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Guyana PMTCT TrainingModule 5, Slide 1 Module 5 HIV Testing and Counselling for PMTCT.

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Presentation on theme: "Guyana PMTCT TrainingModule 5, Slide 1 Module 5 HIV Testing and Counselling for PMTCT."— Presentation transcript:

1 Guyana PMTCT TrainingModule 5, Slide 1 Module 5 HIV Testing and Counselling for PMTCT

2 Guyana PMTCT TrainingModule 5, Slide 2Module 5, Slide 2 Module Objectives  Discuss the integration of HIV testing and counselling in settings where MCH services are provided  Discuss the three guiding principles for testing and counselling  Explain the difference between provider- and client- initiated approaches to HIV testing

3 Guyana PMTCT TrainingModule 5, Slide 3Module 5, Slide 3 Module Objectives (Continued)  Describe the importance of effective communication and counselling skills when working in settings where PMTCT services are provided  Describe the ways to deliver pre-test information & counselling  Provide pre-test information  Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings

4 Guyana PMTCT TrainingModule 5, Slide 4Module 5, Slide 4 Module Objectives (Continued)  Describe HIV Testing Processes  Explain the meaning of positive (reactive) and negative (non-reactive) HIV test results  Describe the steps involved in post-test counselling  Discuss the disclosure process for women who are HIV- infected

5 Guyana PMTCT TrainingModule 5, Slide 5 Session 1 Overview of HIV Testing and Counselling for PMTCT

6 Guyana PMTCT TrainingModule 5, Slide 6Module 5, Slide 6 Session 1 Objectives  Discuss the integration of HIV testing and counselling in settings where MCH services are provided  Discuss the three guiding principles for testing and counselling  Explain the difference between provider- and client- initiated approaches to HIV testing

7 Guyana PMTCT TrainingModule 5, Slide 7Module 5, Slide 7 HIV Testing and Counselling  HIV testing provides:  Information about HIV status  Opportunity to identify women with HIV and empower them to make decisions to prevent MTCT  Opportunity to identify women who are HIV negative and empower them to remain negative

8 Guyana PMTCT TrainingModule 5, Slide 8Module 5, Slide 8 Provider- and Client-Initiated Approaches to HIV Testing  Two basic approaches to HIV testing: 1.Provider-initiated 2.Client-initiated  Both approaches include  Basic information about providing HIV testing  Risks and benefits of testing

9 Guyana PMTCT TrainingModule 5, Slide 9Module 5, Slide 9 Provider-Initiated Approach  HIV testing is a routine, expected part of standard care  Also referred to as “opt-out”  All women provided with pre-test information  All women are tested for HIV and provided with post-test counselling unless they decline testing  Testing is still voluntary under the provider-initiated approach

10 Guyana PMTCT TrainingModule 5, Slide 10Module 5, Slide 10 Client-Initiated Approach  Client specifically requests HIV test  Also referred to as “opt-in”  Clients provided with pre-test counselling  Only clients who specifically request to be tested are provided with HIV testing  Client gives verbal or written consent

11 Guyana PMTCT TrainingModule 5, Slide 11Module 5, Slide 11 Preferred Testing Strategy: Provider-Initiated  Recommended for HIV testing and counselling in ANC, L&D, post-delivery settings  Helps normalize HIV testing  Likely to increase the number of women who get tested for HIV

12 Guyana PMTCT TrainingModule 5, Slide 12Module 5, Slide 12 HIV Testing and Counselling (continued) WHO recommends provider-initiated HIV testing and counselling as a standard part of antenatal care (ANC), labour and delivery and post-delivery care

13 Guyana PMTCT TrainingModule 5, Slide 13  Provider Initiated or Opt-Out Approach  HIV testing is offered as a routine part of care  Women are provided with information and tested for HIV unless they decline to be tested or “opt-out”  Testing is still voluntary under “opt-out” since the client has a right to decline testing  Confidential post-test counselling is provided Guyana’s HIV Testing Policy

14 Guyana PMTCT TrainingModule 5, Slide 14Module 5, Slide 14 Definitions  HIV testing: process of determining if a client is infected with HIV. Blood or body fluids are tested for the presence of antibodies or antigens associated with HIV infection  HIV counselling: confidential dialogue between an individual or a couple and a healthcare worker (HCW) to help clients examine their risk of acquiring or transmitting HIV  HIV counselling is tailored to the risk behaviour, circumstances and special needs of the client

