03. Voluntary HIV Testing and Counseling

8/6/2019 03. Voluntary HIV Testing and Counseling

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VCT The Evidence The V(voluntary ) encourages people to

present at services they may otherwiseavoid.

The C(counselling)is more effective thanthe simply providing health information.

The T(testing) quality, same day testsare cost effective and increases uptakeand demand for VCT .


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The classic VCT model

Individual VCT

Group information giving

VCT for couples


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Brainstorm Activity

Discuss.....

What are the advantages?

What are the disadvantage?


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Model of VCT

Classic model Opt in model Opt out model

Shared confidentiality model HIV screening


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VCT Models Free-standing VCT Integrated into health care services-

- Integrated into general hospital services- Attached to specialized clinics, such as STD,TB, or

antenatal clinic- NGO is provided space to provide VCT within a

hospital

- Attached to research projects- Private sector, Owned by individual or companies Mobile (outreach) VCT Home testing


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Free-standing VCT Advantage

- Separate from medical services- Community links- Dedicated counselors- Post-test support- Flexibility of opening times

Potential disadvantages-- Possible stigma

- Sustainability/funding


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Integrated into Health careservices

Advantage

- Cost- Ease of replication/scaling-up- Stigma-test support

- Liaison with medical interventions- Access for woman- Access for young people

Potential disadvantages-- Workload- Access for men and couples- ? Quality of counseling


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Home testing Advantage

- Privacy- Access for special groups- Cheap (for health system)

Potential disadvantages-- No pre-test counseling- No/limited post-test counseling

- Coercion- Poor quality control- Single test- Difficult to perform


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Informed consent

Confidentiality

Legislation to prevent discrimination

Quality control


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Voluntary counseling andtesting

Client-initiated HIV testing to learn HIVstatus Pre-test counseling on an individual basis

or in group settings with individual follow-up UNAIDS/WHO promote knowledge of HIV

status among any population that mayhave been exposed to HIV through anymode of transmission.


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Diagnostic HIV testing Indicated whenever a person shows

signs or symptoms that are consistentwith HIV-related disease or AIDS to aidclinical diagnosis and management


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Diagnostic HIV testing (contd) Includes HIV testing for all tuberculosis

patients as part of their routinemanagement


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Routine counseling andtesting

Routine C and T is a step towardnormalizing HIV

Less conspicuous Addresses many of the barriers to HIV

testing as it becomes the standard of care.


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WHO/UNAIDS recommend that a routine

offer of HIV testing be made to all persons: Being assessed for STIs In antenatal care Asymptomatic persons seen in health care

settings where HIV is prevalent and ARVtreatment is available


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For provider-initiated testing, patients

retain the right to refuse testing, i.e. to optout of a systematic offer of testing.

The basic conditions of confidentiality,consent and counseling apply but thestandard pre-test counseling is adapted to

simply ensure informed consent, without afull education and counseling session


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Mandatory HIV screening

UNAIDS/WHO support mandatory screeningfor HIV and other blood borne viruses for:

blood that is destined for transfusion or for manufacture of blood products.

Mandatory screening of donors is required: prior to all procedures involving transfer of bodily

fluids or body parts, such as artificial insemination,corneal grafts and organ transplant.


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UNAIDS/WHO DO NOT support

mandatory testing of individuals on publichealth grounds.

Mandatory testing is done in associationwith resettlement, immigration, military

recruits


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Mandatory testing UNAIDS/WHO recommend that such

testing be conducted only whenaccompanied by: counseling for both HIV-positive and HIV-

negative individuals and referral to medical and psychosocial services

for those who receive a positive test result.


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Sound policies provide a supportive

framework for the provision and scaling upof HIV testing Sound public health practice and respect

for basic human rights are mutuallyreinforcing

Thus the voluntary nature of testing mustremain core to the provision of HIV testingservices.


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Anonymous counseling &testing

It is not the same as:

Voluntary counseling & testingor

Confidential counseling & testing


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Voluntary Counseling andTesting (VCT)

The ideal concept for HIV testing to ensuremaximal benefit with least risk from testing

It has been a law in Thailand since 2002. It is not unique for HIV/AIDS but should be

applied to any test with potentialpsychosocial consequence.


