Integrated counseling and Testing centers

1. FIED VISIT:
Integrated Counselling And Testing
Centre (ICTC)
ROLES, REFERRALS & LINKAGES
Dr. Pranil Shah; R-2,
Community Medicine, PIMSR.
ICTC

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3. OG GOATS

4. Current scenario
 National adult (15–49 years) HIV prevalence was
estimated at :
 0.22% (0.17%–0.29%) in 2020;
 0.23% (0.18%–0.31%) among males, and
 0.20% (0.15%–0.26%) among females.
 The national adult prevalence continued to decline
from an estimated peak level of 0.54% in 2000–
2001 through 0.33% in 2010 to 0.22% in 2020

5.  The total number of people living with HIV
(PLHIV) in India was estimated at 23.19 lakh
(18.33 lakh–29.78 lakh) in 2020.
 Children (<15 years) accounted for 3.5%, and
44.3% of total infections were among females.
 Maharashtra had the highest estimated number
of PLHIV (3.90 lakh), followed by Andhra Pradesh
(3.03 lakh), Karnataka (2.55 lakh), Uttar Pradesh
(1.61 lakh), Telangana and Tamil Nadu (1.58 lakh
each).

8. HIV prevalence among different
population groups

9. What is HIV?
 LAV HTLV-III HIV, in may 1986.
 RNA virus of Retrovirus group
 AIDS has emerged as one of the most serious
public health problem.
H — human
I — immunodeficiency
V — virus

11. What is AIDS?
A—Acquired
(not born with)
I—Immune
(body’s defence system)
D—Deficiency
(not working properly)
S—Syndrome
(a group of signs and symptoms)
Transmitted from person to
person.
It affects the body’s immune
system, the part of the body
which usually works to fight off
germs such as bacteria and
viruses.
Malfunctioning of the body’s
immune system
Patient with AIDS may
experience a wide range of
different diseases and
opportunistic infections.

12. EPIDEMIOLOGY
 AIDS (Acquired Immuno Deficiency Syndrome)
 EPIDEMIOLOGICAL DETERMINANTS
1.Agent factors
a) Agent
b) Reservoir of infection (cases & carriers)
c) Source of infection (blood, semen, CSF)
2.Host factors
a) Age
b) Sex
c) High risk group

13. 3. Mode of transmission: EFFICACY
a) Sexual transmission (0.01 to 1%)
b) Blood contact (>90%)
c) Maternal-fetal transmission
(Vertical transmission)( 25-30%)
d) Sharing needles /syringes (3-5%)
e) Mucocutaneous exposure (0.05%)
4. Incubation period (few months to 10 years)
5. Clinical manifestations
1. Initial infection with the virus and development of antibodies
2. Asymptomatic carrier state
3. AIDS-related complex (ARC)
4. AIDS
Most Common Route of
infection: %
a) Sexual : 87.1%
b) Perinatal : 5.4%
c) Blood product: 1%
d) IDU : 1.5%
e) Homosexual:1.5%
f) Unknown : 3.3%

14. CONTROL OF AIDS
1. Prevention
2. Treatment
3. Specific prophylaxis

15. What is an Integrated
Counselling and Testing Centre
(ICTC)?
An integrated counselling and testing centre is a place where a person
is counselled and tested for HIV, on his/her own free will or as advised
by a medical provider.

17. What is ICTC?
ICTC is a public health strategy that aims at
reducing (preventing) HIV transmission by:
1. Increasing people’s access to knowledge and
understanding of HIV status on a voluntary basis
2. Providing tools for the adoption of safe behavior
3. Facilitating early uptake of services for
HIV-positive and -negative people (medical,
psychological, legal, social)
4. Increasing awareness and information in
communities
5. Reducing and removing stigmatization and
discrimination associated with the epidemic

18. 1. EARLY DETECTION OF H.I.V
2. PROVISION OF BASIC INFORMATION ON
* MODES OF TRANSMISSION
* PREVENTION OF H.I.V/AIDS
3. FOR PROMOTING BEHAVIOURAL CHANGE &
REDUCING VULNERABILITY
4. FOR LINKING PEOPLE WITH OTHER H.I.V.
PREVENTION, CARE AND TREATMENT SERVICES
ICTC
MAIN FUNCTIONS

19. Who needs to be tested in an
ICTC?
Subpopulations who are more vulnerable or practice high-risk
behaviour like
1.Sex workers and their clients,
2.Men who have sex with men (MSM),
3.Transgender,
4.Injecting drug users (IDU),
5.Truckers,
6.Migrant workers,
7.Spouses and children of men who are prone to risky behaviour.

