Transcript Voluntary counseling and HIV testing

Overview of HIV Counseling and
Testing
(HCT)
HIV Care and ART:
A Course for Healthcare Providers
Learning Objectives
■ Explain the purpose and benefits of HCT as the
entry point to HIV prevention, care, and treatment
■ List the basic components of a HCT program and
pre- and post-test counseling
■ Identify the skills and characteristics of an effective
HCT counselor
■ Discuss the definition of counseling and Patients’
Rights during Counseling and Testing.
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Learning Objectives
■ Describe how the counselor’s attitudes, values,
and prejudices might affect her/his counseling
■ Describe the difference between VCT and PIHCT
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Values Clarification Exercise
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Definition of counseling
■ Counseling is a two-way communication process
that helps individual :
■ Examine personal issues
■ Make decisions
■ Make plans for taking action
■ In HIV counseling and testing the focus of the
sessions is helping clients make decision based
on their HIV status
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Definition of counseling
■ HIV counseling involves:
■ Listening
■ Respect for the client
■ Confidentiality
■ Asking questions
■ Allowing clients to make their own decisions
■ Helping clients find other services they need
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Definition of Counseling
■ Counseling is not:
■ Telling clients what to do
■ Criticizing clients
■ Forcing ideas or values on clients
■ Taking responsibility for clients’ actions or
decisions
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HIV Counseling and Testing (HCT)
• HCT is the key entry point to all HIV
prevention, Treatment ,Care and Support
services.
• Through HCT people discover their HIV
status and its implication and make
informed choice for their future life.
• HCT can be Client Initiated (VCT) or
Provider initiated (PIHCT) which include
HCT
Diagnostic test, Routine &Mandatory
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Overview of VCT
■ Voluntary Counseling & Testing (VCT) is an
HIV-prevention intervention initiated by the client
at his or her free will.
■ VCT provides the opportunity for the client to
confidentially explore and understand his/her HIV
risks and to learn his/her HIV infection status with
the support of a counselor.
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Objectives of VCT
To assist individuals and couples to:
■ Assess their HIV risk behaviors
■ Develop a risk reduction plan
■ Access HIV testing
■ Adopt risk reduction behavior
■ Access medical and psychosocial referral services
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VCT Models
■ Integrated within existing health services, i.e.,
general clinical care settings and specialized
clinics, such as ANC,TB, STI
■ Free-standing VCT sites
■ Mobile (outreach) VCT services
■ Private VCT services
■ Youth-friendly VCT services
■ Work places
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Components of a VCT
Program (1)
■ Type of counseling session
■ Individual
■ Couple
■ Pre-test counseling
■ Introduction and orientation
■ Risk assessment
■ Option for risk reduction
■ Preparation for the test result
■ HIV Test
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Components of a VCT
Program (2)
■ Post-test counseling
■ HIV negative test result
■ Negotiate risk reduction plan
■ Support for risk reduction plan
■ Negotiate disclosure & partner referral
■ HIV positive test result
■ Identify source of support
■ Negotiate disclosure and partner referral
■ Risk reduction issues
■ Referral
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PIHCT – Definition
■ Routine testing of all patients who need an HIV test
for medical reasons
■ Test is usually offered by a health care worker as
part of regular medical care
■ Confidential test is performed unless the patient
declines the test
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Rationale for PIHCT
■ Increase individuals’ access to HIV testing, and
therefore increase the number of people who know
their status
■ Increase uptake of ARVs
■ Many people prefer to be tested by a health care
provider during a regular visit to the clinic
■ PIHCT takes less time
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Provider-Initiated HIV Counseling and Testing
Services— Definitions
■ Diagnostic – Patient presents with symptoms that may be
attributable to HIV or has an illness associated with HIV,
and diagnosis and clinical management of the patient is
influenced by the diagnosis of HIV.
■ Routine – HIV testing is offered as part of the clinical
evaluation of all patients in settings where HIV is prevalent.
■ “Opt-in” – HIV test is routinely recommended and offered to
each patient and the patient explicitly consents to receive
the HIV test.
