Tuberculosis patients' perspectives on HIV counselling by lay counsellors vis-à-vis counselling rendered by nurses : an exploratory study in two districts of the Free State province, South Africa

Abstract

Due to the high rates of HIV / AIDS and TB, and the subsequent burden placed on the healthcare system that is further accompanied by severe shortages of nurses, the role of lay counsellors has become increasingly important in South Africa. This article reports about TB patients' perspectives on counselling rendered by lay counsellors vis-a-vis counselling rendered by nurses. Structured exit interviews were conducted with a convenience sample of 600 patients across 61 primary healthcare facilities in the Free State province. Data were subjected to both descriptive and inferential statistical analyses. Except for coverage of the 'window period' topic, patients' perspectives on HIV counselling by lay counsellors compared with nurses did not significantly differ in respect of duration of counselling, coverage of other HIV counselling topics and conduct of counsellors. However, 55.0% (n=126) of patients counselled by a lay counsellor would have preferred a nurse, while 42.9% (n=48) of those counselled by a nurse would have preferred a lay counsellor. The findings suggest relative satisfaction with counselling provided by both types of counsellors. Expanded use of lay counsellors in TB / HIV programmes could help mitigate the human resource crisis that has resulted primarily from shortages of nurses. National TB and HIV / AIDS policies need to acknowledge and clarify the role of lay counsellors to facilitate their extended utilisation in TB / HIV services.