20. -An ICTC is located in
1.Health facilities owned by the government, in the private/not for profit
sector,
2.In public sector organizations/other government departments such as the
Railways, Employees' State Insurance Department (ESID)
3.In sectors where nongovernmental organizations (NGOs) have a presence.
4.In the health facility, the ICTC should be well coordinated with the
Department of Medicine, Microbiology, Obstetrics and Gynaecology,
Paediatrics, Psychiatry, Dermatology, Preventive and Social Medicine.
Where can an ICTC
be located?

21. 1. STAND ALONE I.C.T.C
2. FACILITY INTEGRATED
I.C.T.C
3. MOBILE I.C.T.C
TYPES OF ICTC

22. Physical Infrastructure required
for an ICTC
In a facility, the ICTC should be
located in a place that is easily
accessible and visible to the public.
• The counselling room
• Blood collection and testing room—
Refrigerator, Centrifuge, Needle
destroyer, Micropipette, Colour-coded
waste disposal bins.
• CD4 count room

23. Human resources for an ICTC
The ICTC requires a team of skilled persons consisting of the manager
(medical officer), counsellor and LT.
1. ICTC manager (medical officer)-- The administrative head of the facility
where the ICTC is located must identify and nominate a medical officer as
manager in- charge of the ICTC.
duties:-
•Administrative
•Demand generation
•Quality assurance
•Supply and logistics
•Monitoring and supervision

24. 2. Counsellors--The counsellor should be a graduate in
Psychology/Social Work/Sociology/Anthropology/ Human
Development or hold a diploma in Nursing with a minimum of 3–5
years of experience in the field of HIV/AIDS.
duties:-
• Preventive and health education--provided pre-test
information/counselling, post-test counselling and follow-up
counselling.
• Psychosocial support
• Referrals and linkages—Maintain effective coordination with the RCH
and TB programmes as well as with the antiretroviral therapy (ART)
programme,

25. 3.Laboratory technician-- The LT should hold a Diploma in Medical
Laboratory Technology (DMLT) from an institution which is approved
by the state government.
duties:-
• HIV testing according to standard laboratory procedure.
• Keep the facility neat and clean at all times.
• Keep a record of HIV test results and stock of rapid HIV diagnostic kits.
Follow universal safety precautions and strictly adhere to hospital waste
management guidelines.
4. Outreach workers– Mobilize & Follow up Patients. Follow up
the mother–baby pair till 18 months after delivery.

26. THE ROLE OF ICTC IN THE HIV/AIDS EPIDEMIC

27. Purpose of HIV testing
 HIV testing is performed for several reasons:
 Surveillance (epidemiological)
 unlinked, anonymous
 Blood screening (ensuring safe blood supply)
 unlinked, anonymous, mandatory
 VCT (voluntary to ascertain HIV status)
 linked testing (linked, confidential testing)
 Diagnostic testing (clinical management)
 linked testing

28. CONFIDENTIAL AND ANONYMOUS TESTING

29. What is counselling?
 Face to face communication by which
counsellor helps the person/client to make
decisions that is best for him and act on them.
 A process of supporting a person/people to
learn how to solve certain emotional,
interpersonal and decision-making problems
 Helping clients to help themselves
 Can be done with individuals/couples/families
Essence of counseling is conveyed by
‘GATHER’: Greet, Ask, Tell, Explain, Help and
Revisit

30. GATHER
Approach
G = Greet the client
A = Ask about the problem Active listener
Assess degree of risk behavior Show respect and tolerance
Enable patient or client to express freely
Determine access to support and help in family and community
T = Tell the client about specific information that he or she desires
H = Help them to make decisions
E = Explain any myths or misconceptions(also known
DECISION MAKING)
R = Return for follow up or Referral

31. Counselling is…
 Specific to the needs, issues and circumstances of each
individual client
 An interactive, collaborative and mutually respectful
process
 Goal-directed
 Oriented towards developing autonomy,
self- responsibility and confidence in clients
 Sensitive to the socio cultural context
 Eliciting information, enables the client to review options
and develop action plans
 Inculcating coping skills
 Facilitating interpersonal interactions
 Bringing about attitudinal change

32. Counselling is NOT…
 Telling or directing
 Giving advice
 A casual conversation
 An interrogation
 A confession
 Praying