15 Guyana PMTCT TrainingModule 5, Slide 15Module 5, Slide 15 Advantages of Testing and Counselling for All Clients 1.HIV testing and counselling provides clients with an opportunity to learn their HIV status 2.Discuss partner testing and prevention (discordance, disclosure) 3.Receive information on treatment, care, nutrition, family planning and support services 4.Learn about importance of continuous health care 5.Make informed decisions about their pregnancy

16 Guyana PMTCT TrainingModule 5, Slide 16Module 5, Slide 16 Advantages of Testing and Counselling continued For HIV-negative women, advantages include:  Information and support to remain uninfected  Information and support to exclusively breastfeed

17 Guyana PMTCT TrainingModule 5, Slide 17Module 5, Slide 17 Advantages of Testing and Counselling (Continued) For HIV-infected women, advantages include:  PMTCT interventions (ARVs, safer delivery, infant feeding, referrals)  Learn about the needs of HIV-exposed children (HIV testing, cotrimoxazole)

18 Guyana PMTCT TrainingModule 5, Slide 18Module 5, Slide 18 Guiding Principles for HIV Testing 1.Confidentiality 2.Informed consent 3.Post-test support and services

19 Guyana PMTCT TrainingModule 5, Slide 19Module 5, Slide 19 Guiding Principles (Continued) 1.Confidentiality  Important responsibility of all HCWs  Essential to establishing and maintaining client trust  Information shared between HCWs and clients must be kept private

20 Guyana PMTCT TrainingModule 5, Slide 20Module 5, Slide 20 Guiding Principles (Continued) 1.Confidentiality, continued  Personal and medical information may be disclosed to other HCWs only to ensure client receives appropriate medical care  Only those directly involved in client's care will have access to medical records - and only on “need-to-know” basis  Anyone not directly involved in a client’s care (e.g., receptionist at ANC clinic), should not have access to client medical records

21 Guyana PMTCT TrainingModule 5, Slide 21Module 5, Slide 21 Guiding Principles (Continued) 1.Confidentiality, continued  All medical records and registers, whether or not they include HIV- related information, should be kept private and stored in a safe, secure place

22 Guyana PMTCT TrainingModule 5, Slide 22Module 5, Slide 22 Guiding Principles (Continued) 2.Informed Consent  Process during which clients receive clear and accurate information about HIV testing to make an informed decision about whether to accept or decline testing

23 Guyana PMTCT TrainingModule 5, Slide 23Module 5, Slide 23 Guiding Principles (Continued)  Elements of informed consent:  An understanding of the purpose and benefits of testing, counselling and PMTCT services  An understanding of the testing and counselling process  Respect for the client’s testing decision

24 Guyana PMTCT TrainingModule 5, Slide 24Module 5, Slide 24 Guiding Principles (Continued)  Informed consent:  Since HIV testing in Guyana during ANC is offered as part of routine care services (Opt-Out), written informed consent is not required  The client has the right to decline testing and can do so verbally

25 Guyana PMTCT TrainingModule 5, Slide 25Module 5, Slide 25 Guiding Principles (Continued) 3.Post-test counselling support and services  HIV test result should be offered in person as part of an individual (or couple) post-test counselling session  Provide both HIV-negative and HIV-positive women with test results and counselling

26 Guyana PMTCT TrainingModule 5, Slide 26Module 5, Slide 26 Guiding Principles (Continued) 3.Post-test counselling support and services  Ensure privacy when providing HIV test results  Reassure client you will keep the conversation and test results confidential  Inform client that follow-up treatment, care, support are available, including support for disclosure when needed

27 Guyana PMTCT TrainingModule 5, Slide 27  Exercise 5.1  Confidentiality Role Play: Large Group Discussion

28 Guyana PMTCT TrainingModule 5, Slide 28 Session 2  Counselling Skills

29 Guyana PMTCT TrainingModule 5, Slide 29Module 5, Slide 29 Session 2 Objectives  Describe the importance of effective communication and counselling skills when working in settings where PMTCT services are provided

30 Guyana PMTCT TrainingModule 5, Slide 30 Basic counselling Skills  Empathising  Active listening  Open questioning and probing  Focusing  Correcting inaccurate information Module 5, Slide 30