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Counseling skills Construct and predictive validity Maintenance of skills through

practice Validity across cultures and

genders, but difference styleinuse


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Counseling skills

Different theories and differentpatterns of use of skills

Micro-skills social learning model Micro-skills are useful with others

system of training Micro-skills and integration


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Counseling skills

Counselling micro-skills areessential for effective

communication and thedevelopment of a

supportive client-counsellor relationship


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Counseling skills

HIV Prevention Counseling is acounselor-led and Client-focused

exchange designed to helpindividuals make behavior changes that will reduce their riskof acquiring or transmitting HIV


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Counseling skills

active listening Questioning

Silence Non-verbal behavior


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Pre-test counseling

Apply knowledge of basic counselling microskills tothe context of HIV pre-test counselling

Integrate clinical risk assessment, HIV prevention

education and counselling into HIV pre-testcounselling

Assess an individual s coping strategies and

psychosocial support systemFacilitate provision of informed consent by the client


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To ensure that any decision to take the test is fullyinformed & voluntary

To prepare the client for any type of result, whether negative or positive or indeterminate

To provide client risk reduction information &strategies, irrespective of whether testing happens

To provide options for PMTCT

To provide an entry point to treatment & care


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An individualised risk reduction plan

Facilitate the client to enact the plan

Facilitate coping skills acquisition

Facilitate improved support mechanismsto client: interpersonal & familiar


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General principalEstablish relationship with client

Find out why the client has come to the centre(information, counselling and testing)?

Information on HIV Correct any misconceptions give simple

factual information

Discuss HIV transmission including the 4principles ESES


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Help client assess own level of risk & draw up ownrisk reduction plan

Explain the HIV test

Talk about the advantages & disadvantages of the testfor the individual


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Discuss the importance of spouse or partner disclosure (& the counselling assistance that can beprovided for this)

Summarise the session for the client

Obtain informed consent

Reaffirm right to decline testing


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If client decides to test:

Inform client about the procedure for test

Length of time for results immediate/delayed

Amount of and manner in which blood(venipuncture, finger prick, etc) will betaken

Remember to show client blood tube/slidecollection form & labels which have their code


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Some flexibility is requirede.g. If the client is distressed on initial presentationyou will need to address this first


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Post-test counseling Apply a knowledge of basic counselling

techniques used in VCT Understand the basic requirements for the

provision of HIV results Conduct a post- HIV test counselling

session for a negative result

Conduct a post- HIV test counsellingsession for a positive result


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To prepare the client for the result To help client understand and cope with

the result To provide further information to the client

(if necessary)

To refer the client to other services (whererequired) To discuss with the clients strategies to

reduce HIV transmission


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Cross check all results with client file and

blood samples Provide results only face-to-face Be aware of the manner in which you call

clients from the waiting area Provision of written test results is not

advised


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Subject to misuse (for both positive and

negative results) Testing for employment, insurance

special precautions Sharing results with partners best done

at the VCT service


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General Principles

Be calm when you call the client in for their result Be direct in giving the result Give an explanation of their result Allow enough time for results to sink in


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Negative result provision Check for possible exposure in window

period including any risks, which mayhave occurred since pre-test counselling

Reinforce information on transmission,safer sex/drug use.

Exploration of constraints to practice of

such


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Negative result provision Referral for anxiety i.e. worried wells

- easily reassured - HIV phobia, hypochondriasis

Clients may be negative but in the processof sero-conversion and hence may behighly infectious!

Counselling Issues Related to


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Counselling Issues Related to

Negative Results Clients may worry that others will know they

have taken the test and make judgementsabout their personal life or health Clients may fear that employers or insurance

companies will discriminate against themeven though the results are negative

Clients may understand that they need tomodify their behaviour but may worry that

their partners will not want to change Clients who had high risk behaviour maybelieve they are immune from HIV


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Frequent HIV Negative Testers Often engage in high risk behaviours

Have deep seated anxiety and belief thatthey are HIV positive

Should be reassured, if not respondingthen refer to specialist for psychological/psychiatric/mental health follow up

Checklist for Provision of HIV


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Checklist for Provision of HIVNegative Results

Cross check client ID, blood samples andrecords

Check for possible exposure in window

period and inform client of need for anyretest and when this should occur

Reinforce information on HIV transmissionand personal risk reduction plan

Referral for anxiety i.e. worried wells


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Positive Result Provision Some clients may react with severe shock

and distress Others may show no emotion:

Blocked affect Previously tested

Allow enough time for results to sink in

Let the clients acknowledge their fears


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Positive Result Provision Clarify misinformation about meaning of

result and it s implications

Assess supports available for client (refer if necessary)

Assess coping strategies Assess short-term arrangements for

leaving clinic, getting home etc.

P i i R l P i i


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Positive Result Provision

Discuss disclosing status to partner

Provide information on: Health, rest, exercise, diet Safe sex Infection control issues

Ask the client if they have any questions

Offer follow up session Provide written information to read later

Documents

03. Voluntary HIV Testing and Counseling