IntraHealth is working to improve access to HIV/AIDS community services in the Eastern Caribbean island nations of Antigua and Barbuda, Barbados, St. Kitts and Nevis, and St. Vincent and the Grenadines through the Eastern Caribbean Community Action Project (EC-CAP). The International HIV/AIDS Alliance leads EC-CAP, a USAID-funded, three-year project that began in 2007. The University of California at San Francisco also supports the project. EC-CAP has a mandate to support each nation’s National Strategic Priorities and to assist in reaching the most at risk populations in order to mitigate the spread of HIV. The expected results of the project are to increase the use of strategic information to promote sustainable, evidence-based HIV/AIDS community services and to increase access to those services in the Eastern Caribbean.

As an EC-CAP subcontractor, IntraHealth is responsible for designing and implementing a strategy to scale up community-based counseling and testing and community-based rapid testing (CBCT/CBRT). Rapid testing provides not only same-day diagnosis but reveals test results in fewer than 30 minutes and can be done using either a finger prick or an oral swab. Because the test can be performed by trained lay people—freeing up limited health care providers to focus on care and support treatment—the number of testing sites can be increased.

In September 2009, IntraHealth conducted a preliminary evaluation to document the CBCT/CBRT model in Antigua so that the results and lessons learned can be used for further roll-out of CBCT and CBRT services in 2009-2010 in Barbados and St. Kitts and Nevis. The pilot program shows promising results. More people are coming to be tested, and more people are inquiring about the rapid test. From May-September 2009, 847 people underwent rapid testing, out of which 10 tested positive. Stakeholders were satisfied with the program’s implementation, especially their involvement in the operational plan and participation in training and mobile testing activities. “We can get into the homes and do the test not only for one person,” commented one stakeholder, “but for the entire family members who are sexually active and, believe [it] or not, exposed. We are so thankful for CHAA, IntraHealth, UNAIDS for collaborating.”

The National AIDS Secretariat and Ministry of Health (MOH) of Antigua enthusiastically supported CBCT/CBRT. CBCT/CBRT was supported by strong collaboration among the MOH, the Caribbean HIV/AIDS Alliance (CHAA), and regional and international organizations. Additionally, the program was able to mobilize committed local faith-based organizations and nongovernmental organizations involved in HIV/AIDS work. The program was able to build on an existing behavior change communication foundation supported by EC-CAP and work with community animators.

Community animators praised the program’s work in training behavior change advocates; they say that selecting community animators from the most-at-risk populations has been a key to program successes and has reduced stigma and discrimination. They also appreciate the way the program brings testing to the people who need it rather than forcing animators to bring clients to organizations which are doing the testing.

Clients were also pleased with the program, especially the speed with which the counseling and rapid testing service established their HIV status.

“I feel confident,” one client remarked. “People are good and want to save your life.”

Another client noted, “They do not write down your names. They put your initials only. I found it confidential.”

“It is good [that they] come out to the community. Lots of us do not want to go in the town to do it because they think it is not confidential,” added a third client. “As I did it today, I will advise young people to go for it. It is confidential, and I am satisfied.”