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Module 5. HIV Testing and Counselling for PMTCT. Module Objectives. Discuss the integration of HIV testing and counselling into settings where PMTCT services are provided Discuss the three guiding principles for testing and counselling in settings where PMTCT services are provided

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Module 5 l.jpg

Module 5

HIV Testing and Counselling for PMTCT


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Module Objectives

  • Discuss the integration of HIV testing and counselling into settings where PMTCT services are provided

  • Discuss the three guiding principles for testing and counselling in settings where PMTCT services are provided

  • Explain the difference between provider- and client- initiated approaches to HIV testing

PMTCT Generic Training Package Module 5, Slide 2


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Module Objectives (Continued)

  • Describe the importance of effective communication and counselling skills when working in settings where PMTCT services are provided

  • Describe the ways to deliver pre-test information and counselling

  • Provide pre-test information

  • Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings

PMTCT Generic Training Package Module 5, Slide 3


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Module Objectives (Continued)

  • Describe HIV testing processes

  • Understand the procedures to perform a rapid HIV test correctly

  • Explain the meaning of positive (reactive) and negative (non-reactive) HIV test results

  • Describe the steps involved in post-test counselling

  • Discuss the disclosure process for women who are HIV-infected

PMTCT Generic Training Package Module 5, Slide 4


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Session 1

Overview of HIV Testing and Counselling for PMTCT


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Session 1 Objectives

  • Discuss the integration of HIV testing and counselling into settings where PMTCT services are provided

  • Discuss the three guiding principles for testing and counselling in settings where PMTCT services are provided

  • Explain the difference between provider- and client- initiated approaches to HIV testing

PMTCT Generic Training Package Module 5, Slide 6


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HIV Testing and Counselling

  • HIV testing provides:

    • Information about HIV status

    • Opportunity to identify women with HIV and empower them to make decisions to prevent MTCT

    • Opportunity to identify women who are HIV negative and empower them to remain negative

PMTCT Generic Training Package Module 5, Slide 7


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HIV Testing and Counselling (continued)

WHO recommends provider-initiated HIV testing and counselling as a standard part of antenatal care (ANC), labour and delivery and post-delivery care

PMTCT Generic Training Package Module 5, Slide 8


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Definitions

  • HIV testing:process of determining if client is infected with HIV

  • HIV counselling: confidential dialogue between an individual or a couple and a healthcare worker (HCW) to help clients examine their risk of acquiring or transmitting HIV

    • HIV counselling is tailored to the risk behaviour, circumstances and special needs of the client

PMTCT Generic Training Package Module 5, Slide 9


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Advantages of Testing and Counselling

  • HIV testing and counselling provides clients with an opportunity to learn their HIV status

  • For HIV-negative women, advantages include:

    • Information and support to remain uninfected

    • Information and support to exclusively breastfeed for six months

PMTCT Generic Training Package Module 5, Slide 10


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Advantages of Testing and Counselling (Continued)

  • For HIV-infected women, advantages include:

  • PMTCT interventions (ARVs, safer delivery, infant feeding, referrals)

  • Discuss partner testing and prevention (discordance, disclosure)

  • Receive information on treatment, care, nutrition, family planning and support services

  • Learn about importance of continuous health care

  • Learn about needs of HIV-exposed children (testing, co-trimoxazole)

  • Make informed decisions about their pregnancy

PMTCT Generic Training Package Module 5, Slide 11


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Guiding Principles

  • Confidentiality

  • Informed consent

  • Post-test support and services

PMTCT Generic Training Package Module 5, Slide 12


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Guiding Principles (Continued)

  • Confidentiality

    • Important responsibility of all HCWs

    • Essential to establishing and maintaining client trust

    • Information shared between HCWs and clients must be kept private

PMTCT Generic Training Package Module 5, Slide 13


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Guiding Principles (Continued)

  • Confidentiality, continued

    • Personal and medical information may be disclosed to other HCWs only to ensure client receives appropriate medical care

