1. HIV Testing and Counselling for PMTCT
Module 5
HIV Testing and Counselling for PMTCT

2. Module Objectives
Discuss the integration of HIV testing and counselling into settings where PMTCT services are provided
Discuss the three guiding principles for testing and counselling in settings where PMTCT services are provided
Explain the difference between provider- and client- initiated approaches to HIV testing
PMTCT Generic Training Package 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 and counselling
Provide pre-test information
Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings
PMTCT Generic Training Package Module 5, Slide 3

4. Module Objectives (Continued)
Describe HIV testing processes
Understand the procedures to perform a rapid HIV test correctly
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
PMTCT Generic Training Package Module 5, Slide 4

5. Overview of HIV Testing and Counselling for PMTCT
Session 1
Overview of HIV Testing and Counselling for PMTCT

6. Session 1 Objectives
Discuss the integration of HIV testing and counselling into settings where PMTCT services are provided
Discuss the three guiding principles for testing and counselling in settings where PMTCT services are provided
Explain the difference between provider- and client- initiated approaches to HIV testing
PMTCT Generic Training Package 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
PMTCT Generic Training Package Module 5, Slide 7

8. 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
PMTCT Generic Training Package Module 5, Slide 8

9. Definitions
HIV testing: process of determining if client is infected with HIV
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
PMTCT Generic Training Package Module 5, Slide 9

10. Advantages of Testing and Counselling
HIV testing and counselling provides clients with an opportunity to learn their HIV status
For HIV-negative women, advantages include:
Information and support to remain uninfected
Information and support to exclusively breastfeed for six months
PMTCT Generic Training Package Module 5, Slide 10

11. Advantages of Testing and Counselling (Continued)
For HIV-infected women, advantages include:
PMTCT interventions (ARVs, safer delivery, infant feeding, referrals)
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
Learn about needs of HIV-exposed children (testing, co-trimoxazole)
Make informed decisions about their pregnancy
PMTCT Generic Training Package Module 5, Slide 11

12. Guiding Principles Confidentiality Informed consent
Post-test support and services
PMTCT Generic Training Package Module 5, Slide 12

13. 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
PMTCT Generic Training Package Module 5, Slide 13

14. 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
PMTCT Generic Training Package Module 5, Slide 14

15. 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
PMTCT Generic Training Package Module 5, Slide 15

16. 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
The client must give informed consent before being tested
PMTCT Generic Training Package Module 5, Slide 16

17. 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
PMTCT Generic Training Package Module 5, Slide 17

18. Guiding Principles (Continued)
Informed consent:
Where HIV testing is offered routinely (e.g. in a “provider-initiated approach”), written informed consent may not be required
PMTCT Generic Training Package Module 5, Slide 18

19. 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
PMTCT Generic Training Package Module 5, Slide 19

20. 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
PMTCT Generic Training Package Module 5, Slide 20

21. Exercise 5.1 Confidentiality Role Play: Large Group Discussion

22. 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
PMTCT Generic Training Package Module 5, Slide 22

23. 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
PMTCT Generic Training Package Module 5, Slide 23

24. Client-Initiated Approach
Client specifically requests HIV test
Also referred to as “opt-in”
Clients provided with pre-test information
Only clients who specifically request to be tested are provided with HIV testing
Client gives verbal or written consent
PMTCT Generic Training Package Module 5, Slide 24

25. Provider- vs. Client-Initiated Approaches to HIV Testing
Provider-initiated
Client-initiated
Client receives information about HIV testing
Client asks questions; HCW ensures client understands HIV testing in context of PMTCT
Unless client declines, HIV test is performed
Client asks questions; HCW ensures client understands HIV testing in the context of PMTCT
Client specifically requests HIV test and gives verbal or written consent
PMTCT Generic Training Package Module 5, Slide 25

26. 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
PMTCT Generic Training Package Module 5, Slide 26

27. Provider- and Client-Initiated Approaches to HIV Testing
Whether provider- or client-initiated, adhere to the guiding principles of testing and counselling:
Informed consent
Confidentiality
Provision of post-test services
PMTCT Generic Training Package Module 5, Slide 27

28. Session 2
Counselling Skills

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

30. Role of the HCW in Counselling
What client counselling do you currently undertake in your work?
PMTCT Generic Training Package Module 5, Slide 30

31. 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
PMTCT Generic Training Package Module 5, Slide 31

32. Role of the HCW in Counselling (Continued)
HCW is not responsible for:
Solving all of the client’s problems
The client’s decisions
PMTCT Generic Training Package Module 5, Slide 32

