HIV Counseling and Testing HIV Counseling and Testing

MTN-003 MTN-003 Study-Specific TrainingStudy-Specific Training

Overview of PresentationOverview of Presentation

HIV C&T at screening (brief check-in)HIV C&T at screening (brief check-in) HIV C&T at follow-upHIV C&T at follow-up

Scenarios highlighting HIV testing Scenarios highlighting HIV testing algorithm and associated algorithm and associated counseling messagescounseling messages Role playRole play Review of formsReview of forms

Risk reduction counselingRisk reduction counseling DocumentationDocumentation

STARTsample 1

2 different rapid tests

Sample 1WB

Sample 22 different rapid tests

STOP. Report to participant asHIV-uninfected

STOP. Report to participant asHIV-infected

Discordant/requiresadditional testing.

Notify The MTN Network Laboratory

-

-/-

+

+/+

+/-

ind

Repeat testing, beginning at “START” in approximately one month.

HIV Testing at ScreeningHIV Testing at Screening

STARTSample 1rapid test

Sample 1WB

Sample 2WB

STOP. Report to participant asHIV-uninfected

STOP. HIV infection confirmedReport to participant as

HIV-infected

Requiresadditional testing.

- or ind

-

- or ind

+

+

Consult the MTNNetwork Laboratory

for further testing and follow up

+

+

Sample 1HIV viral load

-

HIV C&T at Follow-Up: Scenario HIV C&T at Follow-Up: Scenario #1#1

STARTSample 1rapid test

Sample 1WB

Sample 2WB

STOP. Report to participant asHIV-uninfected

STOP. HIV infection confirmedReport to participant as

HIV-infected

Requiresadditional testing.

- or ind

-

- or ind

+

+

Consult the MTNNetwork Laboratory

for further testing and follow up

+

+

Sample 1HIV viral load

-

HIV C&T at Follow-Up: Scenario HIV C&T at Follow-Up: Scenario #2#2

STARTSample 1rapid test

Sample 1WB

Sample 2WB

STOP. Report to participant asHIV-uninfected

STOP. HIV infection confirmedReport to participant as

HIV-infected

Requiresadditional testing.

- or ind

-

- or ind

+

+

Consult the MTNNetwork Laboratory

for further testing and follow up

+

+

Sample 1HIV viral load

-

HIV C&T at Follow-Up: Scenario HIV C&T at Follow-Up: Scenario #3#3

STARTSample 1rapid test

Sample 1WB

Sample 2WB

STOP. Report to participant asHIV-uninfected

STOP. HIV infection confirmedReport to participant as

HIV-infected

Requiresadditional testing.

- or ind

-

- or ind

+

+

Consult the MTNNetwork Laboratory

for further testing and follow up

+

+

Sample 1HIV viral load

-

HIV C&T at Follow-Up: Scenario HIV C&T at Follow-Up: Scenario #4#4

HIV CounselingHIV Counseling

By the time of the first VOICE follow-up By the time of the first VOICE follow-up visit, participant will have undergone HIV visit, participant will have undergone HIV C&T twice and risk reduction counseling C&T twice and risk reduction counseling three timesthree times

With monthly C&T throughout follow-up, With monthly C&T throughout follow-up, care must be taken to avoid rote repetition care must be taken to avoid rote repetition of the same information each monthof the same information each month

What are your thoughts on discussion of What are your thoughts on discussion of “standard” HIV education and pre-test “standard” HIV education and pre-test information at each visit?information at each visit?

Risk Reduction CounselingRisk Reduction Counseling

A client-centered and case-management A client-centered and case-management type of approach should be used to make type of approach should be used to make risk reduction counseling as effective as risk reduction counseling as effective as possiblepossible Relies on four PsRelies on four Ps Quality of Quality of pparticipant-articipant-pprovider rovider

relationshiprelationship PPartnership in a shared goal artnership in a shared goal Mutually respectful Mutually respectful Non judgmentalNon judgmental

PPersonalized strategies to try to address ersonalized strategies to try to address barriers to risk reductionbarriers to risk reduction

Client-Centered Client-Centered ApproachApproach

Counselor’s role is to ask questions, Counselor’s role is to ask questions, actively listen to participant’s actively listen to participant’s responses, and guide participant responses, and guide participant toward next stepstoward next steps

Outcome should be participant Outcome should be participant identifyingidentifying Her barriers to risk reductionHer barriers to risk reduction Her strategies and action plans to try to Her strategies and action plans to try to

address the barriersaddress the barriers Supported and facilitated by the counselorSupported and facilitated by the counselor