31 Guyana PMTCT TrainingModule 5, Slide 31 Characteristics of a Good Counsellor  Establishes good rapport with client  Has a good understanding of the issue (HIV/AIDS, Infant Feeding, Testing, etc.)  Understands the cultural and psychological factors that may affect a client’s decision  Uses non-judgmental approach  Presents information in a sensitive way  Recognizes when they cannot sufficiently assist a client, and refers him/her to an appropriate provider  Observes and responds to non-verbal communication (body language) Module 5, Slide 31

32 Guyana PMTCT TrainingModule 5, Slide 32Module 5, Slide 32 Role of the HCW in Counselling  Role of HCW during counselling: support and assist client’s decision-making process by:  Listening to client  Understanding the choices client needs to make  Helping client explore her/his circumstances and options  Helping client develop self-confidence to carry out her/his decision about testing

33 Guyana PMTCT TrainingModule 5, Slide 33Module 5, Slide 33 Role of the HCW in Counselling (Continued)  HCW is not responsible for:  Solving all of the client’s problems  The client’s decisions

34 Guyana PMTCT TrainingModule 5, Slide 34Module 5, Slide 34 Counselling Skills: Active Listening  It involves:  Listening to and understanding the client  Taking note of client’s non-verbal behaviour  Listening for client’s social and cultural context  Listening to client’s negative comments or feelings—make note of things that may have to be clarified Active listening helps establish a trusting relationship with the client

35 Guyana PMTCT TrainingModule 5, Slide 35Module 5, Slide 35 Counselling Skills: Self-Awareness  HCWs needs to be aware of their:  Strengths and weaknesses  Fears or anxiety about HIV

36 Guyana PMTCT TrainingModule 5, Slide 36Module 5, Slide 36 Counselling Skills: Self-Awareness (Continued)  Consider your responses to these questions:  What are my expectations of my clients?  How do I feel about discussing HIV infection and AIDS?  What are my feelings about people with HIV infection or AIDS?  What are my feelings about people whose behaviour has placed them at risk?

37 Guyana PMTCT TrainingModule 5, Slide 37Module 5, Slide 37 Counselling Skills: Self-Awareness (Continued)  Consider your responses to these questions:  Which sexual practices would I find most difficult to talk about?  Will I be judgemental of clients whose values, beliefs, attitudes, fears and views differ from mine?  Am I ready to let clients make their own decisions?

38 Guyana PMTCT TrainingModule 5, Slide 38Module 5, Slide 38 Listening and Learning Skills Skill 1: Use helpful non-verbal communication  Includes all aspects of the message not conveyed by words  It includes the impact of gestures, gaze, posture and expressions that convey information  Reflects attitude  Helpful non-verbal communication encourages client to feel HCW is interested in him/her

39 Guyana PMTCT TrainingModule 5, Slide 39Module 5, Slide 39 Non-Verbal Communication R A relaxed and natural attitude with clients O Open posture should be adopted—it shows that you are open to the client and to what client is saying L Leaning forward toward the client is a sign of involvement E Maintain culturally appropriate eye contact S Sit squarely facing client to show involvement

40 Guyana PMTCT TrainingModule 5, Slide 40Module 5, Slide 40 Listening and Learning Skills Skill 1: Use helpful non-verbal communication  Demonstration

41 Guyana PMTCT TrainingModule 5, Slide 41Module 5, Slide 41 Listening and Learning Skills (Continued) Skill 2: Ask open-ended questions  Open-ended questions begin with “how?” “what?” “when?” “where?” or “why?”  Encourages responses that lead to further discussion  Try to avoid questions with a “yes” or “no” answer

42 Guyana PMTCT TrainingModule 5, Slide 42Module 5, Slide 42 Listening and Learning Skills (Continued) Closed-endedOpen-ended You know what HIV is, don’t you?What is HIV? Do you have any other questions about MTCT? What other questions do you have about MTCT? Are you going to tell your partner about your HIV test result? Who are you going to tell about your HIV test result? Is your husband your only partner? How many partners have you had in the last 3 months? Do you plan to replacement feed? How do you plan to feed your baby?

