Improving Testing Accuracy: Competency Assessment Testing for HIV Rapid Testing Among Counsellor Testers in Ekiti State.

In HIV programming, quality of care begins at the point of a client’s first encounter with the health system (testing point). Accurate test results and every word of counselling delivered shapes a client’s journey through care. As WHO and CDC note, proficiency testing is a cornerstone of quality assurance in HIV testing, ensuring consistency, reliability, and accuracy at every level of the system. Extending this rigor to counsellor testers closes a long-standing gap in the quality continuum.

Proficiency Testing and competency assessment has traditionally focused on facilities and laboratories, ECEWS through the SPEED Project is redefining that standard by expanding outreach and point of care settings. With this shift, it’s increasingly critical to maintain the accuracy and reliability of test results. In an innovative and novel approach, the HTS team, in close collaboration with the Laboratory Unit, piloted a competency assessment for all Counsellor Testers in the State. This was done to minimize errors in HIV testing – ranging from improper sample handling to incorrect interpretation of results which can undermine the integrity of the program.

A Novel Approach: Putting the Human Element at the Centre of Quality

Unlike conventional PTs, which test facility laboratory personnels, this exercise focused on the frontline counsellor testers who perform HIV testing daily in communities, outreach sites, and health facilities. The aim was simple yet strategic: to evaluate and strengthen the accuracy, competency, and confidence of those who form the backbone of HIV testing services in Ekiti State. By comparing their results to predetermined reference outcomes, CA offers a snapshot of how well counsellor testers perform under routine conditions.

For many years, proficiency testing within HIV programs has concentrated on laboratory staff and site-level testing points, leaving counsellor testers who form the largest proportion of HIV testing personnel largely unassessed. This first-ever Counsellor Tester competency assessment (CTCA) exercise under the ECEWS SPEED Project was aimed at closing this gap.

Why This Matters: Accuracy Starts with the Counsellor

Counsellor testers are more than test operators; they are educators, motivators, and the first point of trust for clients. Their role determines not only whether a client is correctly diagnosed, but also whether that client is successfully linked to prevention or treatment services.

By periodically evaluating the accuracy of test results, CA enables early identification of performance gaps before they affect client outcomes. It helps remind testers of the importance of strict adherence to Standard Operating Procedures (SOPs) for sample handling, kit use, interpretation and documentation.  CA ensures that clients receive correct diagnoses and are promptly linked to appropriate services. This reduces cases of false positives and false negatives. CA also helps to enhance programmatic efficiency by minimizing wastage of test kits.

Implications for Program Effectiveness and Quality

This initiative has both practical and strategic benefits the HIV program: Its benefits includes enhanced testing accuracy promoting early detection of skill gaps ensures that every client receives a reliable diagnosis, Improved Data Integrity leading to more reliable reporting on positivity rates and linkage outcomes, system efficiency which reduces the cost of re-testing, misdiagnosis, and data correction, boost confidence and morale of the Counsellor testers knowing their skills meet national and international standards and lastly, the success of this pilot positions ECEWS to replicate this model across other project states.

In conclusion, this idea marks a historic milestone for the ECEWS Ekiti SPEED Project. A demonstration that innovation in quality improvement doesn’t always require new technology, but rather a new perspective on how to value and support the people behind the services. By institutionalizing this approach across the “Hills of Ekiti,” we can ensure that every HIV test whether performed under a tent in a rural community or within a busy urban clinic meets the same standard of accuracy, empathy, and excellence. As we expand, our message remains clear: when counsellor testers are proficient, clients are protected, and program quality is assured.