    • Only those directly involved in client's care will have access to medical records—and only on “need-to-know” basis

    • Anyone not directly involved in a client’s care (e.g., receptionist at ANC clinic), should not have access to client medical records

PMTCT Generic Training Package Module 5, Slide 14


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Guiding Principles (Continued)

  • Confidentiality, continued

    • All medical records and registers, whether or not they include HIV-related information, should be kept private and stored in a safe, secure place

PMTCT Generic Training Package Module 5, Slide 15


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Guiding Principles (Continued)

  • Informed Consent

    • Process during which clients receive clear and accurate information about HIV testing to make an informed decision about whether to accept or decline testing

The client must give informed consent before being tested

PMTCT Generic Training Package Module 5, Slide 16


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Guiding Principles (Continued)

  • Elements of informed consent:

    • An understanding of the purpose and benefits of testing, counselling and PMTCT services

    • An understanding of the testing and counselling process

    • Respect for the client’s testing decision

PMTCT Generic Training Package Module 5, Slide 17


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Guiding Principles (Continued)

  • Informed consent:

    • Where HIV testing is offered routinely (e.g. in a “provider-initiated approach”), written informed consent may not be required

PMTCT Generic Training Package Module 5, Slide 18


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Guiding Principles (Continued)

  • Post-test counselling support and services

    • HIV test result should be offered in person as part of an individual (or couple) post-test counselling session

    • Provide both HIV-negative and HIV-positive women with test results and counselling

PMTCT Generic Training Package Module 5, Slide 19


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Guiding Principles (Continued)

  • Post-test counselling support and services

    • Ensure privacy when providing HIV test results

    • Reassure client you will keep the conversation and test results confidential

    • Inform client that follow-up treatment, care, support are available, including support for disclosure when needed

PMTCT Generic Training Package Module 5, Slide 20


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Exercise 5.1

Confidentiality Role Play: Large Group Discussion


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Provider- and Client-Initiated Approaches to HIV Testing

  • Two basic approaches to HIV testing:

    • Provider-initiated

    • Client-initiated

  • Both approaches include

    • Basic information about providing HIV testing

    • Risks and benefits of testing

PMTCT Generic Training Package Module 5, Slide 22


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Provider-Initiated Approach

  • HIV testing is a routine, expected part of standard care

  • Also referred to as “opt-out”

  • All women provided with pre-test information

  • All women are tested for HIV and provided with post-test counselling unless they decline testing

  • Testing is still voluntary under the provider-initiated approach

PMTCT Generic Training Package Module 5, Slide 23


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Client-Initiated Approach

  • Client specifically requests HIV test

  • Also referred to as “opt-in”

  • Clients provided with pre-test information

  • Only clients who specifically request to be tested are provided with HIV testing

  • Client gives verbal or written consent

PMTCT Generic Training Package Module 5, Slide 24


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Provider- vs. Client-Initiated Approaches to HIV Testing

PMTCT Generic Training Package Module 5, Slide 25


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Preferred Testing Strategy: Provider-Initiated

  • Recommended for HIV testing and counselling in ANC, L&D, post-delivery settings

  • Helps normalize HIV testing

  • Likely to increase the number of women who get tested for HIV

PMTCT Generic Training Package Module 5, Slide 26


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Provider- and Client-Initiated Approaches to HIV Testing

  • Whether provider- or client-initiated, adhere to the guiding principles of testing and counselling:

    • Informed consent

    • Confidentiality

    • Provision of post-test services

PMTCT Generic Training Package Module 5, Slide 27


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Session 2

Counselling Skills


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Session 2 Objectives

  • Describe the importance of effective communication and counselling skills when working in settings where PMTCT services are provided

PMTCT Generic Training Package Module 5, Slide 29


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Role of the HCW in Counselling

What client counselling do you currently undertake in your work?

