National Guidelines for HIV Counseling and Testing in Clinical Settings:

1. National Guidelines for HIV Counseling and Testing in Clinical Settings: Provider initiated counseling and testing Thato Farirai Birchwood Hotel August 10,2010

2. What is PICT? Why PICT? • HIV counseling and testing initiated and recommended by health care providers (HCP) to persons attending health care facilities as a standard component of medical care • Voluntary service, patients may decline the test without being denied medical services • HCPs are best suited to provide patient centered care to empower their patients • Providers to make clinical decisions or medical services based on the knowledge of the patient HIV status • Approach to scaling up HCT

3. PICT Objective • To assist HCP to expand quality HCT services in clinical settings to reduce the impact of HIV among individuals, families and communities by reducing HIV transmission.

4. Intended users of the guidelines • HCP involved in the clinical care and management of patients • Providers in both public and private facilities • Need for supportive health system • Trained personnel • Logistics supply at community and facility level

5. Who Should be offered Testing? • All patients attending health facility as part of medical care; • Measures for rational use of resources by prioritizing: • Pregnant women • Patients with TB symptoms and those diagnosed with TB • STI patients • Patients for SRH including FP&TOP • Male patients presenting for SRH • All inpatients • MMC patients • Patients requiring non-occupational PEP • Patients reporting history of IDU • Sexual partners and children of HIV positive patients

6. PICT Principles • Informed consent • Confidentiality • Counseling As prescribed by the HCT policy

7. PICT Process • Health Education • Pre-test counseling • Informed consent • Post test counseling

8. Health Education • Can be provided to patients as a group or individuals • Provide information about HIV • Promote PICT • Prepare patients for the CT process • All patients should be offered the test and those who accept must receive pre-test counseling • Person responsible: the facility manager is responsible for implementing and overseeing the QA procedures

9. Pre Test Counseling • Provided to individuals not to groups • Provider to be guided by the patient’s needs • If lengthy counseling is anticipated then patient is referred to the lay-counselor It should cover the following: • Evaluating the patient’s understanding of HIV information • Reinforce messages • Explain the testing process • Provide an opportunity for patient to ask questions • Obtain consent Person responsible: HCP

10. Informed Consent • HCPs do not have a right to test patient’s without informed consent • PICT requires verbal consent for HIV testing documented in the patient records Person responsible: HCP

11. Post- Test Counseling • Content to be informed by the results of the test • Results to be given to individuals not group except in the case of couples • Minimum content for HIV negative • Minimum content for HIV positive Person responsible: HCP

12. PICT Protocol • Recommended testing algorithm • PICT protocol for out patient settings • PICT protocol for inpatient settings

13. Other issues covered • Confidentiality • Disclosure of results ( patient and HCP) • Referrals and linkages • Issuing of written results • Frequency of testing

14. Special Considerations • PICT for children • Obtaining consent and assent • Abandoned babies • Disclosure in children • Appropriate HIV tests for children • PICT in ANC • Couple counseling • PICT in TB services • PICT in SRH • PICT in MMC • Integration on PICT in MMC • Incapacitated patients • Testing in the context of sexual offences

15. Special Considerations • Patient flow • Caring of carers • Occupational exposure • Infection control • Stigma and prevention • Quality assurance • Social mobilization • Monitoring and evaluation • Supervision • ART

16. THANK YOU