43 Guyana PMTCT TrainingModule 5, Slide 43Module 5, Slide 43 Listening and Learning Skills (Continued) Skill 2: Ask open-ended questions  Demonstration

44 Guyana PMTCT TrainingModule 5, Slide 44Module 5, Slide 44 Listening and Learning Skills (Continued) Skill 3: Use gestures and responses that show interest  Gestures: nodding and smiling  Responses: “Mmm,” “Aha”  Attending skills: clarifying and summarizing - invite client to relax, talk about herself and her problems

45 Guyana PMTCT TrainingModule 5, Slide 45Module 5, Slide 45 Listening and Learning Skills (Continued)  Clarifying  Prevents misunderstanding  Helps sort out what has been said  Summarizing  Helps ensure client and HCW understand each other  Summarizing can offer support and encouragement to clients to help them carry out decisions they have made

46 Guyana PMTCT TrainingModule 5, Slide 46Module 5, Slide 46 Listening and Learning Skills (Continued) Skill 3: Use gestures and responses that show interest  Demonstration

47 Guyana PMTCT TrainingModule 5, Slide 47Module 5, Slide 47 Listening and Learning Skills (Continued) Skill 4: Reflect back what the client says  Encourages person to say more  Shows HCW is actively listening, encourages dialogue, gives HCW opportunity to better understand client’s feelings  Say what client said in a slightly different way  If client says, “I don’t know what to give she to eat, she ain’t want nothing” HCW might reflect back by saying: “You sure she not eating anything at all?”

48 Guyana PMTCT TrainingModule 5, Slide 48Module 5, Slide 48 Listening and Learning Skills (Continued) Skill 4: Reflect back what the mother says  Demonstration

49 Guyana PMTCT TrainingModule 5, Slide 49Module 5, Slide 49 Listening and Learning Skills (Continued) Skill 5: Empathize - show you understand how client feels  Used in response to an emotional statement  Encourages client to discuss the issue further  If client says, “I don’t know how to tell he I got the virus,” HCW could respond with “Wha you mean, you don’t know how to tell he?”  HCW is not empathizing if she responds with a question that has a factual answer

50 Guyana PMTCT TrainingModule 5, Slide 50Module 5, Slide 50 Listening and Learning Skills (Continued) Skill 5: Empathize—show you understand how client feels  Demonstration

51 Guyana PMTCT TrainingModule 5, Slide 51Module 5, Slide 51 Listening and Learning Skills (Continued) Skill 6: Avoid words that sound judging  Words like: right, wrong, well, badly, good, enough, properly  Using these words may make client feels she is wrong, or that there is something wrong with her baby  BUT, sometimes HCW needs to use “good” judging words to build a mother's confidence

52 Guyana PMTCT TrainingModule 5, Slide 52Module 5, Slide 52 Listening and Learning Skills (Continued) Skill 6: Avoid words that sound judging  Demonstration

53 Guyana PMTCT TrainingModule 5, Slide 53  Exercise 5.2  Listening and learning skills: demonstration (in the large group) and practice (in small groups)

54 Guyana PMTCT TrainingModule 5, Slide 54Module 5, Slide 54 Common Mistakes  Controlling the discussion  Judging the client  Preaching to a client  Labelling a client instead of finding out their individual motivations, fears or anxieties  Reassuring a client without knowing what the outcome could be

55 Guyana PMTCT TrainingModule 5, Slide 55Module 5, Slide 55 Common Mistakes (Continued)  Not accepting the client’s feelings  Advising before client has arrived at a personal solution  Interrogating  Encouraging dependence  Persuading or coaxing

56 Guyana PMTCT TrainingModule 5, Slide 56 Session 3  HIV Pre-test Information, Counselling and Testing

57 Guyana PMTCT TrainingModule 5, Slide 57Module 5, Slide 57 Session 3 Objectives  Describe the ways to deliver pre-test information  Provide pre-test information  Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings  Describe HIV Testing Processes  Explain the meaning of positive (reactive) and negative (non-reactive) HIV test results

58 Guyana PMTCT TrainingModule 5, Slide 58Module 5, Slide 58 Pre-test Information  The purpose of the pre-test session in PMTCT settings is to provide the woman or couple with adequate information to make an informed decision about HIV testing

59 Guyana PMTCT TrainingModule 5, Slide 59Module 5, Slide 59 Pre-test Information (Continued) Objectives and components of the pre-test session:  Help client understand HIV  Explain importance and benefits of HIV testing  Explain HIV testing procedures  Explain importance of partner testing, discordance, disclosure  Explain risk reduction and available services (condoms, MTCT) and provide referrals  Encourage continuous healthcare attendance (ANC and post- delivery)