PMTCT Generic Training Package Module 5, Slide 30


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Role of the HCW in Counselling

  • Role of HCW during counselling: support and assist client’s decision-making process by:

    • Listening to client

    • Understanding the choices client needs to make

    • Helping client explore her/his circumstances and options

    • Helping client develop self-confidence to carry out her/his decision about testing

PMTCT Generic Training Package Module 5, Slide 31


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Role of the HCW in Counselling(Continued)

  • HCW is not responsible for:

    • Solving all of the client’s problems

    • The client’s decisions

PMTCT Generic Training Package Module 5, Slide 32


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Counselling Skills: Active Listening

Active listening helps establish a trusting relationship with the client

  • It involves:

    • Listening to and understanding the client

    • Taking note of client’s non-verbal behaviour

    • Listening for client’s social and cultural context

    • Listening to client’s negative comments or feelings—make note of things that may have to be challenged

PMTCT Generic Training Package Module 5, Slide 33


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Counselling Skills: Self-Awareness

  • HCWs needs to be aware of their

    • Strengths and weaknesses

    • Fears or anxiety about HIV

PMTCT Generic Training Package Module 5, Slide 34


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Counselling Skills: Self-Awareness (Continued)

  • Consider your responses to these questions:

    • What are my expectations of my clients?

    • How do I feel about discussing HIV infection and AIDS?

    • What are my feelings about people with HIV infection or AIDS?

    • What are my feelings about people whose behaviour has placed them at risk?

PMTCT Generic Training Package Module 5, Slide 35


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Counselling Skills: Self-Awareness (Continued)

  • Consider your responses to these questions:

    • Which sexual practices would I find most difficult to talk about?

    • Will I be judgemental of clients whose values, beliefs, attitudes, fears and views differ from mine?

    • Am I ready to let clients make their own decisions?

PMTCT Generic Training Package Module 5, Slide 36


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Listening and Learning Skills

Skill 1: Use helpful non-verbal communication

  • Includes all aspects of message not conveyed by literal meaning of the words

  • It includes the Impact of gestures, gaze, posture and expressions that convey information

  • Reflects attitude

  • Helpful non-verbal communication encourages client to feel HCW is interested in her

PMTCT Generic Training Package Module 5, Slide 37


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Non-Verbal Communication

PMTCT Generic Training Package Module 5, Slide 38


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Listening and Learning Skills

Skill 1: Use helpful non-verbal communication

  • Demonstration

PMTCT Generic Training Package Module 5, Slide 39


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Listening and Learning Skills (Continued)

Skill 2: Ask open-ended questions

  • Open-ended questions begin with “how?” “what?” “when?” “where?” or “why?”

  • Encourages responses that lead to further discussion

  • Try to avoid questions with a “yes” or “no” answer

  • PMTCT Generic Training Package Module 5, Slide 40


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    Listening and Learning Skills (Continued)

    Skill 2: Ask open-ended questions, examples of closed-ended questions:

    • You know what HIV is, don’t you?

    • Do you have any other questions about MTCT?

    • Are you going to tell your partner that you tested for HIV today?

    • Is your husband your only partner?

    • Do you plan to replacement feed?

  • How would you revise these questions so that they are open-ended?

  • PMTCT Generic Training Package Module 5, Slide 41


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    Listening and Learning Skills (Continued)

    PMTCT Generic Training Package Module 5, Slide 42


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    Listening and Learning Skills (Continued)

    Skill 2: Ask open-ended questions

    • Demonstration

    PMTCT Generic Training Package Module 5, Slide 43


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    Listening and Learning Skills (Continued)

    Skill 3: Use gestures and responses that show interest

    • Gestures: nodding and smiling

    • Responses: “Mmm,” “Aha”

    • Attending skills: clarifying and summarizing—invite client to relax, talk about herself and her problems

    PMTCT Generic Training Package Module 5, Slide 44


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    Listening and Learning Skills (Continued)

    • Clarifying

      • Prevents misunderstanding

      • Helps sort out what has been said, e.g., if client says, “I can’t exclusively breastfeed my baby,” HCW may ask, “In what way is exclusive breastfeeding a concern for you?”

