1. 1 Module 2: HIV Counseling and Testing for PMTCT Ministry of Health/HAPCO, Ethiopia

2. 2 Module 2: Objectives Describe principles of HIV Testing and Counseling in MNCH services Describe the use of Testing and Counseling Protocols for PMTCT Describe the process of HIV testing Describe Post test services and sessions

3. 3 HIV Testing and Counseling for PMTCT Session 1 Overview of HIV Testing and Counseling of Pregnant Women

4. 4 HIV Testing and Counseling (TC) Plays vital role in identifying HIV-positive women and provide services Provides an entry point to comprehensive HIV/AIDS treatment, care, and support Helps identify and reduce behaviors or risks that increase HIV transmission Becomes available to all women of childbearing age and their male partners

5. 5 HIV Testing and Counseling HIV Testing The process that determines whether a person is infected with HIV HIV Counseling Confidential discussion between an individual and care provider to examine HIV transmission risk and explore options for reducing risk. HIV TC A flexible intervention integrated into ANC Settings.

6. 6 HIV Testing and Counseling All pregnant women in ANC should receive information on: Safer sex practices Prevention and treatment of Sexually Transmitted Infections (STIs) PMTCT Posttest counseling and follow-up services

7. 7 Guiding Principles for Testing and Counseling in PMTCT Confidentiality All patient information is kept private Information shared only with providers directly involved in care-and only on a “need to know” basis All medical records and registers kept in secure place

8. 8 Guiding Principles for TC in PMTCT Informed Consent Clarifies the purpose, advantages, and disadvantages of testing Ensures understanding of the TC process Respects the client’s testing decision

9. 9 Guiding Principles for TC in PMTCT Posttest support and services Always give results in person Provides appropriate post-test information Offer counseling or referral

10. 10 Approach to Testing Opt-in Explicit request to be tested Written or verbal informed consent Opt-out Testing is routinely offered Clients not explicitly asked to be tested Client has right to refuse

11. 11 Preferred Strategy Opt-out approach Normalizes HIV testing by integrating it into ANC care ……… Increases the number of women who receive testing and PMTCT interventions May increase the uptake of PMTCT services including testing

12. 12 HIV Testing and Counseling for PMTCT Session 2 Providing Pre-Test Information and Counseling

13. 13 Pretest Information Provision Prepares women and partner for the TC process Explores personal risks to HIV Protects confidentiality

14. 14 Individual Pretest Counseling May be offered in ANC settings Labor and Delivery Post Partum FP and other services

15. 15 Group Information Provision HIV and AIDS Transmission and prevention HIV testing and test results interpretation Individual counseling and risk assessment

16. 16 Let us Exercise! Will make two groups Each will again divide into sub groups All members will take time to review the TC aid ANC, L&D and FP Group I: Group information session Group II: Individual counseling 75 minutes

17. 17 Questions What do you feel about giving group information session? And individual counseling? What will you do for you participants? What is the most important exercise in HTC?

18. 18 Working with Couples Provides TC to male partners Emphasizes male responsibility to protect the health of partner and family Reduces “blaming” the woman Identifies discordant couples

19. 19 Discordant Couples One partner is not infected with HIV and the other is infected with HIV. Discuss safer sex options Referral of the partner with HIV infection for treatment, care and support

20. 20 HIV Testing and Counseling for PMTCT Session 3 HIV Testing

21. 21 Test Selection Decision National/local policies Availability of supplies Availability of trained personnel Evaluation of specific tests in country Costs

22. 22 Steps in the Testing Process 1)Obtain test sample Blood, saliva, urine 2)Process sample, on site or through laboratory 3)Obtain results Keep confidential, Method determined by clinic protocols and client. 4)Provide results to client 5)Provide posttest counseling, support, and referral

23. 23 Rapid and ELISA Antibody Tests Rapid Tests Sample: blood from finger prick, saliva swabs Lab: with limited facilities Ease: minimal training Result time: less than 30 minutes ELISA Sample: blood from arm Lab: special equipment Ease: trained lab technician Result time: up to weeks

24. 24 Algorithm for Use of 3 Rapid Tests in Testing and Counseling Services Pre-Test Education and/or Counseling First HIV Rapid Test Positive Test ResultNegative test result/ Counsel for Negative Results Second HIV Rapid Test Positive Test Result/Counsel for Positive ResultsNegative Test Result Third HIV Rapid Test Negative Test Result/ Counsel for Negative Test Result Positive Test Result/Counsel for Positive Test Result

25. 25 Determine----- Capillus-------Unigold KHB Rapid-----Stat pak--------Unigold

26. 26 HIV Antigen Tests and Viral Assays HIV antigen tests detect the presence of HIV in blood and must be done by laboratory personnel There are two type of antigen tests PCR (Polymerase chain reaction) tests detects DNA or measure RNA (viral load) in the blood p24 antigen tests which measure one of the proteins found in HIV

27. 27 Practice ! HIV Rapid Testing Who wants to Demonstrate?

28. 28 HIV Testing and Counseling for PMTCT Session 4 Posttest Information and Counseling

29. 29 Posttest Counseling for ALL Women Provide the test results Help the woman understand the test result Provide PMTCT essential messages when indicated Provide support, information and referral when indicated Encourage risk-reducing behavior Encourage disclosure and partner testing

30. 30 Posttest Counseling HIV-negative result Prevent future infection Review MTCT risk with new infection Educate partner and encourage partner testing.

31. 31 Posttest Counseling HIV-positive results Clarify understanding Acknowledge feelings Review benefits of knowing HIV status Address immediate concerns Schedule follow-up visit Provide name and telephone number of clinic and contact person

32. 32 Disclosure Ensure confidentiality Respect woman’s choices Encourage partner testing Review prevention of transmission Identify support

33. 33 Module 2: Key Points Pre-test information, HIV testing and post- test counseling should be available to all pregnant women The need for individual pre-test counseling should be determined based on national or local policies The healthcare provider and the facility must maintain confidentiality of HIV status

34. 34 Module 2: Key Points Partner testing and couples counseling are encouraged Rapid tests with same day results are the recommended procedure for most ANC settings. Infant diagnosis is complex but important for clinical management - Standard diagnosis is done by antibody test at 18 months - Earlier diagnosis is possible with PCR testing

35. 35 Module 2: Key Points Post-test counseling is important for all women: - For women who are not HIV-infected, emphasize the prevention of HIV infection - For women infected with HIV, provide referrals to the PMTCT program and options for treatment, care and support Disclosure skills building should be encouraged for all women regardless of HIV status