hiv

1. Session 10:
Demonstrate HIV Counseling and
Testing Skills to Repeat Testers
Presented by
Ms Ruth Alex & Mr John Jumapili
1

2. 10.1 Learning tasks
At the end of this session, students are expected
to be able to:
• Define the term repeat testers
• Identify reasons why clients test more than
once
• Discuss the importance and methodology of
counselling repeat testers
• Demonstrate skill in counselling repeat testers

3. 10.2 Definition
• Repeat Testers are clients who have taken an
HIV test before, but for various reasons come
to get tested again
• Repeat testing is a common event at HIV
counselling and testing sites

4. 10.3 Reasons for Repeat Testing
• Still in window period
• Involved in risky behaviour after the last time
tested
• Exposed to professional hazards on an on-
going basis
• For material support or ‘proof’ of result
• Lost a spouse and suspect the reason is HIV

5. 10.4 Reasons for Repeat Testing
• Not well helped by counsellor the first time
they were tested (still have questions)
• Tested positive but in denial
• Tested negative but keep falling ill frequently
• Worried well

6. 10.5 Reasons for Repeat Testing….
• Worried well:
o This term generally refers to people who are
worried that they have a particular disease,
even though they are physically well (in other
words, they do not actually have the disease.)

7. 10.6 Importance of Counselling
Repeat Testers
• Helps client accept and cope with test result
• Enables client to adopt and sustain new
behaviour
• Clarifies clients’ misconceptions and
misinformation
• Identifies the ‘worried well’
• Prevents clients from unnecessarily returning for
testing, reducing the burden on the health care
system

8. 10.7 Negative Impact of Repeat
Testing
• The frequent visit to the health facility, which
can be costly and waste the client’s time
• The addition of not-at-risk clients who come
for repeat testing increases the burden on the
healthcare system and healthcare providers.

9. 10.8 Steps in Counselling Repeat
Testers
• Worksheet 10.1: Steps in Counselling Repeat
Testers

10. 10.8 Steps in Counselling Repeat
Testers
• Have a positive attitude towards the client and
prepare yourself to follow professional ethics
before client enters
• Establish rapport as usual
• Review client’s knowledge of HIV, TB, STIs,
ARVs
• Discuss major reasons for repeat testing
• Use probing skills to ascertain real reason for
testing and encourage client to open up

11. 10.8 Steps in Counselling Repeat
Testers….
• Discuss possible test results (positive,
negative) and their implications
• Establish a risk reduction plan
• Get informed consent and send client for HIV
test
• Check if client is ready to receive test result
• Sensitively deliver test result

12. 10.8 Steps in Counselling Repeat
Testers….
• Review previously chosen risk reduction plan
and options chosen
• Strengthen plan/come up with new plan as
required
• Assess/strengthen/affirm problem solving
skills and techniques
• Identify need for additional services/referral
and link as required and provide take home
material

13. 10.8 Steps in Counselling Repeat
Testers….
• Review and clarify main points of the
discussion
• Schedule next appointment as necessary
• Complete administrative tasks of recording
and reporting for HIV surveillance

14. 10.9 Points to Remember While
Counselling Repeat Testers
• Place emphasis on:
o Asking and answering questions
o Active listening
o Checking understanding
o Helping client adopt new behaviours

15. 10.9 Points to Remember While
Counselling Repeat Testers….
If during pre-test counselling, client’s questions
are clarified AND there is no medical reason for
repeat testing, then:
o Provide counselling support as required
o Refer if necessary for other services

16. 10.9 Points to Remember While
Counselling Repeat Testers….
• It is not necessary for the client to take a test
and complete post-test counselling if during
pre-test counselling:
o The client is identified as ‘worried well’ and
adequate counselling and education are
provided so the client gets referred for further
psychological assessment and support

17. 10.9 Points to Remember While
Counselling Repeat Testers….
o If the doubts due to which the client came for
repeat testing are established and clarified
during pre-test counselling AND there are no
medical reasons for repeat HIV testing (such
as the client being in the window period)

18. 10.9 Points to Remember While
Counselling Repeat Testers….
• Counsellors should identify areas the client
requires support in and accordingly provide
services or refer to other centres. For
example:
o Continuing with the risk reduction plan
o Additional emotional and psychological
support

19. 10.9 Points to Remember While
Counselling Repeat Testers….
• However, if a medical reason for repeat
testing is established during pre-test
counselling,
• then the counsellor/healthcare provider
should continue with the process as usual:
• obtaining informed consent, testing, and
providing post-test counselling.

20. Key points
• Repeat testers are clients who have taken an
HIV test but for various reasons come to get
tested again.
• Repeat testing is not uncommon and there are
many reasons for it.
• Repeat testing without medical reasons can be
a burden both on the client as well as the
healthcare system.

21. Review questions
1. What are the reasons for clients testing
more than once?
2. What is the negative impact of repeat
testing?
3. What is the importance of repeat testing?
4. What are the steps in counselling repeat
tester?
5. What are the skills to use when counselling
repeat testers?
21

22. Key points
• Fisher J., Spurlock-McLendon J., et al (l999). An
Assessment of the Counselling and Programmatic
Implications of Repeat HIV Testing. National HIV
Prevention Conference:Atlanta, GA.
• Sowadsky, R. (2010). Are you a ‘Worried Well’
Person? The Body: The Complete HIV/AIDS
Resource. Retrieved 15 June 2010 from
http://www.thebody.com/content/living/art2306
.html