    • Summarizing

      • Helps ensure client and HCW understand each other

      • Summarizing can offer support and encouragement to clients to help them carry out decisions they have made

    PMTCT Generic Training Package Module 5, Slide 45


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    Listening and Learning Skills (Continued)

    Skill 3: Use gestures and responses that show interest

    • Demonstration

    PMTCT Generic Training Package Module 5, Slide 46


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    Listening and Learning Skills (Continued)

    Skill 4: Reflect back what the mother says

    • Encourages her to say more

    • Shows HCW is actively listening, encourages dialogue, gives HCW opportunity to better understand client’s feelings

      • Say what client said in a slightly different way

      • If client says, “I don’t know what to give my child; she refuses everything,” HCW might reflect back by saying: “Your child is refusing all the food you offer her?”

    PMTCT Generic Training Package Module 5, Slide 47


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    Listening and Learning Skills (Continued)

    Skill 4: Reflect back what the mother says

    • Demonstration

    PMTCT Generic Training Package Module 5, Slide 48


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    Listening and Learning Skills (Continued)

    Skill 5: Empathize—show you understand how she feels

    • Used in response to an emotional statement

    • Encourages mother to discuss the issue further

      • If client says, “I just can’t tell my partner that I have HIV,” HCW could respond with “You sound like you are afraid to tell your partner your HIV test result”

    • HCW is not empathizing if she responds with a question that has a factual answer

    PMTCT Generic Training Package Module 5, Slide 49


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    Listening and Learning Skills (Continued)

    Skill 5: Empathize—show you understand how she feels

    • Demonstration

    PMTCT Generic Training Package Module 5, Slide 50


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    Listening and Learning Skills (Continued)

    Skill 6: Avoid words that sound judging

    • Words like: right, wrong, well, badly, good, enough, properly

    • Using these words may make client feels she is wrong, or that there is something wrong with her baby

    • BUT, sometimes HCW needs to use “good” judging words to build a mother's confidence

    PMTCT Generic Training Package Module 5, Slide 51


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    Listening and Learning Skills (Continued)

    Skill 6: Avoid words that sound judging

    • Demonstration

    PMTCT Generic Training Package Module 5, Slide 52


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    Exercise 5.2

    Listening and learning skills: demonstration (in the large group) and practice (in small groups)


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    Common Mistakes

    • Controlling the discussion

    • Judging the client

    • Preaching to a client

    • Labelling a client instead of finding out their individual motivations, fears or anxieties

    • Reassuring a client without knowing

    PMTCT Generic Training Package Module 5, Slide 54


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    Common Mistakes (Continued)

    • Not accepting the client’s feelings

    • Advising before client has arrived at a personal solution

    • Interrogating

    • Encouraging dependence

    • Persuading or coaxing

    PMTCT Generic Training Package Module 5, Slide 55


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    Session 3

    Pre-test Information and Counselling


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    Session 3 Objectives

    • Describe the ways to deliver pre-test information and counselling

    • Provide pre-test information

    • Provide an overview of HIV testing of women with unknown status in labour and delivery (L&D) settings

    PMTCT Generic Training Package Module 5, Slide 57


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    Pre-test Information

    • The purpose of the pre-test session in PMTCT settings is to provide the woman or couple with adequate information to make an informed decision about HIV testing

    PMTCT Generic Training Package Module 5, Slide 58


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    Pre-test Information (Continued)

    Objectives and components of the pre-test session:

    • Help client understand HIV

    • Explain importance and benefits of HIV testing

    • Explain HIV testing procedures

    • Explain importance of partner testing, discordance, disclosure

    • Explain risk reduction and available services (sexual, MTCT) and provide referrals

    • Encourage continuous healthcare attendance (ANC and post-delivery)

    PMTCT Generic Training Package Module 5, Slide 59


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    Delivery of Pre-test Information

    Pre-test delivery model should:

    • Optimize the staff available

    • Not disrupt client flow

    • Maximize the number of women tested during their first visit

      Pre-test session models:

    • Group information

    • Individual counselling

    • Couple counselling

    PMTCT Generic Training Package Module 5, Slide 60


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    Group Pre-test Information

    Group information:

    • Optimize human resources

    • Allow for interaction among participants

    • Can be easily integrated into the clinic flow

      Group information sessions:

    • Are recommended for ANC settings

    • Can be used in post-delivery settings

    • Not practical or recommended for the L&D setting

    PMTCT Generic Training Package Module 5, Slide 61


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    Group Pre-test Information (Continued)

    Key considerations for group sessions:

    • Adjust information to fit group's level of knowledge

    • Emphasize behaviour change, including safer sex practices

    • Set aside time for questions and answers

    • Have enough knowledge and skills to answer questions

    • Refer for individual counselling, when requested

    PMTCT Generic Training Package Module 5, Slide 62


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    Group Pre-test Information (Continued)

    • Support and encourage women to be tested at their first ANC visit

    • Accommodate the need for family support and return visits where requested

    • Welcome family members; provide them with the same HIV pre-test information given to the client

    PMTCT Generic Training Package Module 5, Slide 63


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    Exercise 5.3

    Providing pre-test information: demonstration (in the large group) and practice (in small groups)

    PMTCT Generic Training Package Module 5, Slide 64


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    Individual Pre-test Session

    The individual session is used either to:

    • Provide pre-test information (rather than the group pre-test information session),OR

    • Provide information that complements group session to:

      • Reinforce pre-test information and answer questions

      • Address barriers to testing

      • Provide risk assessment, risk reduction counselling

    Individual pre-test counselling should be available in all PMTCT settings

    PMTCT Generic Training Package Module 5, Slide 65


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    Individual Pre-test Session(Continued)

    When testing and counselling is part of ANC services, clients must be reassured that declining an HIV test will NOT affect her access to services.

    Emphasize that if the client changes her mind and wants to be tested, an HIV test can be provided during a later visit.

    PMTCT Generic Training Package Module 5, Slide 66


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    Couple Pre-test Session

    Encourage involvement of male partners:

    • Stress his role as protector

    • Reduce chance that the woman will be blamed for bringing HIV into the family

    • Encourage safer sex

    • Support women and men who test HIV-negative to stay negative, especially those in discordant relationships

    • If both are infected — refer both for care

    • Gain support for PMTCT and adherence to PMTCT interventions

    PMTCT Generic Training Package Module 5, Slide 67


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    Couple Pre-test Session(Continued)

    Discordance in couples:

    • Means one partner is HIV-positive and other is HIV-negative

    • In counselling HIV-negative pregnant women, emphasize the heightened risk of MTCT if they become infected during pregnancy

    PMTCT Generic Training Package Module 5, Slide 68


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    Couple Pre-test Session(Continued)

    What are the advantages of couple counselling?

    PMTCT Generic Training Package Module 5, Slide 69


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    Couple Pre-test Session(Continued)

    Advantages of couple counselling:

    • Partners hear messages together shared understanding

    • Environment is safe to discuss concerns

    • HCW can ease tension and diffuse blame

    • Post-test counselling messages reflect the test results of both partners

    • Neither is burdened with disclosure or partner referral

    • Facilitates risk reduction such as condom use

    • Prevention (including PMTCT), care and treatment decisions can be made together

    PMTCT Generic Training Package Module 5, Slide 70


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    Couple Pre-test Session(Continued)

    Considerations in counselling couples:

    • Establish a relationship with each partner

    • Assure confidentiality

    • Assess each person's understanding of HIV

    • Do not allow one to dominate the conversation

    • Explain the testing process

    PMTCT Generic Training Package Module 5, Slide 71


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    Couple Pre-test Session(Continued)

    Considerations in counselling couples (cont’d):

    • Discuss post-test counselling

      • Ask if they want results separately or together

      • Mention possibility of discordant results

      • Provide information on PMTCT interventions

      • Confirm benefits of knowing one’s HIV status

      • Ask who else might be affected by test results

      • Confirm couple’s willingness to be tested

      • Be prepared to refer couple for further counselling

      • Be prepared to refer couple for HIV care and treatment

    PMTCT Generic Training Package Module 5, Slide 72


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    Testing and Counselling in L&D