■ “Opt-out” – HIV test is routinely recommended and provided
to each patient and the patient is informed of his/her right
to refuse the test
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Difference between VCT and PIHCT
VCT
PIHCT
■ Expect to get tested
■Come to clinic specifically for
HIV test
■Come to clinic because they
have TB/STI or any of the
opportunistic infections
suggestive of HIV
■ More likely to be
asymptomatic
■ Not necessarily expecting
HIV test
Providers
■Usually trained counselors,
not
necessarily trained as
health care providers
Health care providers trained to
provide counseling/education
Purpose of HIV
counseling and testing
■Primary purpose is on
preventing HIV transmission
through risk assessment, risk
reduction and testing
Primary purpose focus is on
diagnosing HIV for appropriate
opportunistic and HIV
management, particularly by
referral for HIV care
Clients/Patients
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Difference between VCT and PIHCT
■
Pre-test
encounter
VCT
PIHCT
■Client centered - counseling
■Provider recommending test as
routine for anyone coming to this
clinic
■ Usually a one – a – one encounter
■ As important to discuss results
with negatives as positives because
the focus is on prevention
■ Limited discussion about need
for HIV testing
■ Little time spent with those
who test negative
■ Primary focus on those who test
positive with emphasis on their
medical care
Follow Up
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■HIV positive clients referred to medical
care services and other support services,
some in community.
▪Care of HIV positive patients
coordinated between TB and HIV
providers, referred for other support
services, some in community.
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Patientsُ Rights during counseling
■ confidentiality
■ privacy
■ refuse testing
■ be treated with respect
■ information
■ Ask questions
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HCT as a Foundation of HIV Prevention and
Care Services
ACCEPTING AND
AND
ACCEPTING
COPING
WITH
HIV
COPING WITH HIV
STATUS
STATUS

··
··
··
LIVINGPOSITIVELY
POSITIVELY
LIVING
Nutrition
Nutrition
CLEAN WATER
WATER
CLEAN
REDUCEDSTRESS
STRESS
REDUCED
WELLBEING
WELLBEING
RISK REDUCTION
·
BEHAVIOR CHANGE
·
DISCLOSURE OF
STATUS
·
PARTNER REFERRAL
TO VCT
·
CONDOM ACCESS
·
·
·
SUPPORT
FAMILY
SOCIAL-FELLOWSHIP
PEER-HIV POSITIVE
HIV
VOLUNTARY
COUNSELING
COUNSELING
&TESTING
&TESTING
·
·
·
MEDICAL CARE
STI –TB TREATMENT
TB PROPHYLAXSIS
OI PROPHYLAXSIS
(HCT)
PLANNING FOR FUTURE
·
FAMILY PLANNING
·
ORPHAN CARE
·
FINANCIAL
PLANNING (WILL)
·
·
·
COMMUNITY
INTERVENTIONS
SENSITIZATION
MOBILIZATION
DESTIGMATIZATION
PREVENTION OF MOTHER
TO CHILD TRANSMISION
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Algorithm for Use of 3 Rapid Tests
in Testing and Counseling Services
Pre-Test Education and/or Counseling
First HIV Rapid Test
Positive Test Result
Negative test result/ Counsel for Negative Results
Second HIV rapid Test
Positive Test Result/Counsel for Positive Results
Negative Test Result
Third HIV Rapid Test
Positive Test Result/Counsel for
Positive Test Result
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Negative Test Result/ Counsel
for Negative Test Result
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Parallel Test
Sample
T1
Neg
T2
Pos
Neg
Pos
T3
Neg
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Pos
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Major VCT Program Areas
Minimum Package of VCT
1.Counseling
2.Testing
3.Referral
Others
4. Information management system
5. Community sensitization to raise
awareness about HCT
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Benefits/Concerns of VCT
■ To the individual
■ To the couple and family
■ To the community
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Counseling Skills and VCT
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Skills and Characteristics of
Effective VCT Counselors (1)
■ Believes that HIV prevention counseling can make
a difference in preventing and controlling HIV for
the individual, the family, and the community
■ Uses active listening skills
■ Balances well-selected, open-ended questions with
statements, summaries, and reflections that guide
the session and maintain the focus on risk issues
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Skills and Characteristics of
Effective VCT Counselors (2)
■ Is comfortable discussing specific HIV risk activities
and able to remain focused on risk issues
■ Is able to help a client develop a realistic and
relevant risk reduction plan
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Counseling Essentials
Remember to always:
■ Demonstrate professionalism and maintain rapport
throughout the session
■ Convey to the client that his or her confidentiality
will be strictly protected
■ Speak with the client at his or her level of
understanding
■ Conduct an interactive session focused on risk
reduction
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Counseling Essentials (2)
■ Clarify important misconceptions, but avoid
extended talk on issues not related to risk
■ Stay organized, and avoid counseling outside the
protocol’s structure
■ Know that it is all right to tell the client that you will
be covering something later
■ Avoid collecting data about the client during the
