Health System- Related Barriers to the Uptake of Vct Services in a Rural Setting, a Case of Chivuna Southern Province

Abstract

For the past two decades, HIV and AIDS pandemic has been one of the most challenging problems faced by humanity globally with the sub Saharan region being the most affected. Within the region, Zambia is one of the countries worst hit by the HIV and AIDS pandemic. Since 2005, the government has been providing ART free of charge in all public heath institutions. To ensure access to life-saving drugs, VCT, which is the entry point to ART Uptake, has been stepped up by providing free testing services and increasing the number of both static and mobile free testing services throughout the country. However, available literature shows that despite the efforts aimed at increasing access to testing, very few Zambians have taken up testing. Methodology: Drawing on data from a wider ethnographic study conducted in a remote Zambian rural setting on the factors influencing VCT and adherence to ART, this paper focuses on the barriers that limited people's access to VCT services within the context of the health care system. Results: The study findings reveal and hence confirm that VCT services which were crucial for ART uptake were wide spread in a rural setting like Chivuna. However, the study found out that access and utilization of these services was not guaranteed. This was due to a number of bottlenecks within the health system itself. Among these were: lack of confidentiality among staff, inadequate training, low staffing levels, non-availability of equipment and inadequate nutritional support. This was compounded by other factors such as the challenge of travelling great distances to the nearest VCT and having to raise money for transport, securing money for food for one to use when away from home to attend VCT services in a distant place, lack of financial resources and the poor road network. Conclusion: The study has shown a level of association between health system-related factors and people's uptake of VCT services. In this regard, it is important for stakeholders to redress barriers in the health delivery system so as to enhance early HIV testing in order to enable entry into the continuum of care for people found HIV positive. This has the potential to contribute to reduced morbidity, reduced mortality and reduced transmission of new HIV infection cases.