60 Guyana PMTCT TrainingModule 5, Slide 60Module 5, Slide 60 Delivery of Pre-test Information Pre-test delivery model should:  Optimize the staff available  Not disrupt client flow  Maximize the number of women tested during their first visit Pre-test session models:  Group information  Individual information  Couple counselling

61 Guyana PMTCT TrainingModule 5, Slide 61Module 5, Slide 61 Group Pre-test Information Group information:  Optimize human resources  Allow for interaction among participants  Can be easily integrated into the clinic flow Group information sessions:  Are recommended for ANC settings  Not practical or recommended for the L&D setting

62 Guyana PMTCT TrainingModule 5, Slide 62Module 5, Slide 62 Group Pre-test Information (Continued) Key considerations for group sessions:  Adjust information to fit group's level of knowledge  Emphasize behaviour change, including safer sex practices  Set aside time for questions and answers  Have enough knowledge and skills to answer questions  Refer for individual counselling, when requested

63 Guyana PMTCT TrainingModule 5, Slide 63Module 5, Slide 63 Group Pre-test Information (Continued) Key information for group sessions:  Definitions of HIV & AIDS  Modes of HIV transmission  How to prevent HIV & other STIs  Safer sex practices  Confidentiality  HIV Testing Process  Interventions to prevent MTCT (e.g., ARVs, etc)

64 Guyana PMTCT TrainingModule 5, Slide 64Module 5, Slide 64 Group Pre-test Information (Continued)  Support and encourage women to be tested at their first ANC visit  Accommodate the need for family support and return visits where requested  Welcome family members; provide them with the same HIV pre-test information given to the client

65 Guyana PMTCT TrainingModule 5, Slide 65Module 5, Slide 65 Exercise 5.3 Providing pre-test information: demonstration (in the large group) and practice (in small groups)

66 Guyana PMTCT TrainingModule 5, Slide 66Module 5, Slide 66 Individual Pre-test Session The individual session is used either to: 1.Provide pre-test information OR 2.Provide information that complements group session to:  Reinforce pre-test information and answer questions  Address barriers to testing  Provide risk assessment, risk reduction counselling

67 Guyana PMTCT TrainingModule 5, Slide 67Module 5, Slide 67 Individual Pre-test Session (Continued) When testing and counselling is part of ANC services, clients must be reassured that declining an HIV test will NOT affect access to services. Emphasize that if the client changes his/her mind and wants to be tested, an HIV test can be provided during a later visit.

68 Guyana PMTCT TrainingModule 5, Slide 68Module 5, Slide 68 Testing and Counselling in L&D L&D presents unique challenges for HIV testing:  It is busy and the patient has very little privacy  Women are often anxious and in pain Women of unknown/undocumented HIV status at time of labour may be tested in L&D Make the woman comfortable, ensure testing is as confidential as possible

69 Guyana PMTCT TrainingModule 5, Slide 69Module 5, Slide 69 Testing and Counselling in L&D (Continued) ScenarioPossible solution Woman presents to L&D in early labour Provide pre-test information, rapid testing and result Woman presents to L&D in advanced labour with just enough time for pre-test session Provide pre-test information and testing if possible. Woman presents to L&D late in labour or is unable to test during labour Offer pre-test information, testing and result after delivery

70 Guyana PMTCT TrainingModule 5, Slide 70Module 5, Slide 70 Testing and Counselling in L&D (Continued) Content of the pre-test session in L&D 1.Introduce yourself 2.Explain MTCT 3.Discuss importance of testing 4.Explain testing process

71 Guyana PMTCT TrainingModule 5, Slide 71Module 5, Slide 71 Conducting the Pre-Test Session in L&D  Agree on a signal for contractions; wait until the contraction is over  If no record of HIV testing, inform mother she will receive information and testing for HIV  HIV testing is done, unless woman declines  Speak in soft tones, but make sure she can hear  Use a temporary screen or curtain for privacy or conduct session in another quiet area

72 Guyana PMTCT Training Module 5, Slide 72 Overview of HIV Testing  HIV tests detect antibodies or antigens associated with HIV in whole blood, saliva, or urine  Blood sampling is the most common method of testing  HIV tests are very accurate

