models involved 106,232 clients tested for HIV at Pangani district council between 2016 and 2020. PITC contributed a total of 77,617 people who made (73.06%). The model became more effective in increasing the number of people in testing compared to other models due to its feature that required all symptomatic and non-symptomatic inpatient and outpatient clients have to be tested for HIV. This model seems to be more contributing to increased number of people in testing as reported by (Ogbo et al., 2017).
PMTCT contributed 13.72% of the total people tested for HIV, which is higher than VCT and index. This contribution is likely to be caused by mandatory HIV testing of pregnant mothers and their sexual partners during the ANC services. The mandatory testing increased the number of people tested for HIV through PMTCT model. The same effect of PMTCT seems in the study done by (Pope et al., 2008). The study discovered that; mandatory HIV testing increased the number of people in HIV testing. VCT and Index seem to perform low due to their uniqueness and that they are specific. VCT is now discouraged by PITC since all clients attending the facility have to test for HIV before seeing a doctor.
Pangani district council tested positive 2,843 (2.7) people by different models from 2016 to 2020. Among them, 73.40% of the total cases were contributed by PITC model; index model contributed up to 18.15%, PMTCT contributed 4.22% while VCT model contributed about 2.78%. The contribution of case detection is directly proportion to the number of people tested for HIV per model. This concurs with UNAIDS fast tracking strategy. The number of people in testing will increase the number of case detection. This led to first 95 of the UNAIDS strategy Girum et al. (2018) and Ogbo et al. (2017)
The study observed that, creation of demand for HIV testing is initiated by health care providers. In health center and district hospital was the role of lay counselor and OPD doctor and nurse. At the dispensary, this was the duty of all providers at a particular facility. This practice is directed by national HTS guideline and UNAIDS fast tracking strategy. The findings of this study are supported by the study of Shahira Ahmed et al. (2016). Most pre counseling were done before a client attended to the clinician for consultation. This helped to increase the number of people to test.
The shortage of physical space and lack of privacy may discourage some people to be counseled and tested. Availability of physical facilities for counseling and testing is reported in the study of (Ahmed et al. 2016). The study reported shortage of physical space as a factor impinging the effort to increase the number of people in HIV testing. Also, it is against the HTS guideline and protocol, the guideline requires setting of room with fool privacy that facilitates counseling process.
Pangani district hospital was a facility with special room for HIV testing, but the hospital had more than 10 testing points. These points included OPD clinician rooms, lab, dental unit, VCT room, labour ward, pediatric ward, male and female medical and surgical wards, private ward male and female, RCH, minor theatre and clinic room. This made Pangani hospital to perform more in testing compared to other facilities with low number of testing points. Health centers and dispensaries had only two to three testing points which were clinician rooms; lab and RCH were used as HIV testing points. Health centers and dispensaries had low testing points due to shortage of physical space, multifunction rooms as well shortage of staff.
The findings show among the five facilities supported by AMREF that; all have trained HIV testers. This involved those who attended special training on HIV testing and those who got on job training given during the supportive supervision. This can be among the factors which led to high performance. The performance of facilities supported by Amref program was higher than those with no support. There was no training prepared for none program supported facilities. This led to lower morale of work among the health workers, low awareness of new strategies introduced in testing as proposed by UNAIDS fast track strategies on HIV free generation by 2030 (Ahmed et al. 2016).
The study discovered 100% availability of HTS kits at all facility levels. This is like to be caused by the fact that HIV services are under the vertical program. They make order to MSD and they get on time. Availability of HIV testing kits facilitate the implementation of UNAIDS fast track strategy. This is supported by the study of (Bolu et al. 2007). Availability of HIV testing kits facilitated the implementation of UNAIDS fast track strategy. The study findings health care workers were not satisfied with motivation and rewards given to them and some were totally not motivated. Motivation of key implementers and actors of strategy is a catalyst to effective implementation (Dalal et al., 2011)