33. 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 challenged
PMTCT Generic Training Package Module 5, Slide 33

34. Counselling Skills: Self-Awareness
HCWs needs to be aware of their
Strengths and weaknesses
Fears or anxiety about HIV
PMTCT Generic Training Package Module 5, Slide 34

35. 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?
PMTCT Generic Training Package Module 5, Slide 35

36. 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?
PMTCT Generic Training Package Module 5, Slide 36

37. Listening and Learning Skills
Skill 1: Use helpful non-verbal communication
Includes all aspects of message not conveyed by literal meaning of the 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 her
PMTCT Generic Training Package Module 5, Slide 37

38. 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
PMTCT Generic Training Package Module 5, Slide 38

39. Listening and Learning Skills
Skill 1: Use helpful non-verbal communication
Demonstration
PMTCT Generic Training Package Module 5, Slide 39

40. 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
PMTCT Generic Training Package Module 5, Slide 40

41. Listening and Learning Skills (Continued)
Skill 2: Ask open-ended questions, examples of closed-ended questions:
You know what HIV is, don’t you?
Do you have any other questions about MTCT?
Are you going to tell your partner that you tested for HIV today?
Is your husband your only partner?
Do you plan to replacement feed?
How would you revise these questions so that they are open-ended?
PMTCT Generic Training Package 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 have in the last 3 months?
Do you plan to replacement feed?
How do you plan to feed your baby?
PMTCT Generic Training Package Module 5, Slide 42

43. Listening and Learning Skills (Continued)
Skill 2: Ask open-ended questions
Demonstration
PMTCT Generic Training Package 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
PMTCT Generic Training Package Module 5, Slide 44

45. Listening and Learning Skills (Continued)
Clarifying
Prevents misunderstanding
Helps sort out what has been said, e.g., if client says, “I can’t exclusively breastfeed my baby,” HCW may ask, “In what way is exclusive breastfeeding a concern for you?”
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
PMTCT Generic Training Package Module 5, Slide 45

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

47. Listening and Learning Skills (Continued)
Skill 4: Reflect back what the mother says
Encourages her 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 my child; she refuses everything,” HCW might reflect back by saying: “Your child is refusing all the food you offer her?”
PMTCT Generic Training Package Module 5, Slide 47

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

49. Listening and Learning Skills (Continued)
Skill 5: Empathize—show you understand how she feels
Used in response to an emotional statement
Encourages mother to discuss the issue further
If client says, “I just can’t tell my partner that I have HIV,” HCW could respond with “You sound like you are afraid to tell your partner your HIV test result”
HCW is not empathizing if she responds with a question that has a factual answer
PMTCT Generic Training Package Module 5, Slide 49

50. Listening and Learning Skills (Continued)
Skill 5: Empathize—show you understand how she feels
Demonstration
PMTCT Generic Training Package 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
PMTCT Generic Training Package Module 5, Slide 51

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

53. Exercise 5.2
Listening and learning skills: demonstration (in the large group) and practice (in small groups)

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
PMTCT Generic Training Package 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
PMTCT Generic Training Package Module 5, Slide 55

56. Pre-test Information and Counselling
Session 3
Pre-test Information and Counselling

57. Session 3 Objectives
Describe the ways to deliver pre-test information and counselling
Provide pre-test information
Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings
PMTCT Generic Training Package 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
PMTCT Generic Training Package 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 (sexual, MTCT) and provide referrals
Encourage continuous healthcare attendance (ANC and post-delivery)
PMTCT Generic Training Package 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 counselling
Couple counselling
PMTCT Generic Training Package 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
Can be used in post-delivery settings
Not practical or recommended for the L&D setting
PMTCT Generic Training Package 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
PMTCT Generic Training Package Module 5, Slide 62

63. 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
PMTCT Generic Training Package Module 5, Slide 63

64. Exercise 5.3
Providing pre-test information: demonstration (in the large group) and practice (in small groups)
PMTCT Generic Training Package Module 5, Slide 64

65. Individual Pre-test Session
The individual session is used either to:
Provide pre-test information (rather than the group pre-test information session), 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
Individual pre-test counselling should be available in all PMTCT settings
PMTCT Generic Training Package Module 5, Slide 65

66. 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 her access to services.
Emphasize that if the client changes her mind and wants to be tested, an HIV test can be provided during a later visit.
PMTCT Generic Training Package Module 5, Slide 66