73 Guyana PMTCT Training Module 5, Slide 73 HIV Tests Antibody tests  After infection with HIV, the body makes antibodies to fight the virus  It may take 4 to 6 weeks, but occasionally up to 3 months for antibodies to become detectable in the blood  During this time, a person can still transmit the virus to others  Rapid HIV tests and the ELISA are the most common antibody tests in PMTCT settings

74 Guyana PMTCT Training Module 5, Slide 74 HIV Tests (Continued) Rapid HIV tests  Accurate results within 20-40 minutes  Can be done in the clinic setting  Accurate when performed correctly  Usually performed on serum or whole blood (by fingerprick or venous sample); some rapid HIV tests use saliva  No batching required  HCWs can be trained to perform the tests  Usually do not require special equipment, electricity or refrigeration

75 Guyana PMTCT Training Module 5, Slide 75 HIV Tests (Continued) Benefits of rapid HIV testing include:  On-site testing and same day results  Lower risk of administrative error  Accepted by clients  Fewer resources required:  Human resources  Resources at the facility  Financial resources  Lower risk of occupational exposure

76 Guyana PMTCT Training Module 5, Slide 76 Guyana’s Rapid HIV Testing Algorithm Parallel testing  Two HIV tests are performed on same sample at the same time, e.g., in parallel  If both are non-reactive, client reported HIV-negative  If both are reactive, client reported HIV-positive  If one is reactive and the other non-reactive, a “tiebreaker test” is performed

77 Guyana PMTCT Training Module 5, Slide 77 Guyana’s Rapid HIV Testing Algorithm (Parallel Testing)

78 Guyana PMTCT Training Module 5, Slide 78 ELISA The ELISA is also an HIV antibody test  Accuracy of the ELISA and rapid testing are comparable  Limitations of the ELISA:  Tests must be done in batches of 40  90  Positive results must be confirmed with another ELISA or Western blot  Specimens sent to a laboratory for testing — results may take days to weeks  Test requires refrigeration and specific reagents

79 Guyana PMTCT Training Module 5, Slide 79 Interpreting HIV Antibody Tests  A positive HIV test means that antibodies to HIV are present. It does not mean that the client has AIDS  A negative HIV test can mean:  The person is not infected with HIV, or  The person is infected with the virus but is in the “window period” A negative test does not mean that person cannot become infected. There is no such thing as immunity to HIV infection

80 Guyana PMTCT Training Module 5, Slide 80 HIV Viral Tests  Viral tests detect the presence of HIV in blood  Viral tests must be done by trained personnel in the laboratory

81 Guyana PMTCT Training Module 5, Slide 81 HIV Viral Tests (Continued)  There are two types of viral tests:  p24 antigen test: measures one of the HIV proteins used for screening blood and for infant diagnosis  PCR (polymerase chain reaction) tests:  DNA PCR detects presence of HIV in blood and is used for infant diagnosis  RNA PCR detects and measures amount of virus in blood (viral load)

82 Guyana PMTCT TrainingModule 5, Slide 82Module 5, Slide 82 Steps to HIV Testing 1.Information is provided to client 2.Consent obtained 3.Blood specimen taken 4.The specimen is processed 5.Test is conducted by a HCW or laboratory technician 6.The client is told their result 7.HCW provides post-test counselling, support and appropriate referrals

83 Guyana PMTCT TrainingModule 5, Slide 83 Session 4  HIV Post-test Counselling

84 Guyana PMTCT TrainingModule 5, Slide 84Module 5, Slide 84 Session 4 Objectives  Describe the steps involved in post-test counselling  Discuss the disclosure process for women who are HIV- infected

85 Guyana PMTCT TrainingModule 5, Slide 85Module 5, Slide 85 Post-test Counselling – All Clients  All HIV test results, whether positive or negative, must be given in person, privately (as a single client or couple)  Put the client or couple at ease  Where possible, provide a quiet and private room for the discussion  Ideally, the same HCW who conducted the pre-test session will also conduct the post-test session

86 Guyana PMTCT TrainingModule 5, Slide 86Module 5, Slide 86 Post-test Counselling HIV-negative Client Post-test counselling provides an opportunity for the woman to:  Review the meaning of the test result and discuss the “window period”  Learn how to protect herself and her infant from HIV infection  Learn that if infected during pregnancy or breastfeeding, risk of MTCT is increased