    Women of unknown HIV status at time of labour may be tested in L&D

    L&D presents unique challenges for HIV testing:

    • It is busy and the patient has very little privacy

    • Women are often anxious and in pain

    Make the woman comfortable, ensure counselling is as confidential as possible

    PMTCT Generic Training Package Module 5, Slide 73


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    Testing and Counselling in L&D(Continued)

    PMTCT Generic Training Package Module 5, Slide 74


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    Testing and Counselling in L&D(Continued)

    • If test results of a woman tested in L&D are not available within 1 hour of delivery, breastfeeding should be initiated

    • An infant can be given ARV prophylaxis up to 72 hours after birth

    PMTCT Generic Training Package Module 5, Slide 75


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    Testing and Counselling in L&D(Continued)

    Content of the pre-test session in L&D

    • Introduce yourself

    • Explain MTCT

    • Discuss importance of testing

    • Explain testing process

    PMTCT Generic Training Package Module 5, Slide 76


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    Conducting the Pre-Test Session in L&D

    PMTCT Generic Training Package Module 5, Slide 77


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    Session 4

    HIV Testing


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    Session 4 Objectives

    • Describe HIV testing processes

    • Understand the procedures to perform a rapid HIV test correctly

    • Explain the meaning of positive (reactive) and negative (non-reactive) HIV test results

    PMTCT Generic Training Package Module 5, Slide 79


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    Overview of HIV Testing

    • HIV tests detect antibodies or antigens associated with HIV in whole blood, saliva, or urine

    • Blood sampling is the most common method of testing

    • HIV tests are very accurate

    PMTCT Generic Training Package Module 5, Slide 80


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    HIV Tests

    Antibody tests

    • After infection with HIV, the body makes antibodies to fight the virus

    • It may take 4 to 6 weeks, but occasionally up to 3 months for antibodies to become detectable in the blood

      • During this time, a person can still transmit the virus to others

    • Rapid HIV tests and the ELISA are the most common antibody tests in PMTCT settings

    PMTCT Generic Training Package Module 5, Slide 81


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    HIV Tests (Continued)

    Rapid HIV tests

    • Accurate results within 20-40 minutes

    • Can be done in the clinic setting

    • Accurate when performed correctly

    • Usually performed on serum or whole blood (by fingerprick or venous sample); some rapid HIV tests use saliva

    • No batching required

    • HCWs can be trained to perform the tests

    • Usually do not require special equipment, electricity or refrigeration

    PMTCT Generic Training Package Module 5, Slide 82


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    HIV Tests (Continued)

    Benefits of rapid HIV testing include:

    • On-site testing and same day results

    • Lower risk of administrative error

    • Accepted by clients

    • Fewer resources required:

      • Human resources

      • Resources at the facility

      • Financial resources

    • Lower risk of occupational exposure

    PMTCT Generic Training Package Module 5, Slide 83


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    Rapid HIV Testing Algorithms

    • Serial testing

    • Blood sample taken and tested once

    • If first test result is non-reactive, result is given to client as HIV-negative

    • If first test result is reactive, blood sample is tested again using different brand of rapid test

      • If second test is reactive, result is reported as HIV-positive

      • If second test is negative, a third test known as a “tiebreaker” is performed

    PMTCT Generic Training Package Module 5, Slide 84


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    Rapid HIV Testing(Serial testing)

    First Test

    Positive

    NegativeCounsel for Negative Result

    Second Test

    PositiveCounsel for Positive Result

    Negative

    Tie-breaker Test

    PositiveCounsel for Positive Result

    NegativeCounsel for Negative Result

    PMTCT Generic Training Package Module 5, Slide 85


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    Rapid HIV Testing Algorithms (Continued)