67. Couple Pre-test Session
Encourage involvement of male partners:
Stress his role as protector
Reduce chance that the woman will be blamed for bringing HIV into the family
Encourage safer sex
Support women and men who test HIV-negative to stay negative, especially those in discordant relationships
If both are infected — refer both for care
Gain support for PMTCT and adherence to PMTCT interventions
PMTCT Generic Training Package Module 5, Slide 67

68. Couple Pre-test Session (Continued)
Discordance in couples:
Means one partner is HIV-positive and other is HIV-negative
In counselling HIV-negative pregnant women, emphasize the heightened risk of MTCT if they become infected during pregnancy
PMTCT Generic Training Package Module 5, Slide 68

69. Couple Pre-test Session (Continued)
What are the advantages of couple counselling?
PMTCT Generic Training Package Module 5, Slide 69

70. Couple Pre-test Session (Continued)
Advantages of couple counselling:
Partners hear messages together  shared understanding
Environment is safe to discuss concerns
HCW can ease tension and diffuse blame
Post-test counselling messages reflect the test results of both partners
Neither is burdened with disclosure or partner referral
Facilitates risk reduction such as condom use
Prevention (including PMTCT), care and treatment decisions can be made together
PMTCT Generic Training Package Module 5, Slide 70

71. Couple Pre-test Session (Continued)
Considerations in counselling couples:
Establish a relationship with each partner
Assure confidentiality
Assess each person's understanding of HIV
Do not allow one to dominate the conversation
Explain the testing process
PMTCT Generic Training Package Module 5, Slide 71

72. Couple Pre-test Session (Continued)
Considerations in counselling couples (cont’d):
Discuss post-test counselling
Ask if they want results separately or together
Mention possibility of discordant results
Provide information on PMTCT interventions
Confirm benefits of knowing one’s HIV status
Ask who else might be affected by test results
Confirm couple’s willingness to be tested
Be prepared to refer couple for further counselling
Be prepared to refer couple for HIV care and treatment
PMTCT Generic Training Package Module 5, Slide 72

73. 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 HIV status at time of labour may be tested in L&D
Make the woman comfortable, ensure counselling is as confidential as possible
PMTCT Generic Training Package Module 5, Slide 73

74. 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 session if possible. Try to obtain results before delivery
Woman presents to L&D late in labour — no time for pre-test
Offer pre-test information, test and result after delivery
PMTCT Generic Training Package Module 5, Slide 74

75. Testing and Counselling in L&D (Continued)
If test results of a woman tested in L&D are not available within 1 hour of delivery, breastfeeding should be initiated
An infant can be given ARV prophylaxis up to 72 hours after birth
PMTCT Generic Training Package Module 5, Slide 75

76. 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
PMTCT Generic Training Package Module 5, Slide 76

77. 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 about HIV
Ask whom, if anyone, she would like present. If she would like to be alone, ask the family to leave the room
Ask whom should be present for post-test session
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
PMTCT Generic Training Package Module 5, Slide 77

78. Session 4
HIV Testing

79. Session 4 Objectives Describe HIV testing processes
Understand the procedures to perform a rapid HIV test correctly
Explain the meaning of positive (reactive) and negative (non-reactive) HIV test results
PMTCT Generic Training Package Module 5, Slide 79

80. 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
PMTCT Generic Training Package Module 5, Slide 80

81. 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
PMTCT Generic Training Package Module 5, Slide 81

82. 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
PMTCT Generic Training Package Module 5, Slide 82

83. 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
PMTCT Generic Training Package Module 5, Slide 83

84. Rapid HIV Testing Algorithms
Serial testing
Blood sample taken and tested once
If first test result is non-reactive, result is given to client as HIV-negative
If first test result is reactive, blood sample is tested again using different brand of rapid test
If second test is reactive, result is reported as HIV-positive
If second test is negative, a third test known as a “tiebreaker” is performed
PMTCT Generic Training Package Module 5, Slide 84

85. Rapid HIV Testing (Serial testing)
First Test
Positive
Negative Counsel for Negative Result
Second Test
Positive Counsel for Positive Result
Negative
Tie-breaker Test
Positive Counsel for Positive Result
Negative Counsel for Negative Result
PMTCT Generic Training Package Module 5, Slide 85

86. Rapid HIV Testing Algorithms (Continued)
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
PMTCT Generic Training Package Module 5, Slide 86

87. Rapid HIV Testing (Parallel Testing)
First AND Second Test
Both Tests Positive Counsel for Positive Result
Discordant
Both Tests Negative Counsel for Negative Result
Tie-breaker Test
Positive Counsel for Positive Result
Negative Counsel for Negative Result
PMTCT Generic Training Package Module 5, Slide 87

