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National Guidelines for HIV Counseling and Testing in Clinical Settings: . Provider initiated counseling and testing Thato Farirai Birchwood Hotel August 10,2010. What is PICT? Why PICT?.
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National Guidelines for HIV Counseling and Testing in Clinical Settings: Provider initiated counseling and testing Thato Farirai Birchwood Hotel August 10,2010
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
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.
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
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
PICT Principles • Informed consent • Confidentiality • Counseling As prescribed by the HCT policy
PICT Process • Health Education • Pre-test counseling • Informed consent • Post test counseling
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
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
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
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
PICT Protocol • Recommended testing algorithm • PICT protocol for out patient settings • PICT protocol for inpatient settings
Other issues covered • Confidentiality • Disclosure of results ( patient and HCP) • Referrals and linkages • Issuing of written results • Frequency of testing
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
Special Considerations • Patient flow • Caring of carers • Occupational exposure • Infection control • Stigma and prevention • Quality assurance • Social mobilization • Monitoring and evaluation • Supervision • ART