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HIV Testing and Counselling for PMTCT

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

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 Module 5, Slide 2 Guyana PMTCT Training Module 5, Slide 2

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 Module 5, Slide 3 Guyana PMTCT Training Module 5, Slide 3

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 Module 5, Slide 4 Guyana PMTCT Training Module 5, Slide 4

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

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 Module 5, Slide 6 Guyana PMTCT Training Module 5, Slide 6

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 Module 5, Slide 7 Guyana PMTCT Training Module 5, Slide 7

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

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 Module 5, Slide 9 Guyana PMTCT Training Module 5, Slide 9

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 Module 5, Slide 10 Guyana PMTCT Training Module 5, Slide 10

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 Module 5, Slide 11 Guyana PMTCT Training Module 5, Slide 11

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 Module 5, Slide 12 Guyana PMTCT Training Module 5, Slide 12

13 Guyana’s HIV Testing Policy
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 PMTCT Training Module 5, Slide 13

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 Module 5, Slide 14 Guyana PMTCT Training Module 5, Slide 14

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

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 Module 5, Slide 16 Guyana PMTCT Training Module 5, Slide 16

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) Module 5, Slide 17 Guyana PMTCT Training Module 5, Slide 17

18 Guiding Principles for HIV Testing
Confidentiality Informed consent Post-test support and services Module 5, Slide 18 Guyana PMTCT Training Module 5, Slide 18

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

20 Guiding Principles (Continued)
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 Module 5, Slide 20 Guyana PMTCT Training Module 5, Slide 20

21 Guiding Principles (Continued)
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 Module 5, Slide 21 Guyana PMTCT Training Module 5, Slide 21

22 Guiding Principles (Continued)
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 Module 5, Slide 22 Guyana PMTCT Training Module 5, Slide 22

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 Module 5, Slide 23 Guyana PMTCT Training Module 5, Slide 23

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 Module 5, Slide 24 Guyana PMTCT Training Module 5, Slide 24

25 Guiding Principles (Continued)
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 Module 5, Slide 25 Guyana PMTCT Training Module 5, Slide 25

26 Guiding Principles (Continued)
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 Module 5, Slide 26 Guyana PMTCT Training Module 5, Slide 26

27 Exercise 5.1 Confidentiality Role Play: Large Group Discussion
Guyana PMTCT Training Module 5, Slide 27

28 Session 2 Counselling Skills Guyana PMTCT Training Module 5, Slide 28

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

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

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 Guyana PMTCT Training Module 5, Slide 31

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 Module 5, Slide 32 Guyana PMTCT Training Module 5, Slide 32

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

34 Counselling Skills: Active Listening
Active listening helps establish a trusting relationship with the client 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 Guyana PMTCT Training Module 5, Slide 34 Module 5, Slide 34

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

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? Module 5, Slide 36 Guyana PMTCT Training Module 5, Slide 36

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? Module 5, Slide 37 Guyana PMTCT Training Module 5, Slide 37

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 Module 5, Slide 38 Guyana PMTCT Training Module 5, Slide 38

39 Non-Verbal Communication
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 Module 5, Slide 39 Guyana PMTCT Training Module 5, Slide 39

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

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 Module 5, Slide 41 Guyana PMTCT Training Module 5, Slide 41

42 Listening and Learning Skills (Continued)
Closed-ended Open-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? Module 5, Slide 42 Guyana PMTCT Training Module 5, Slide 42

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

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 Module 5, Slide 44 Guyana PMTCT Training Module 5, Slide 44

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 Module 5, Slide 45 Guyana PMTCT Training Module 5, Slide 45

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

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?” Module 5, Slide 47 Guyana PMTCT Training Module 5, Slide 47

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

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 Module 5, Slide 49 Guyana PMTCT Training Module 5, Slide 49

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

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 Module 5, Slide 51 Guyana PMTCT Training Module 5, Slide 51

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

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

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 Module 5, Slide 54 Guyana PMTCT Training Module 5, Slide 54

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 Module 5, Slide 55 Guyana PMTCT Training Module 5, Slide 55

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

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 Module 5, Slide 57 Guyana PMTCT Training Module 5, Slide 57

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 Module 5, Slide 58 Guyana PMTCT Training Module 5, Slide 58

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) Module 5, Slide 59 Guyana PMTCT Training Module 5, Slide 59

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 Module 5, Slide 60 Guyana PMTCT Training Module 5, Slide 60

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 Module 5, Slide 61 Guyana PMTCT Training Module 5, Slide 61

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 Module 5, Slide 62 Guyana PMTCT Training Module 5, Slide 62

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) Module 5, Slide 63 Guyana PMTCT Training Module 5, Slide 63

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 Module 5, Slide 64 Guyana PMTCT Training Module 5, Slide 64

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

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

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. Module 5, Slide 67 Guyana PMTCT Training Module 5, Slide 67

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 Module 5, Slide 68 Guyana PMTCT Training Module 5, Slide 68

69 Testing and Counselling in L&D (Continued)
Scenario Possible 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 Module 5, Slide 69 Guyana PMTCT Training Module 5, Slide 69

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

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 Module 5, Slide 71 Guyana PMTCT Training Module 5, Slide 71

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 Guyana PMTCT Training Module 5, Slide 72

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 Guyana PMTCT Training Module 5, Slide 73

74 HIV Tests (Continued) Rapid HIV tests
Accurate results within 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 Guyana PMTCT Training Module 5, Slide 74

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 Guyana PMTCT Training Module 5, Slide 75

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 Guyana PMTCT Training Module 5, Slide 76

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

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 Guyana PMTCT Training Module 5, Slide 78

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 Guyana PMTCT Training Module 5, Slide 79

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

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) Guyana PMTCT Training Module 5, Slide 81

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

83 HIV Post-test Counselling
Session 4 HIV Post-test Counselling Guyana PMTCT Training Module 5, Slide 83

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

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 Module 5, Slide 85 Guyana PMTCT Training Module 5, Slide 85

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 Module 5, Slide 86 Guyana PMTCT Training Module 5, Slide 86

87 Post-test Counselling HIV-negative Client (Continued)
Objectives of the post-test session: Provide HIV test result and assess understanding of result Identify and address client questions 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 Provide referrals, take-home information Module 5, Slide 87 Guyana PMTCT Training Module 5, Slide 87

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 Module 5, Slide 88 Guyana PMTCT Training Module 5, Slide 88

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 Module 5, Slide 89 Guyana PMTCT Training Module 5, Slide 89

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 Module 5, Slide 90 Guyana PMTCT Training Module 5, Slide 90

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 Guyana PMTCT Training Module 5, Slide 91 Module 5, Slide 91

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

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 Module 5, Slide 93 Guyana PMTCT Training Module 5, Slide 93

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 Module 5, Slide 94 Guyana PMTCT Training Module 5, Slide 94

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 Module 5, Slide 95 Guyana PMTCT Training Module 5, Slide 95

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. Module 5, Slide 96 Guyana PMTCT Training Module 5, Slide 96

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 Module 5, Slide 97 Guyana PMTCT Training Module 5, Slide 97


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