88. Rapid HIV Testing Algorithms (Continued)
In the L&D setting, a single positive test result is adequate to:
Start ARV prophylaxis for the mother during labour and for the infant upon delivery
Testing should be repeated and results confirmed after delivery
PMTCT Generic Training Package Module 5, Slide 88

89. 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
PMTCT Generic Training Package Module 5, Slide 89

90. 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
PMTCT Generic Training Package Module 5, Slide 90

91. HIV Viral Tests Viral tests detect the presence of HIV in blood
Viral tests must be done by trained personnel in the laboratory
PMTCT Generic Training Package Module 5, Slide 91

92. 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)
PMTCT Generic Training Package Module 5, Slide 92

93. Five Steps to HIV Testing
A specimen is obtained
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
PMTCT Generic Training Package Module 5, Slide 93

94. Testing Procedure for HIV Infection
Observe these points:
Infection control and Standard Precautions
Proper labelling
Proper specimen collection procedures
Required volume per test
Proper reagents per test
Correct timing per test
Interpretation of results
Proper record-keeping
Proper disposal procedures
PMTCT Generic Training Package Module 5, Slide 94

95. Testing Procedure for HIV Infection (Continued)
Factors affecting test performance:
Storage and handling of test kits
Changes in the environment
Accuracy of equipment; external and internal controls
Shelf-life of the chemicals for the tests (reagents)
Technique for sample collection
Quality of sample
Use of equipment
PMTCT Generic Training Package Module 5, Slide 95

96. Exercise 5.4 Rapid testing: demonstration in the large group

97. Post-test Counselling
Session 5
Post-test Counselling

98. Session 5 Objectives
Describe the steps involved in post-test counselling
Discuss the disclosure process for women who are HIV-infected
PMTCT Generic Training Package Module 5, Slide 98

99. Post-test Counselling
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
PMTCT Generic Training Package Module 5, Slide 99

100. When Client Tests HIV-negative
Post-test counselling provides an opportunity for woman to:
Learn how to protect herself and her infant from HIV infection
Learn that if infected during pregnancy or breastfeeding, risk of MTCT is increased
PMTCT Generic Training Package Module 5, Slide 100

101. When Client Tests HIV-negative (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
PMTCT Generic Training Package Module 5, Slide 101

102. When Client Tests HIV-positive
Client reactions to results can range from acceptance to disbelief
Remain non-judgemental, supportive and confident throughout the counselling process
Provide all key PMTCT messages during the initial post-test counselling session
Encourage client to return for her ANC visits and follow-up HIV post-test counselling
PMTCT Generic Training Package Module 5, Slide 102

103. When Client Tests HIV-positive (Continued)
Objectives of the post-test session:
Same as for post-test session when client tests HIV-negative, but HCW should additionally discuss:
ARV therapy or prophylaxis
Infant feeding options
Treatment and support services for client and family
PMTCT Generic Training Package Module 5, Slide 103

104. 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
PMTCT Generic Training Package Module 5, Slide 104

105. Exercise 5.5
Post-test Counselling: demonstration (in the large group) and practice (in small groups)

106. Subsequent ANC Visits
Discuss, or reinforce, the following during subsequent visits:
Interventions for PMTCT
Infant feeding options
Follow-up care and treatment for the woman and her infant
Family planning options
If the woman is unlikely to return, these topics should be discussed during the first ANC visit
PMTCT Generic Training Package Module 5, Slide 106

107. Key Points
Pre-test information, individual pre-test counselling, 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
PMTCT Generic Training Package Module 5, Slide 107

108. Key Points (Continued)
WHO recommends the provider-initiated approach to HIV testing and counselling in ANC, labour and delivery and post-delivery settings. With the provider-initiated approach, HIV testing is a routine part of patient care
Partner testing and couple counselling are encouraged
Rapid HIV tests with same day results are highly recommended in PMTCT settings. Rapid tests are accurate and enable HCWs to provide post-testing counselling during the same visit
PMTCT Generic Training Package Module 5, Slide 108

109. Key Points (Continued)
Two processes for rapid HIV testing: parallel and serial. Serial testing is more cost-effective in which a positive (reactive) antibody test is tested again using a different brand of rapid HIV test. Initial negative test results do not require confirmation
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
PMTCT Generic Training Package Module 5, Slide 109

110. Key Points (Continued)
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
PMTCT Generic Training Package Module 5, Slide 110