33. How is counselling different from
health education?
COUNSELLING HEALTH EDUCATION
• Confidential • Not confidential
• A ‘one-to-one’ process or
a small group process
• For groups of people
• Focused, specific and
goal-directed
• Generalized
• Facilitates change of
attitudes and motivates
behaviour change
• Increases knowledge and
information
• Problem-oriented • Content-oriented
• Based on the needs of the
client
• Based on public health
needs

34. Key qualities of an effective
counsellor
 Shows acceptance
 Has unconditional positive regard for the
client
 Is non-judgemental
 Is an active listener
 Has patience
 Has empathy
 Facilitates congruence
 Is open to experience

35. An effective counsellor
Is sensitive to cultural (contextual/ situational)
differences
Encourages free expression of feelings by the client
Rewards and facilitates communication by the client
Enables the client to think of alternative ways of
solving problems
Recognizes one’s own limitations and makes
referrals when required
Respects the confidentiality of all that is disclosed
Does not indulge in easy gossip

36. Skills of counselling
• Rapport-building
• Information-gathering
• Attending and listening
• Information-giving
• Predicting
• Coping with burn-out and stress

37. WHAT IS HIV / AIDS
COUNSELLING?
 A confidential communication between a
client and a care provider
 Enabling the client to cope with stress and
take personal decisions relating to HIV /
AIDS.
 The counselling process includes: the
evaluation of personal risk of HIV
transmission, facilitation of preventive
behaviour and evaluation of coping
mechanisms when the client is confronted
with a positive result.

38. WHY IS HIV/AIDS COUNSELLING
IMPORTANT?
 HIV/AIDS is a life-threatening, life-long
illness
 Preventive counselling and behaviour
change can prevent transmission of
HIV/AIDS and improve the quality of life
 Diagnosis of HIV/AIDS has many
implications—physical, psychological and
social

39. Aims of HIV / AIDS counselling
1. Providing information
2. Providing psychological, social and emotional support for
—people who have contracted the virus
—others affected by the virus
3. Preventing transmission of HIV by
—providing information about risk behaviours (such as
unsafe sex or needle sharing)
—motivating people to take good care of their health
—assisting people to develop personal skills necessary for
behaviour change
—adopting and negotiating safe sexual practices
4. Ensuring effective use of treatment programmes by
establishing treatment goals and ensuring regular follow-up

40. The strategies
 Client-initiated
 Voluntary counselling and testing
 Provider-initiated
 Diagnostic HIV testing
 Routine offer of HIV testing
 Mandatory screening of blood units

41. AIMS OF PRE-TEST COUNSELLING
 To prepare the client for any type of result, whether negative,
positive or indeterminate
 To ensure that the test is fully informed and voluntary
 To provide information on risk reduction
 Develop an individualized risk-reduction plan
 To provide options for PPTCT
 To provide an entry point to treatment and care
 Facilitate the enactment of the client’s plan
 Facilitate the acquisition of coping skills
 Facilitate the use of social support systems and improved
support mechanisms (interpersonal and familiar)
 Focus on issues regarding the test
 Respect the client’s privacy

42. Process of pre-test counselling
 Establish a rapport with the client
 Determine the purpose of the client’s visit to the
centre (information/ counseling/ testing)
 Give information on HIV
1. Discuss HIV transmission
2. Correct any misconceptions— give simple, factual
information
 Help clients assess their own level of risk & draw up
an individualized risk-reduction plan
 Explain the HIV test
 Obtain informed consent
 Reaffirm the right to decline testing
 Discuss the advantages & disadvantages of the test
for the individual

43.  Discuss the importance of disclosure of test results to
spouse or partner
 Summarize the session
 Demonstrate the use of condoms to ensure that the
client knows how to use them
-If the client decides to undergo the test:
 Inform the client about the test procedure
 Length of time for results
 Amount of & manner of blood collection
 Remember to show the client blood tube/slide
collection form & labels that have the client’s code
 Some flexibility is required, e.g. if the client is
distressed at initial presentation, you will need to

44. PRE-TEST COUNSELLING
Risk assessment in HIV/AIDS
 Requires the counsellor to ask explicit questions about
various practices of an individual including:
 Sexual practices,
 Drug-using practices,
 Occupational practices, and
 Receipt of blood products, organs or donor semen
 Need
 Promote greater awareness about STIs and HIV
 Preventive counselling & education
 Determination of necessary health investigations
 Feedback to the client regarding levels of risk
associated with various practices

