Guyanas Voluntary Counseling Testing Program Ppt Ccas 09 Final) Copy
03. Voluntary HIV Testing and Counseling
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Transcript of 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