HIV Counseling and Testing

HIV Counseling and Testing MTN-003 Study-Specific Training

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

HIV Testing at Screening START sample 1 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 Sample 1 WB - + ind Sample 2 2 different rapid tests Repeat testing, beginning at “START” in approximately one month.

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

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?

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

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

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

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?

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

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

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

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?

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

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

HIV Counseling Worksheet • 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

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

What Are Your Questions Thoughts and Reactions?

HIV Counseling and Testing