45. HIV diagnosis
HIV infection is diagnosed largely by the
detection of antibodies against HIV in the
blood of infected patients
There are three main types of HIV antibody
tests:
• ELISA
• Western blot assay
• Rapid HIV tests

47. Acute HIV infection
‘Window period’
 Follows acute infection with HIV, before HIV
antibodies can be detected in the patient’s blood
stream
 Patient is highly infectious, despite testing HIV
antibody negative; HIV is replicating rapidly in all
parts of the body
 Typically up to 12 weeks’ duration but may be
shorter in more sensitive HIV antibody assays
(particularly those incorporating HIV p24 antigen)

48. Diagnosis in the newborn
• Due to transmission of maternal antibodies,
HIV antibody tests cannot be used to diagnose
HIV infection in the newborn
• Maternal antibodies can be detected for up to 18
months
• Non-antibody assays for the early detection of
HIV infection in the newborn include:
• HIV p24 antigen
• Viral culture
• Detection of viral genes (either HIV DNA or
HIV RNA)

49. Objectives of post-HIV test
counselling
 To prepare the client for the result
 To help the client understand and cope with the
result
 To provide further information to the client
 To refer the client to other services
 To counsel for risk reduction

50. General principles for HIV post-test
counselling
 Be calm when you call the client in for their result
 Be direct in giving the result
 Give an explanation of their result
 Allow enough time for results to sink in
 Build up a relationship by including a greeting/ small talk
 Confirm that the client is ready to collect the test result:
Comprehension
Psychosocial condition
Coping strategies
 Provide the client space and time to react
 Help manage emotional response

51. GUIDELINES FOR THE PROVISION OF
NEGATIVE TEST RESULTS
 Check for possible exposure in the window
period, including any since pre-test
counselling
 Reinforce information on transmission,
safe sex & drug use
 Exploration of constraints to practice of
safe behavior
 Encourage spouse testing
 Refer to appropriate source for help

52. POSITIVE RESULT PROVISION
 Provide a safe, empathetic & accepting environment
 Allow sufficient time to accept the result
 Avoid giving false reassurance
 Clarify any misinformation about the meaning of the
result & its implications
 Assess coping strategies
 Assess support available to the client & make
appropriate referrals
Discuss partner disclosure and spouse testing
Provide information on: health, rest, exercise, diet, risk
reduction, home-based care, infection-control issues
Ask the client if they have any questions
Offer follow-up session

53. Managing emotional responses
 Crying: Let the client cry; this allows them to
vent their feelings
 Anger: Stay calm, let the client express their
feelings, acknowledge that these feelings are
normal
 No response: Due to shock, denial or
helplessness
 Denial: Client has difficulty in accepting the
result
For all responses, encourage the client to talk
about their feelings.

54. FOLLOW-UP COUNSELLING
 HIV tests identify not only infected persons but also
several affected ones close to them
 Important issues need to be addressed
 Counseling micro-skills and techniques to be used.
Refusal to disclose to sexual partners may put
partners at serious risk of infection. Counsellors
should:
- Encourage the client to bring their partner in for
counselling.
- Assess each case separately for benefits or harms in
the event of both disclosure and non-disclosure

55. FOLLOW-UP COUNSELLING VISITS
Answer questions
Assess the impact of the diagnosis on aspects of
the client’s life
Use problem-solving techniques to handle
adjustment, interpersonal and emotional issues
Use family therapy for resolving issues arising
from the HIV status
Discuss treatment options
Review support services
Make appropriate referral

56. PPTCT
(PREVENTION OF PARENT TO CHILD TRANSMISSION)
Voluntary
Counseling &
Testing Centre
Prevention of
Parent to Child
Transmission
Integrated
Counseling & Testing
Centre

57. Indian Scenario….
 27 million new pregnancies per year
 97,000 in HIV +ve mothers (prevalence- 0.36%)
 30,000 HIV infected babies
(25-30% transmission rate)
 < 5% of all pregnant women receive HIV testing and
counseling
 < 5% of HIV +ve pregnant women received ART

58. Studies shows…..
 Administration of zidovudine to mother from the
14th week of pregnancy, during labour & to the
newborn decreased the risk of MTCT by nearly
70% (absence of BF)
 A shorter zidovudine-alone regimen starting from
the 36th week of pregnancy was shown to reduce
the risk of transmission of HIV at 6 months by 50%
in non BF infants & by 37% in those who were
given BF
 Breast feeding is thought to increase the rate of
transmission by 10 – 20%.

