Unit 3 counseling for pmtct

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Unit 3 counseling for pmtct

  1. 1. Counselling and testing in PMTCT context
  2. 2. Session Objective and content <ul><li>Objective: At the end of the session the participant should be able Discuss counselling and testing in the PMTCT context </li></ul><ul><li>Content </li></ul><ul><ul><ul><li>General information on PMTCT in ANC </li></ul></ul></ul><ul><ul><ul><li>Counselling (individual counselling, spouse involvement, confidentiality) </li></ul></ul></ul><ul><ul><ul><li>Testing (opt in opt out approaches, timing of testing -- pre pregnancy, antenatal, intrapartum, postpartum) </li></ul></ul></ul>
  3. 3. Benefits of testing <ul><li>PMTCT </li></ul><ul><li>Prevention of opportunistic infections </li></ul><ul><li>Reduction of HIV transmission risk </li></ul><ul><li>Access to care </li></ul><ul><li>Future Planning </li></ul>
  4. 4. Confidentiality in TC in PMTCT <ul><li>All patient information is kept private. </li></ul><ul><li>Information is shared only with providers directly involved in care—and only on a “need to know” basis. </li></ul><ul><li>All medical records and registers are kept in secure place. </li></ul>
  5. 5. General information <ul><li>All pregnant women should receive information on </li></ul><ul><ul><li>Safer sexual practices </li></ul></ul><ul><ul><li>Prevention and treatment of STIs </li></ul></ul><ul><ul><li>PMTCT </li></ul></ul><ul><ul><ul><li>HIV and AIDS </li></ul></ul></ul><ul><ul><ul><li>Transmission and prevention </li></ul></ul></ul><ul><ul><ul><li>HIV testing and test result interpretation </li></ul></ul></ul><ul><ul><ul><li>Availability of counseling and follow-up services </li></ul></ul></ul>
  6. 6. Pre test counselling in PMTCT <ul><li>Clarify the purpose, advantages, and disadvantages of testing </li></ul><ul><li>Ensures understanding of the TC process </li></ul><ul><li>Respects the client's testing decision </li></ul>
  7. 7. Post test counseling in PMTCT <ul><li>Always give results in person. </li></ul><ul><li>Post-test counseling for all. </li></ul><ul><ul><li>Provide the test result. </li></ul></ul><ul><ul><li>Help the woman understand the test result. </li></ul></ul><ul><ul><li>Encourage risk-reducing behaviour. </li></ul></ul><ul><ul><li>Encourage disclosure and partner testing. </li></ul></ul><ul><li>Post test counseling for HIV-positive result </li></ul><ul><ul><li>Clarify understanding. </li></ul></ul><ul><ul><li>Acknowledge feelings. </li></ul></ul><ul><ul><li>Review benefits of knowing HIV status. </li></ul></ul><ul><ul><li>Address immediate concerns. </li></ul></ul><ul><ul><li>Schedule follow - up visit. </li></ul></ul><ul><ul><li>Provide name and telephone number of clinic and contact person. </li></ul></ul>
  8. 8. Approaches to HIV Testing in PMTCT <ul><li>Opt-In </li></ul><ul><li>Explicit request to be tested </li></ul><ul><li>Written or verbal informed consent </li></ul><ul><li>Opt-Out </li></ul><ul><li>Testing routinely offered </li></ul><ul><li>Clients not explicitly asked to be tested </li></ul><ul><li>Client may refuse </li></ul>
  9. 9. Opt-Out strategy <ul><li>Opt-Out approach </li></ul><ul><li>Normalises HIV testing by integrating it into ANC care </li></ul><ul><li>Increases the number of women who receive testing and PMTCT interventions </li></ul><ul><li>May increase the uptake of PMTCT services including testing </li></ul>
  10. 10. Algorithm for Use of 3 Rapid HIV Tests (Serial Testing) First HIV Rapid Test Pre-Test Education and/or Counselling Positive Test* Result Negative Test Result/Counsel for Negative Result Second HIV Rapid Test Positive Test Result/Counsel for Positive Result Negative Test Result Third HIV Rapid Test Positive Test Result/Counsel for Positive Result Negative Test Result/Counsel for Negative Result * In the context of labour in a MTCT-prevention setting, it is advised to give a single dose of nevirapine on the basis of a single positive rapid test. This should then be confirmed after delivery.
  11. 11. Diagnosing HIV in Infants Exposed to HIV <ul><li>Antiretroviral prophylaxis reduces but does not eliminate MTCT transmission of HIV infection. </li></ul><ul><li>Since maternal antibodies cross the placenta, antibody testing is not recommended prior to 18 months of age. </li></ul><ul><li>Infants who are breastfeeding require additional testing once breastfeeding has completely discontinued. </li></ul>
  12. 12. Antibody Testing of the Infant Exposed to HIV <ul><li>Non-breastfeeding </li></ul><ul><li>At or after 18 months of age: </li></ul><ul><li>Negative HIV antibody test indicates that the child is not infected. </li></ul><ul><li>Positive HIV antibody test indicates that the child is infected. </li></ul><ul><li>Breastfeeding </li></ul><ul><li>At or after 18 months of age: </li></ul><ul><li>Negative HIV antibody test should be repeated 6 weeks after complete cessation of breastfeeding. </li></ul><ul><li>Positive HIV antibody test indicates that the child is infected. </li></ul>
  13. 13. HIV DNA PCR in Infants <ul><li>Detects presence of virus (antigen) in the blood </li></ul><ul><li>Can be done as early as 48 hours after birth </li></ul><ul><li>Early diagnosis means early treatment and care. </li></ul>
  14. 14. DNA PCR in Exposed Infants <ul><li>For children who are not breastfeeding: </li></ul><ul><ul><li>Consider testing the neonate before 48 hours (optional) and if positive, the child is considered HIV-infected during pregnancy. </li></ul></ul><ul><ul><li>If negative, child could still be infected during delivery and will need to be re-tested at 1–2 months and possibly 3–6 months.   </li></ul></ul><ul><li>For children who are breastfeeding: </li></ul><ul><ul><li>Consider testing the neonate before 48 hours and if positive, the child is considered HIV-infected during pregnancy. </li></ul></ul><ul><ul><li>If negative, child could still be infected during delivery and will need to be re-tested at 2–6 months. </li></ul></ul><ul><ul><li>If positive at 2 – 6 months of age, a second viral assay should be repeated as soon as possible on a second blood specimen. A second positive viral assay confirms that the infant has HIV infection. </li></ul></ul>
  15. 15. Working with Couples <ul><li>Provides TC to male partners </li></ul><ul><li>Emphasises male responsibility to protect the health of partner and family </li></ul><ul><li>Reduces “blaming” the woman </li></ul><ul><li>Identifies discordant couples </li></ul>
  16. 16. Timing of testing <ul><li>Pre pregnancy- ideal </li></ul><ul><li>Antenatally – as Early as possible </li></ul><ul><li>Intrapartum </li></ul><ul><li>Post partum </li></ul><ul><li>Post pregnancy </li></ul>

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