Use of data from HIV counselling and testing services for HIV surveillance in Africa

This article from the Lancet warns against the inappropriate use of data collected at voluntary HIV counselling and testing clinics in Africa. The article points out that the data collected at these clinics is unreliable for wider use as a measurement of HIV prevalence or for tracking behavioural patterns. Those attending clinics are a self-selecting group and cannot be taken as representative of the population as whole. Combining data from different clinics to get national figures overlooks the different ways in which people come to clinics, such as the difference between those who walk in and those who are referred from other medical services.

Collecting this sort of data also has an impact on how the clinics deliver their services. Asking a client a series of structured questions about their sexual behaviour disrupts the flow of the relationship between the counsellor and client, and also raises serious issues in relation to client confidentiality. The article recommends that the principle purpose of data-collecting at these clinics be to ensure that the correct test result is given to each client, and to monitor demand and take-up of the service. It also recommends that data-collection activity should only happen before and after, but not during, counselling sessions and be carried out by administrative staff rather than counsellors.