59. MEASURES TO REDUCE PPTCT
During labour and delivery:
 Delay rupture of the membranes (ROM)
 Carry out only minimal digital examinations
after ROM
 Cleanse the vagina with viricides, if available
 Reduce the use of assisted delivery with
forceps
 Reduce the use of episiotomy
 Elective caesarean section protects better
against PTCT than vaginal delivery
 If not already on ART, give nevirapine

60. After delivery
 Avoid mechanical nasal suction
 Clean the newborn immediately of all maternal
secretions and blood
 Support safe infant feeding
 If breastfeeding is chosen as an option: encourage
exclusive breastfeeding & advise early cessation
(before six months) or breast-milk substitutes
 Advise giving breast-milk substitutes where
conditions are suitable(i.e.when replacement
feeding is acceptable, feasible, affordable,
sustainable and safe (AFASS). Mothers should
avoid all breastfeeding

61. PPTCT intervention package
 Antenatal care
 Group education/pre-test counselling
 HIV testing: After informed consent
 Post-test counselling
 Institutional delivery: Safe delivery practices
 Administration of nevirapine to the woman
during labour
 Administration to the BABY of SINGLE DOSE
of suspension nevirapine (2 mg/kg) within first
72 hours
 Counselling of mother for infant feeding options
 Care and support

62. Home-based care: A working
definition
‘A set of activities responding to medical,
nursing, psychological and social needs of
people infected and families in the home
environment.’

63. OBJECTIVES OF HOME-BASED CARE
 To facilitate a continuum of care & support
to PLHA extending from the health care
facility to the home & family
 To promote family & community awareness
of HIV/AIDS prevention & care
 To empower PLHA, family & community with
the knowledge needed to ensure long-term
care & support

64.  Reduction of the stigma & discrimination
associated with HIV/AIDS within families as well
as within communities
 To create an effective network of referral services
from institutional health care facilities & to the
community & also from communities to adequate
health set-ups as required.
 Development of home-based care as the vital link
between prevention and care
 To mobilize both human and financial resources
essential for the sustainability of the system

65. Nutritional management
• Nutrition can affect the morbidity and mortality of
PLHA—nutritional intervention is fundamental at
all stages of illness
• Weight loss and nutritional deficiencies, and
malnutrition (particularly PCM) are common
among PLHA
• It is important that the counsellor identifies
appropriate referrals for individualized long-term
professional nutritional support and follow-up

66. ART
Started :
Symptomatic HIV infection
Asymptomatic HIV infection with CD4 <350 or
viral load >20,000 (b DNA)
Acute retroviral syndrome (Primary HIV infection)
Monitoring:
Plasma viral loads
CD4 counts

67.  Blood safety
 Relationship between STIs and HIV infection
 Universal work precautions

68. Post-exposure Prophylaxis: deciding chemoprophylactic
regimen
 Should be started immediately (within 2
hours),
 NOT recommended after 72 hours,
 Decide EC (exposure code) & SC (status
code), Give BASIC or EXPANDED regimen
accordingly.
(ref.: NACO guidelines for PEP)

69. Deciding EC
Is the source material blood, body fluid,
other infected material or a contaminated instrument?
YES NO
No PEP
Type of exposure
Intact skin only
Mucous membrane or
skin-integrity compromised
Percutaneous exposure
No PEP Volume
Small
EC 1
Large
EC 2
Severity
Less severe
EC 2
More severe
EC 3

70. Decide SC
HIV status of the exposure source
HIV Negative HIV Positive
Status
Unknown
Source
Unknown
No PEP
Low titer exposure
(CD4 high)
HIV SC 1
High titer exposure
(CD4 high)
HIV SC 2
HIV SC
Unknown

71. Decide Regimen
EC SC PEP Recommendation
1 1 PEP not required.
1 2 Consider BASIC Regimen PEP. (HIV risk little)
2 1 Recommend BASIC Regimen of PEP.
(Most exposure are in this category)
2 2 Recommend EXPANDED Regimen.
3 1 or 2 Recommend EXPANDED Regimen
2/3 UNKNOWN Consider BASIC Regimen. (according to
epidemiological risk factors)
 BASIC Regimen : Zidovudine 300mg BD + Lamivudine
150mg for 4 weeks
 EXPANDED Regimen : BASIC + Indinavir 800mg TDS
for 4 weeks