    • Parallel testing

    • Two HIV tests are performed on same sample at the same time, e.g., in parallel

    • If both are non-reactive, client reported HIV-negative

    • If both are reactive, client reported HIV-positive

    • If one is reactive and the other non-reactive, a “tiebreaker test” is performed

    PMTCT Generic Training Package Module 5, Slide 86


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    Rapid HIV Testing(Parallel Testing)

    First AND Second Test

    Both Tests PositiveCounsel for Positive Result

    Discordant

    Both Tests NegativeCounsel for Negative Result

    Tie-breaker Test

    PositiveCounsel for Positive Result

    NegativeCounsel for Negative Result

    PMTCT Generic Training Package Module 5, Slide 87


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    Rapid HIV Testing Algorithms (Continued)

    • In the L&D setting, a single positive test result is adequate to:

      • Start ARV prophylaxis for the mother during labour and for the infant upon delivery

      • Testing should be repeated and results confirmed after delivery

    PMTCT Generic Training Package Module 5, Slide 88


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    ELISA

    The ELISA is also an HIV antibody test

    • Accuracy of the ELISA and rapid testing are comparable

    • Limitations of the ELISA:

      • Tests must be done in batches of 4090

      • Positive results must be confirmed with another ELISA or Western blot

      • Specimens sent to a laboratory for testing—results may take days to weeks

      • Test requires refrigeration and specific reagents

    PMTCT Generic Training Package Module 5, Slide 89


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    Interpreting HIV Antibody Tests

    • A positive HIV test means that antibodies to HIV are present. It does not mean that the client has AIDS

    • A negative HIV test can mean:

      • The person is not infected with HIV, or

      • The person is infected with the virus but is in the window period

    A negative test does not mean that person cannot become infected. There is no such thing as immunity to HIV infection

    PMTCT Generic Training Package Module 5, Slide 90


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    HIV Viral Tests

    • Viral tests detect the presence of HIV in blood

    • Viral tests must be done by trained personnel in the laboratory

    PMTCT Generic Training Package Module 5, Slide 91


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    HIV Viral Tests (Continued)

    • There are two types of viral tests:

      • p24 antigen test: measures one of the HIV proteins used for screening blood and for infant diagnosis

      • PCR (polymerase chain reaction) tests:

        • DNA PCR detects presence of HIV inblood and is used for infant diagnosis

        • RNA PCR detects and measures amount of virus in blood (viral load)

    PMTCT Generic Training Package Module 5, Slide 92


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    Five Steps to HIV Testing

    • A specimen is obtained

    • The specimen is processed

    • Test is conducted by a HCW or laboratory technician

    • The client is told their result

    • HCW provides post-test counselling, support and appropriate referrals

    PMTCT Generic Training Package Module 5, Slide 93


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    Infection control and Standard Precautions

    Proper labelling

    Proper specimen collection procedures

    Required volume per test

    Proper reagents per test

    Correct timing per test

    Interpretation of results

    Proper record-keeping

    Proper disposal procedures

    Testing Procedure for HIV Infection

    Observe these points:

    PMTCT Generic Training Package Module 5, Slide 94


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    Testing Procedure for HIV Infection(Continued)

    Factors affecting test performance:

    • Storage and handling of test kits

    • Changes in the environment

    • Accuracy of equipment; external and internal controls

    • Shelf-life of the chemicals for the tests (reagents)

    • Technique for sample collection

    • Quality of sample

    • Use of equipment

    PMTCT Generic Training Package Module 5, Slide 95


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    Exercise 5.4

    Rapid testing: demonstration in the large group


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    Session 5

    Post-test Counselling


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    Session 5 Objectives

    • Describe the steps involved in post-test counselling

    • Discuss the disclosure process for women who are HIV-infected

    PMTCT Generic Training Package Module 5, Slide 98


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    Post-test Counselling

    • All HIV test results, whether positive or negative, must be given in person, privately (as a single client or couple)

    • Put the client or couple at ease

    • Where possible, provide a quietand private room for the discussion

    • Ideally, the same HCW who conducted the pre-test session will also conduct the post-test session

