This document provides an overview of HIV counseling and testing (C&T) training for a study. It discusses C&T procedures at screening and follow-up visits, including the testing algorithm and scenarios. It emphasizes using a client-centered approach to risk reduction counseling, where the counselor guides the participant to identify barriers, strategies, and action plans to reduce risk. Counseling should be personalized and build on past discussions, with documented plans reviewed and updated each visit. Referrals are also followed up on to support risk reduction.

1. HIV Counseling and Testing
MTN-003
Study-Specific Training

2. Overview of Presentation
 HIV C&T at screening (brief check-in)
 HIV C&T at follow-up
 Scenarios highlighting HIV testing
algorithm and associated counseling
messages
 Role play
 Review of forms
 Risk reduction counseling
 Documentation

3. START
sample 1
2 different
rapid tests
Sample 1
WB
Sample 2
2 different
rapid tests
STOP. Report to participant as
HIV-uninfected
STOP. Report to participant as
HIV-infected
Discordant/requires
additional testing.
Notify The MTN Network Laboratory
-
-/-
+
+/+
+/-
ind
Repeat testing, beginning at “START” in
approximately one month.
HIV Testing at Screening

4. START
Sample 1
rapid test
Sample 1
WB
Sample 2
WB
STOP. Report to participant as
HIV-uninfected
STOP. HIV infection confirmed
Report to participant as
HIV-infected
Requires
additional testing.
- or ind
-
- or ind
+
+
Consult the MTN
Network Laboratory
for further testing and follow up
+
+
Sample 1
HIV viral load
-
HIV C&T at Follow-Up: Scenario #1

5. START
Sample 1
rapid test
Sample 1
WB
Sample 2
WB
STOP. Report to participant as
HIV-uninfected
STOP. HIV infection confirmed
Report to participant as
HIV-infected
Requires
additional testing.
- or ind
-
- or ind
+
+
Consult the MTN
Network Laboratory
for further testing and follow up
+
+
Sample 1
HIV viral load
-
HIV C&T at Follow-Up: Scenario #2

6. START
Sample 1
rapid test
Sample 1
WB
Sample 2
WB
STOP. Report to participant as
HIV-uninfected
STOP. HIV infection confirmed
Report to participant as
HIV-infected
Requires
additional testing.
- or ind
-
- or ind
+
+
Consult the MTN
Network Laboratory
for further testing and follow up
+
+
Sample 1
HIV viral load
-
HIV C&T at Follow-Up: Scenario #3

7. START
Sample 1
rapid test
Sample 1
WB
Sample 2
WB
STOP. Report to participant as
HIV-uninfected
STOP. HIV infection confirmed
Report to participant as
HIV-infected
Requires
additional testing.
- or ind
-
- or ind
+
+
Consult the MTN
Network Laboratory
for further testing and follow up
+
+
Sample 1
HIV viral load
-
HIV C&T at Follow-Up: Scenario #4

8. HIV Counseling
 By the time of the first VOICE follow-up visit,
participant will have undergone HIV C&T twice
and risk reduction counseling three times
 With monthly C&T throughout follow-up, care
must be taken to avoid rote repetition of the
same information each month
 What are your thoughts on discussion of
“standard” HIV education and pre-test
information at each visit?

9. Risk Reduction Counseling
 A client-centered and case-management type of
approach should be used to make risk reduction
counseling as effective as possible
 Relies on four Ps
 Quality of participant-provider relationship
 Partnership in a shared goal
 Mutually respectful
 Non judgmental
 Personalized strategies to try to address
barriers to risk reduction

10. Client-Centered Approach
 Counselor’s role is to ask questions,
actively listen to participant’s responses,
and guide participant toward next steps
 Outcome should be participant identifying
 Her barriers to risk reduction
 Her strategies and action plans to try to
address the barriers
 Supported and facilitated by the counselor

11. Client-Centered Approach
 Greet client and establish rapport
 Describe purpose of the session
 Emphasize confidentiality of the session
 Listen effectively, allow client to speak, avoid
interruptions
 Communicate effectively, verbally and non-verbally
 Communicate at client’s level of understanding
 Use open-ended questions
 Clarify misconceptions
 Provide positive reinforcement

12. Closed-Ended vs Open-Ended
 Do you know how HIV is passed from one
person to another?
 Do you understand what your test results
mean?
 Do any of these risk factors apply to you?

13. Client-Centered Approach
 Strategies and action plans should:
 Reflect the participant’s current risk
assessment
 Be realistic and practical, yet challenging
toward risk reduction
 Be agreed upon by the participant
 Be documented, with copy available to
participant if desired

14. Client-Centered Approach
 Participant’s risk reduction issues/barriers
may be significant
 Strategies may need to be incremental
 Participant’s risk reduction issues/barriers
may change over time
 Strategies may need to evolve over time

15. Client-Centered Approach
 Counselor should also
 Offer skills building
 How to use male and female condoms
(hands-on demonstrations)
 How to talk to partners (role play)
 Offer couples counseling and/or other
counseling with influential persons

16. Risk Reduction Counseling
 Each month, risks/issues/barriers and
action plans identified at the previous
counseling session should be reviewed
and discussed with the participant
 What was her experience over the past
month?
 Was she able to carry out her plan?
 What was the outcome?

17. Risk Reduction Counseling
 Action plans for the coming month should
build on the past month’s experience
 Successful strategies should be continued
 Additional strategies may be identified to
achieve further risk reduction
 Alternative strategies may be identified if
strategies tried over the past month were not
successful
 All as identified and agreed upon by the
participant with the counselor’s guidance and
support

18. Risk Reduction Counseling
 For this type of approach to be successful
 Issues/barriers/strategies/action plans
discussed at each session must be
documented
 Documentation must be accessible for
review at the next session

19.  General
 HIV education and pre-test
counseling
 HIV post-test counseling
 Risk assessment
 Risk factors and barriers to risk
reduction
 Risk reduction plan – experience
and outcomes since last visit
 Risk reduction plan – strategies
for the coming month
 Additional notes page
HIV Counseling Worksheet

20. Referrals
 Referrals are expected components of risk
reduction plans (when indicated)
 Referrals should be actively followed up at
subsequent visits to determine
 If participant sought the services to which she was
referred
 The outcome of the referral
 If additional referrals are needed
 Document all referrals, outcomes, and follow-up
plans and actions

21. What Are
Your Questions
Thoughts and
Reactions?