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Door-to-Door, Family-to-Family HIV Counseling and Testing

Bata Geleto walks up to a small mud house in Shashemene, a town in the southern region of Ethiopia. She carries a large, blue bag and an umbrella to protect herself from the sun as she walks house to house. Bata knocks gently on the door and is greeted by a smiling, pregnant woman, Maza.  

Maza welcomes Bata and offers her a seat in the small house, alongside Mata’s husband and two small children. Bata met this young couple on her last visit to their home and has now returned to offer them HIV counseling and testing, which they agreed to the last time Bata saw them.

Bata is a nurse who works in Ethiopia’s Urban Health Extension Professional program. The ambitious program, launched by the Ethiopian government, aims to train thousands of community health workers to offer basic health services in the communities and in homes. Bata is just one of the 2,550 community health workers trained through the Community Prevention of Mother-to-Child project last year to offer basic maternal and child care as well as educate couples about preventing vertical HIV transmission. The project has also developed an effective referral system that refers pregnant women to health centers for antenatal care through referral cards and collaborations with local health facilities. The project will be working with these women as they go door to door and also train new community health workers to expand the project’s reach into other communities.

In the case of the family Bata is now with, her visits save them from walking 15 miles to the nearest health center for care. It’s not only the distance that can discourage couples like Maza and her husband from seeking an HIV test. Bata also knows that her clients worry about a lack of confidentiality around HIV testing and how their neighbors in Shashamene might discriminate against them if they test positive.

In the privacy of their own home, the couple seems more comfortable although perhaps nervous. Bata talks them through the pre-test counseling session and then takes a rapid test kit from her bag and administers it to Maza and her husband. To much relief, the couple is HIV-negative. Bata delivers this good news, and then sits with them awhile. She talks to them about how HIV is transmitted, including vertical transmission, and how they can continue to protect themselves so their family can remain HIV-negative. She also talks to them about the importance of antenatal care and skilled care during labor and delivery. Before she leaves, Bata gives Maza a referral card for her antenatal visits at the local health center. She notes the date for her next visit in her log book and then makes her way to another house down the road.

The second house belongs to Tigist, a widow, whom Bata counseled and tested for HIV during her last visit. The last time Bata was there, Tigist learned she is living with HIV. Bata referred her to the health center to get her CD4 count, which determined that she’s eligible for antiretroviral treatment. Now Bata is back to check on Tigist, to see how she’s doing. Bata will visit her every month to make sure she is continuing the treatment, to talk to her about family planning and how to protect herself and her partners from HIV, and to offer emotional support and counseling.

Today, about one million Ethiopians like Tigist are living with HIV, including more than 90,000 children younger than 15. As many as 66,000 pregnant Ethiopian women living with HIV do not have access to treatment, making Bata’s work and that of the many other community health workers all the more critical as one of the only practical ways to reach people  with basic care in this large and populous nation.

The Community Prevention of Mother-to-Child Transmission Project is led by IntraHealth International and funded by USAID.