PROVIDER INITIATED COUNSELING AND TESTING THATO FARIRAI BIRCHWOOD HOTEL AUGUST 10,2010 National Guidelines for HIV Counseling and Testing in Clinical Settings:

PROVIDER INITIATED COUNSELING AND TESTING

THATO FARIRAIBIRCHWOOD HOTEL

AUGUST 10,2010

National Guidelines for HIV Counseling and Testing in

Clinical Settings:

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 facilitiesNeed 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 consentConfidentialityCounseling

As prescribed by the HCT policy

PICT Process

Health EducationPre-test counselingInformed consentPost test counseling

Health Education

Can be provided to patients as a group or individualsProvide information about HIVPromote PICTPrepare patients for the CT processAll 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 groupsProvider to be guided by the patient’s needsIf lengthy counseling is anticipated then patient is

referred to the lay-counselor

It should cover the following:Evaluating the patient’s understanding of HIV

informationReinforce messagesExplain the testing processProvide an opportunity for patient to ask questionsObtain consentPerson 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 negativeMinimum content for HIV positive

Person responsible: HCP

PICT Protocol

Recommended testing algorithmPICT protocol for out patient settingsPICT protocol for inpatient settings

Other issues covered

ConfidentialityDisclosure of results ( patient and HCP)Referrals and linkagesIssuing of written resultsFrequency 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 flowCaring of carersOccupational exposureInfection controlStigma and preventionQuality assuranceSocial mobilizationMonitoring and evaluationSupervisionART

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