HIV Testing and Counselling (HTC)


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HIV Testing and Counselling (HTC)

  1. 1. Concept of Disease Screening ©karawita
  2. 2. AIDS Clinical stage 4 AIDS Defining illnesses Overview of the HIV natural history 75% WHO Clinical stage 2 WHO Clinical stage 3 Clinical stage 1 8 to 12 years 1-4wks 3wks HIV Seroconversion illness PGL 33% ©karawita Morbidityscale Time
  3. 3. Biological onset of Disease 1st possible detection Usual time of detection (Disease detection by symptoms) Survival time Survival time Death Death Final critical point Screening time Disease detection by screening Behaviours Vulnerabilities (external/ environmental factors) Risk Risk Lead time Outcome achieved by early detection Concept of screening diseases ©karawita
  4. 4. Types of screening • Mass screening/Universal screening – screening of a whole population or a sub group • High risk or selective screening – conducted among risk populations only • Multiphaisc screening – application of two or more tests to a large population at one time. ©karawita
  5. 5. Criteria for screening Condition Related 1. Important health problem (prevalence should be high) 2. Recognizable latent or early asymptomatic stage. 3. Natural history of the condition should be well known. 4. There should be a test 5. Facilities should be available to confirm the disease 6. Effective treatment should be there Test Related 1. Availability of a suitable test 2. Acceptable to the population 3. Economical 4. Repeatability ©karawita
  6. 6. Screening Benefits of screening 1. Reassurance from a correct negative test. 2. Disease prognosis can be improved. 3. Disease morbidity can be reduced. 4. Quality of life can be improved. 5. Reduced resources needed for treatment. Possible adverse effects associated with screening 1. Morbidity associated with the test itself. 2. Prolong period of morbidity with early diagnosis. 3. Diagnosis of pseudo disease and over treatment 4. False reassurance form a false negative test. 5. Anxiety and morbidity associated with a the false positive test 6. Diverting resources from other services. ©karawita
  7. 7. HIV testing models ©karawita
  8. 8. HIV testing models HIV පපපපපපප පපපපප • Voluntary Counseling and testing (VCT) • Provider Initiated Counseling and Testing (PIT) • Mandatory testing (blood safety, tissue/organ transplants etc) • Screening for diagnostic workups • HIV surveillance (unlinked anonymous testing) • Legal requirements ©karawita
  9. 9. Voluntary Counselling and Testing ©karawita
  10. 10. VCT Is it all abut knowing the HIV sero-status? ©karawita
  11. 11. VCT • Case finding strategy in HIV. (Active/Passive) • Service package. • It is the entry point to HIV care and treatment. (especially early in the disease process before they become symptomatic) • It is a place for behaviour change communication. • What is the OPD situation in a hospital? ©karawita
  12. 12. HIV counseling and testing services • Pre- HIV test counseling • Post-test counseling UN policy ©karawita
  13. 13. HIV testing - Overview A • Pre test counseling • Patient agrees for the test B • Send blood for HIV screening and confirmation C • Post test counseling • for negative results • for positive results • for indeterminate test ©karawita
  14. 14. Reasons to provide HIV counseling and testing 1. Clinical risk assessment and realistic feed back 2. HIV prevention counselling  Is effective at i. Reducing risky behaviours in HIV-infected and uninfected persons (Behaviour change communication). ii. Behaviour development communication. ©karawita
  15. 15. Pre- HIV test counseling ©karawita
  16. 16. 1. Greeting, Introduction and Orientation. Demographic data collection, How did you learn about the site (important for VCT social marketing) 2. Reason for visit/client’s need – HIV related issues/ other issues 3. Inform the confidentiality of the process. 4. Prepare the client for the HIV test and the provision of informed consent. Pre- HIV test counseling ©karawita
  17. 17. 5. Clinical risk assessment – assess sexual behaviour, sharing of injecting equipments, blood and blood product transfusions, occupational exposures, other exposures to potentially infectious materials – Time the risk behaviour in relation to the window period of the test • If before the window period – do the test in the first contact • If within window period – repeat the test in 3 months – Give a realistic feedback on the risk Pre- HIV test counseling ©karawita
  18. 18. 6. Provision of HIV/AIDS related knowledge. 7. Behaviour change communication • HIV prevention education and counseling  is effective at Reducing risky behaviours in HIV-infected and uninfected persons. • Personal risk reduction plan (risk reduction model, risk elimination model, harm reduction model) 8. Explaining the implication of knowing sero-status (positive, negative or inconclusive) 9. Assess the individual’s coping strategies and psychosocial support available/system. Pre- HIV test counseling ©karawita
  19. 19. Post-test counseling ©karawita
  20. 20.  Prepare the client for the result  Helps the client to understand and cope with the HIV test result  Provides the client with any further information required  Referring the client to other services  Further discuss strategies to reduce HIV transmission  forms of post-HIV test counseling session depends on what the result is. Post test counseling - Overview ©karawita
  21. 21. Forms of post-test counseling HIV positive test counseling HIV negative test counseling Inconclusive test counseling Cross-check all results prior to counseling session Cross-check all results prior to counseling session Cross-check all results prior to counseling session Assessment of psychological preparedness/support +++ Assessment of psychological preparedness/support + Assessment of psychological preparedness/support ++ Provide results to the client in person, direct and clearly Explain the Meaning of positive test Provide results to the client in person, direct and clearly Explain the Meaning of Negative test (you are safe for exposures before the window period) Provide results to the client in person, direct and clearly Explain the Meaning of inconclusive test Behaviour change communication Reinforce Behaviour change communication Reinforce Behaviour change communication Discuss care and support services available Other issues – Frequent testers, worried wells, Anxiety issues, Feeling of false immunity Repeat the test – refer to a consultant ©karawita
  22. 22. VCT in special situations • Mobile populations • Prison • Sexual assault • Occupational exposure • IDU • Sex workers • Youth and children • MSM • PMTCT • ANC • VCT@WORK ©karawita
  23. 23. Service delivery settings 1. Free standing 2. Mobile/Out reach 3. Institutional/Integrated a) STI clinics b) General health system (MOH, ANC, OPD) c) Private sector hospitals d) Prison e) Drug and Alcohol services f) Gay and Lesbian health services. ©karawita
  24. 24. Summary of VCT Make sure your client more smarter after VCT 1. HIV/AIDS knowledge 2. Knowledge on real risk 3. HIV status known 4. Use condoms/ do not share needles (protective sexual or drug using behaviour) 5. Improve health seeking behaviour Client may come with a perceived risk Make a protected man in the society HIV counselling and testing services ©karawita
  25. 25. ©karawita