87 Guyana PMTCT TrainingModule 5, Slide 87Module 5, Slide 87 Post-test Counselling HIV-negative Client (Continued) Objectives of the post-test session: 1.Provide HIV test result and assess understanding of result 2.Identify and address client questions 3.Discuss:  Partner HIV testing and disclosure  Safer sex and risk reduction  Exclusive breastfeeding  Antenatal care, post-delivery care  Importance of delivering in a healthcare facility  Infant care 4.Provide referrals, take-home information

88 Guyana PMTCT TrainingModule 5, Slide 88Module 5, Slide 88 Post-test Counselling HIV-positive Client  Inform the client of the result simply & clearly and give time to consider it  Client reactions to results can range from acceptance to disbelief; help client cope with these emotions  Discuss what “HIV-positive” result means  Remain non-judgemental, supportive and confident throughout the counselling process

89 Guyana PMTCT TrainingModule 5, Slide 89Module 5, Slide 89 Post-test Counselling HIV-positive Client (Continued)  Discuss any immediate concerns, including personal safety and issues of domestic violence  Assist the client to determine who in social/family network can provide support  Arrange a specific date & time for a follow-up visit  Provide the client with a contact person’s name and phone number  Encourage client to return for her ANC visits and follow- up HIV post-test counselling

90 Guyana PMTCT TrainingModule 5, Slide 90Module 5, Slide 90 Post-test Counselling HIV-positive Client (Continued) Other topics for post-test sessions:  Coping strategies  Issues of Domestic Violence  ARV therapy or prophylaxis  Infant feeding options  Maternal nutrition including iron & folic acid supplementation  Safer sex, including provision of male and female condoms and guidance on their use  Treatment and support services for client and family

91 Guyana PMTCT TrainingModule 5, Slide 91Module 5, Slide 91 Disclosure of HIV Status  Disclosure is informing others of a test result  Clients who disclose are in a better position to:  Encourage partner(s) to be tested  Prevent transmission of HIV to partner(s)  Access PMTCT interventions  Receive support from partner(s) and family It is important to respect client's choice regarding timing and process of disclosure

92 Guyana PMTCT TrainingModule 5, Slide 92  Exercise 5.4  Post-test Counselling: demonstration (in the large group) and practice (in small groups)

93 Guyana PMTCT TrainingModule 5, Slide 93Module 5, Slide 93 Subsequent ANC Visits  Discuss, or reinforce, the following during subsequent visits:  ARV Interventions for PMTCT  Infant feeding options  Follow-up care and treatment for the woman and her infant  Family planning options  These topics should be discussed beginning during the first ANC visit

94 Guyana PMTCT TrainingModule 5, Slide 94Module 5, Slide 94 Key Points  Guyana utilizes the provider-initiated approach to HIV testing and counselling in ANC, labour and delivery and post-delivery settings.  With the provider-initiated approach, the client has the right to decline the test. Testing will be done, unless the client declines  Partner testing and couple’s counselling are encouraged

95 Guyana PMTCT TrainingModule 5, Slide 95Module 5, Slide 95 Key Points (Continued)  Pre-test information, HIV testing and post-test counselling should be available to all pregnant women  There are three guiding principles for testing and counselling in PMTCT settings: confidentiality, informed consent and post-test support and services

96 Guyana PMTCT TrainingModule 5, Slide 96Module 5, Slide 96 Key Points (Continued)  There are two processes for rapid HIV testing: parallel and serial testing  Guyana uses parallel HIV testing. Two HIV tests are performed on the same sample at the same time. If both are non-reactive, client is reported as negative, while if they are both reactive, client is reported as positive. If the two results are different a “tiebreaker” test is performed.

97 Guyana PMTCT TrainingModule 5, Slide 97Module 5, Slide 97 Key Points (Continued)  Post-test counselling is important for all women:  For women who are HIV-negative, to emphasize prevention of HIV infection  For women infected with HIV, to give information on PMTCT and referrals for HIV care, treatment and social services, where available  An important component of the post-test session is the offer of subsequent healthcare visits and referrals for HIV prevention, treatment, care and support services.  All women should be encouraged and assisted to return for subsequent healthcare visits, particularly those who test HIV- positive


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