counseling session
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Skills Used to Talk with CT Clients
■ Empathizing
■ Active Listening
■ Open Questioning
■ Probing
■ Focusing
■ Affirming
■ Clarifying
■ Correcting False Information
■ Summarizing
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Counseling is a Relationship
Client and counselor both
bring:
 Hope
 Knowledge
 Questions and answers
 Personal experiences
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Questioning Skills
■ Acknowledge that you have heard and understood the
client
■ Ask appropriate follow-up questions
■ Ask questions to complete information related to HIV risk,
risk reduction, coping, and support
■ Ask client to elaborate on unclear issues
■ Ask client to clarify confusing or contradictory information
■ Blend reflective, guiding, and directive statements with well
chosen open-ended questions
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Ethical Principles for
Counselors
Respect For Client’s Dignity and Rights
■ Dignity
■ Acceptance
■ Non-judgment
■ Rights
■ Confidentiality
■ Privacy
■ Autonomy
■ Self-determination
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Ethical and Legal Issues
■ Respect autonomy of individual
■ Avoid discrimination/stigma
■ Protect confidentiality of individual
■ Informed consent
■ Age of consent
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Disclosure
■ To whom and when is always the choice of the
patient
■ Can encourage the partner to have an HIV test
■ Can prevent the spread of HIV to the partner
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Closing a Counseling Session
■ Remind client of pre-test
information
■ Assess client’s emotional
state
■ Give client space to ask
questions
■ Schedule client for further
sessions
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Referrals
■ Developing linkages with other services
■ Referral directory of services
■ Referring clients
■ Developing a system for tracking referrals
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VCT Client Referral
VCT Client
Pre and Post Test
Counseling
Referral
Medical Examination
(Clinical and Lab)
NO
YES
ART counseling
ART administration
and follow up
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Working With Couples
■ Make sure both partners
have an understanding of
HIV/AIDS
■ Review willingness to have
HIV test
■ Explain the process of
testing and receiving
results
■ Discuss advantages and
disadvantages of knowing
results as a couple
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Working With Couples:
Making a Plan
■ Review options for
positive, negative, and
discordant results
■ Explore the possibility of
discordant results
■ Identify others who may be
affected by the outcome
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Pre-Test Counseling
■ What does the client
understand about HIV?
■ What does the client
understand about HIV
testing?
■ How does this information
apply to the client?
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HIV-Negative Results
■ Give time and space for the client to express
emotions
■ Explore the client’s reaction
■ Review the meaning of the test result (revisit the
window period)
■ Discuss prevention/risk reduction
■ Refer for ongoing support/counseling at
appropriate site
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Giving HIV-Positive Results
■ Allow some time
■ Discuss what this means
■ Identify a coping strategy
■ Emphasize risk reduction
■ Link with support services
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Key Points (1)
■ VCT is an HIV-prevention intervention initiated by
the client at his or her free will.
■ VCT provides the opportunity for the client to
confidentially explore and understand his/her HIV
risks and to learn his/her HIV infection status with
the support of a counselor.
■ HCT is a cornerstone of early access to prevention
as well as care and support
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Key Points (2)
■ VCT assists individuals and couples to:
■ Assess their HIV risk behaviors
■ Develop a risk reduction plan
■ Adopt risk reduction behavior
■ Access medical and psychosocial referral services
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Key Points (3)
■ Components of a VCT program include counseling,
testing, and referral
■ Effective counseling requires a number of qualities,
characteristics and skills that can be developed
and improved with practice.
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Key Points(4)
■ Normalizes HIV CT in the clinic, health care facility and the community
■ HIV testing becomes the standard of care
■ Provides an alternative and feasible model for delivering HIV CT
services in a clinical setting
■ Optimizes the use of human resources
■ Increases uptake of HIV CT services
■ Identifies ARV eligible clients
■ Improves management of TB and HIV disease
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References
■ CDC GAP Trainer’s Manual on VCT (March 2003).
■ FXB-CDC, Zimbabwe PMTCT TOT Curriculum.
■ Tekeste Kebede (Nov 2003) Voluntary Counseling
and HIV Testing Nazareth Training, International
Training & Education Center for HIV (I-TECH).
■ JHPIEGO,PIHCT trainers Manual
■ JHPIEGO,PMTCT Participant Hand Book
■ Zimbabwe PMTCT TOT Curriculum (FXB-CDC).
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