    PMTCT Generic Training Package Module 5, Slide 99


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    When Client Tests HIV-negative

    Post-test counselling provides an opportunity for woman to:

    • Learn how to protect herself and her infant from HIV infection

    • Learn that if infected during pregnancy or breastfeeding, risk of MTCT is increased

    PMTCT Generic Training Package Module 5, Slide 100


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    When Client Tests HIV-negative (Continued)

    Objectives of the post-test session:

    • Provide HIV test result and assess understanding of result

    • Identify and address client questions

    • Discuss:

      • Partner HIV testing and disclosure

      • Safer sex and risk reduction

      • Exclusive breastfeeding

      • Antenatal care, post-delivery care

      • Importance of delivering in a healthcare facility

      • Infant care

    • Provide referrals, take-home information

    PMTCT Generic Training Package Module 5, Slide 101


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    When Client Tests HIV-positive

    • Client reactions to results can range from acceptance to disbelief

    • Remain non-judgemental, supportive and confident throughout the counselling process

    • Provide all key PMTCT messages during the initial post-test counselling session

    • Encourage client to return for her ANC visits and follow-up HIV post-test counselling

    PMTCT Generic Training Package Module 5, Slide 102


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    When Client Tests HIV-positive (Continued)

    Objectives of the post-test session:

    • Same as for post-test session when client tests HIV-negative, but HCW should additionally discuss:

      • ARV therapy or prophylaxis

      • Infant feeding options

      • Treatment and support services for client and family

    PMTCT Generic Training Package Module 5, Slide 103


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    Disclosure of HIV Status

    • Disclosure is informing others of a test result

    • Clients who disclose are in a better position to:

      • Encourage partner(s) to be tested

      • Prevent transmission of HIV to partner(s)

      • Access PMTCT interventions

      • Receive support from partner(s) and family

    It is important to respect client's choice regarding timing and process of disclosure

    PMTCT Generic Training Package Module 5, Slide 104


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    Exercise 5.5

    Post-test Counselling:demonstration (in the large group) and practice (in small groups)


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    Subsequent ANC Visits

    • Discuss, or reinforce, the following during subsequent visits:

      • Interventions for PMTCT

      • Infant feeding options

      • Follow-up care and treatment for the woman and her infant

      • Family planning options

    • If the woman is unlikely to return, these topics should be discussed during the first ANC visit

    PMTCT Generic Training Package Module 5, Slide 106


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    Key Points

    • Pre-test information, individual pre-test counselling, HIV testing and post-test counselling should be available to all pregnant women

    • There are three guiding principles for testing and counselling in PMTCT settings: confidentiality, informed consent and post-test support and services

    PMTCT Generic Training Package Module 5, Slide 107


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    Key Points (Continued)

    • WHO recommends the provider-initiated approach to HIV testing and counselling in ANC, labour and delivery and post-delivery settings. With the provider-initiated approach, HIV testing is a routine part of patient care

    • Partner testing and couple counselling are encouraged

    • Rapid HIV tests with same day results are highly recommended in PMTCT settings. Rapid tests are accurate and enable HCWs to provide post-testing counselling during the same visit

    PMTCT Generic Training Package Module 5, Slide 108


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    Key Points (Continued)

    • Two processes for rapid HIV testing: parallel and serial. Serial testing is more cost-effective in which a positive (reactive) antibody test is tested again using a different brand of rapid HIV test. Initial negative test results do not require confirmation

    • Post-test counselling is important for all women:

      • For women who are HIV-negative, to emphasize prevention of HIV infection

      • For women infected with HIV, to give information on PMTCT and referrals for HIV care, treatment and social services, where available

    PMTCT Generic Training Package Module 5, Slide 109


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    Key Points (Continued)

    • An important component of the post-test session is the offer of subsequent healthcare visits and referrals for HIV prevention, treatment, care and support services. All women should be encouraged and assisted to return for subsequent healthcare visits, particularly those who test HIV-positive

    PMTCT Generic Training Package Module 5, Slide 110


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