Client-Centered Client-Centered ApproachApproach

Greet client and establish rapportGreet client and establish rapport Describe purpose of the session Describe purpose of the session Emphasize confidentiality of the sessionEmphasize confidentiality of the session Listen effectively, allow client to speak, avoid Listen effectively, allow client to speak, avoid

interruptionsinterruptions Communicate effectively, verbally and non-Communicate effectively, verbally and non-

verballyverbally Communicate at client’s level of understandingCommunicate at client’s level of understanding Use open-ended questionsUse open-ended questions Clarify misconceptionsClarify misconceptions Provide positive reinforcementProvide positive reinforcement

Closed-Ended vs Open-Closed-Ended vs Open-EndedEnded

Do you know how HIV is passed from Do you know how HIV is passed from one person to another?one person to another?

Do you understand what your test Do you understand what your test results mean?results mean?

Do any of these risk factors apply to Do any of these risk factors apply to you?you?

Client-Centered Client-Centered ApproachApproach

Strategies and action plans should:Strategies and action plans should: Reflect the participant’s current risk Reflect the participant’s current risk

assessmentassessment Be realistic and practical, yet Be realistic and practical, yet

challenging toward risk reductionchallenging toward risk reduction Be agreed upon by the participantBe agreed upon by the participant Be documented, with copy available to Be documented, with copy available to

participant if desiredparticipant if desired

Client-Centered Client-Centered ApproachApproach

Participant’s risk reduction Participant’s risk reduction issues/barriers may be significantissues/barriers may be significant Strategies may need to be incrementalStrategies may need to be incremental

Participant’s risk reduction Participant’s risk reduction issues/barriers may change over timeissues/barriers may change over time Strategies may need to evolve over timeStrategies may need to evolve over time

Client-Centered Client-Centered ApproachApproach

Counselor should alsoCounselor should also Offer skills buildingOffer skills building

How to use male and female How to use male and female condoms (hands-on demonstrations)condoms (hands-on demonstrations)

How to talk to partners (role play)How to talk to partners (role play) Offer couples counseling and/or Offer couples counseling and/or

other counseling with influential other counseling with influential personspersons

Risk Reduction CounselingRisk Reduction Counseling

Each month, risks/issues/barriers and Each month, risks/issues/barriers and action plans identified at the action plans identified at the previous counseling session should previous counseling session should be reviewed and discussed with the be reviewed and discussed with the participantparticipant

What was her experience over the What was her experience over the past month? past month?

Was she able to carry out her plan?Was she able to carry out her plan? What was the outcome?What was the outcome?

Risk Reduction CounselingRisk Reduction Counseling

Action plans for the coming month Action plans for the coming month should build on the past month’s should build on the past month’s experienceexperience

Successful strategies should be continuedSuccessful strategies should be continued Additional strategies may be identified to Additional strategies may be identified to

achieve further risk reductionachieve further risk reduction Alternative strategies may be identified if Alternative strategies may be identified if

strategies tried over the past month were strategies tried over the past month were not successfulnot successful

All as identified and agreed upon by the All as identified and agreed upon by the participant with the counselor’s guidance participant with the counselor’s guidance and supportand support

Risk Reduction CounselingRisk Reduction Counseling

For this type of approach to be For this type of approach to be successfulsuccessful

Issues/barriers/strategies/action plans Issues/barriers/strategies/action plans discussed at each session must be discussed at each session must be documented documented

Documentation must be accessible for Documentation must be accessible for review at the next sessionreview at the next session

GeneralGeneral

HIV education and pre-test HIV education and pre-test counselingcounseling

HIV post-test counseling HIV post-test counseling

Risk assessmentRisk assessment

Risk factors and barriers to Risk factors and barriers to risk reductionrisk reduction

Risk reduction plan – Risk reduction plan – experience and outcomes experience and outcomes since last visitsince last visit

Risk reduction plan – Risk reduction plan – strategies for the coming strategies for the coming monthmonth

Additional notes pageAdditional notes page

HIV Counseling HIV Counseling WorksheetWorksheet

ReferralsReferrals Referrals are expected components of risk Referrals are expected components of risk

reduction plans (when indicated)reduction plans (when indicated) Referrals should be actively followed up at Referrals should be actively followed up at

subsequent visits to determine subsequent visits to determine If participant sought the services to which If participant sought the services to which

she was referredshe was referred The outcome of the referralThe outcome of the referral If additional referrals are neededIf additional referrals are needed

Document all referrals, outcomes, and Document all referrals, outcomes, and follow-up plans and actionsfollow-up plans and actions

What Are What Are Your QuestionsYour Questions Thoughts and Thoughts and

Reactions?Reactions?