1. ICTC Team Training 1 Why do patients need counselling?

2. ICTC Team Training 2 Questions a. In general, how easy was it to help the person to consider the behaviour change? b. What problems were discussed and what solutions were offered in each group? c. What solutions or suggestions were most successful in your group? Why were they successful? d. What solutions or suggestions were not successful? Why were they not successful? e. What kind of objections did the person raise? What counter-arguments did the group offer? f. How does this relate to HIV/AIDS counselling in the ICTC?

3. ICTC Team Training 3 Counselling A confidential dialogue between a client and a counsellor aimed at providing information on HIV/AIDS and bringing about behaviour change in the client. Also aimed at enabling the client to take a decision regarding HIV testing and to understand the implications of the test results

4. ICTC Team Training 4 ICTC

5. ICTC Team Training 5 ICTC

6. ICTC Team Training 6 Advantages of knowing your sero-status Early referral for appropriate medical treatment: prophylaxis, early detection, curative treatment, antiretroviral treatment. Precautions to protect others. Prevention against re-infection with HIV.

7. ICTC Team Training 7 Understanding Behaviour Change Unaware Aware Concerned Knowledgeable Motivated to change Practising new behaviour initially Maintaining new behaviour

8. ICTC Team Training 8 3 models of behaviour change Risk Elimination Model Risk Reduction Model Harm Reduction Model (The HIV Counselling Training Modules for VCT, PPTCT and ART Counsellors, NACO, 2006)

9. ICTC Team Training 9 Knowing one’s sero-status is the first step to getting HIV services. Only 1 in 3 infected people knows their sero-status. Need to increase the no. of people visiting ICTC. Provider Initiated Testing: HIV Counselling and Testing is recommended by health care providers to people who come to them for other health concerns when they display signs and symptoms suggestive of HIV infection or other co-infections. Provider-Initiated Testing

10. ICTC Team Training 10 3 specific groups: Patients who present themselves to a health facility with symptoms suggestive of HIV infection like TB, pneumonia or persistent diarrheoa Patients with conditions that could be associated with HIV such as STI/RTI Pregnant women who register at ANCs. This also include pregnant women who directly come in labour without any ANC. Provider-Initiated Testing: Who?

11. ICTC Team Training 11 Provider-Initiated Testing: Steps Clients are referred by health care providers to the ICTC. At the ICTC, they are given basic information on HIV, they are educated about HIV testing, and are informed about the clinical and prevention advantages of being tested. Counselling personnel then makes a routine offer of HIV testing: The counsellor asks the client: “Do you wish to be test for HIV or not?” The client has a right to accept or to refuse testing and “opt out.” If the client agrees, he/ she is tested for HIV. Testing is followed by post-test counselling.

12. ICTC Team Training 12 Informed Consent The client agrees to HIV testing through giving his/ her informed consent. Informed consent is a deliberate and autonomous permission given by a client to a health-care provider to proceed with the proposed HIV test procedure. This permission is based on adequate understanding of the advantages, risks, potential consequences and implications of an HIV test result, which could be both positive and negative. This permission is entirely the choice of the client and can never be implied or presumed. (From ICTC Operational Guidelines)

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