72. WHO CILINICAL STAGING OF HIV/AIDS
FOR ADULTS AND ADOLESCENTS
Primary HIV infection
 Asymptomatic
 Acute retroviral syndrome
Clinical stage 1
 Asymptomatic
 Persistent generalized lymphadenopathy

73. Clinical stage 2
 Moderate and unexplained weight loss (<10% of
presumed or measured body weight)
 Recurrent respiratory tract infections (such as
sinusitis, bronchitis, otitis media, pharyngitis)
 Herpes zoster
 Recurrent oral ulcerations
 Papular pruritic eruptions
 Angular cheilitis
 Seborrhoeic dermatitis
 Fungal finger nail infections

74. Clinical stage 3
Conditions where a presumptive diagnosis
can be made on the basis of clinical signs or
simple investigations:
 Unexplained chronic diarrhoea for longer than
one month
 Unexplained persistent fever (intermittent or
constant for longer than one month)
 Severe weight loss (>10% of presumed or
measured body weight)
 Oral candidiasis
 Oral hairy leukoplakia

75.  Pulmonary tuberculosis (TB) diagnosed in last
two years
 Severe presumed bacterial infections (e.g.
pneumonia, empyema, meningitis, bacteraemia,
pyomyositis, bone or joint infection)
 Acute necrotizing ulcerative stomatitis, gingivitis
or periodontitis
 Conditions where confirmatory diagnostic
testing is necessary:
 Unexplained anaemia (< 80 g/l), and or
neutropenia (<500/µl) and or thrombocytopenia
(<50 000/ µl) for more than one month

76. Clinical stage 4
Conditions where a presumptive diagnosis can
be made on the basis of clinical signs or simple
investigations.
 HIV wasting syndrome
 Pneumocystis pneumonia
 Recurrent severe or radiological bacterial
pneumonia
 Chronic herpes simplex infection (orolabial,
genital or anorectal of more than one month’s
duration)
 Oesophageal candidiasis

77.  Kaposi’s sarcoma
 Central nervous system toxoplasmosis
 HIV encephalopathy
Conditions where confirmatory
diagnostic testing is necessary:
 Extrapulmonary cryptococcosis including
meningitis
 Disseminated non-tuberculous mycobacteria
infection
 Progressive multifocal leukoencephalopathy
 Candida of trachea, bronchi or lungs

78.  Cryptosporidiosis
 Isosporiasis
 Visceral herpes simplex infection
 Cytomegalovirus (CMV) infection (retinitis or of an
organ other than liver, spleen or lymph nodes)
 Any disseminated mycosis (e.g. histoplasmosis,
coccidiomycosis, penicilliosis)
 Recurrent non-typhoidal salmonella septicaemia
 Lymphoma (cerebral or B cell non-Hodgkin)
 Invasive cervical carcinoma
 Visceral leishmaniasis

79. ICTC & ITS LINKAGES

81. A.R.T. CENTRES
• All clients diagnosed with H.I.V. should be
referred to nearest ART center for
assessment & treatment.

82. A.R.T. CENTRES
Services available
• 1. Identify eligible PLWHAs who require ART
* HIV testing
* CD4 count etc
• 2. Free ARV drugs to eligible persons with HIV/AIDS
• 3. Counseling for adherence
• 4. Education on nutritional requirements, hygiene …
• 5. Referral for specialized services
• 6. Condom distribution

83. are entry point for clients into the health system.
They form a part of a range of services.
Must maintain good linkages with other facilities.
ICTCs fall into category of prevention & identification
BUT
ICTC personnel must be aware of how their services
flow into care services at other facilities.
ICTC

84. Assignment
• Maintain a separate note book for visits
• Make index in first page with serial number,
Date, Topic and Faculty.
• Get it signed with the respected teacher
concerned with the visit.
• Don’t make assignment in pin pages. Please
maintain a separate book for PSM visits.

85. ICTC
1. Enumerate the services available at ICTC .
2. Expand the acronym “GATHER” in relation to
family planning counselling.
3. Enlist the activities carried out at PPTCT.
4. Write the staff pattern at ICTC.

86. JOURNAL QUESTIONS
1. Which ICTC was visited by you? Write the
type of ICTC you visited.
2. Enlist the staff of ICTC you visited.
3. Which are the high-risk groups subjected to
HIV testing at the ICTC?

87. THANK YOU
• OFF TO HOSPITAL…