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Provider Initiated HIV testing and counseling in the STI by kuy13163

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									   Provider Initiated HIV testing and
counseling in the STI clinic setting in Fiji



             Dr. Sophaganine Ty Ali
              Senior M/O In-charge
          Reproductive Health Clinic, Fiji
                    Outline

•   Demographic and health structure
•   Structure of STI clinic and service delivery
•   Procedure of HIV testing
•   HIV testing and counseling procedure
•   Future planning
•   Challenges and conclusion


                                                   2
     1. Demographic and Health structure


 •   Located in the South Pacific
 •   332 islands—110 inhabited
 •   Population: 905,949
 •   Ethnic: Fijian(51%), Indian(44%), Other(5%)

 • Autonomy: 4 divisional areas (Central, Eastern,
   Western and Northern)
 • Each division has an STI clinic

                                                     3
Source: Bureau statistic Fiji, 2006
 2. Structure of the STI clinic (RH)

• Human Resource/Staff: 1 medical officer,
  4 clinical staff, 1 laboratory staff, 1 cleaner

• Is the referral center for STI/HIV from
  other medical areas

• Opening hours: weekdays, 8am to 4:30pm

                                                    4
    Service provided by the clinic
• STI/HIV counseling and testing
• Treatment for STIs and HIV (OIs and HAART)
• Family planning, Pap smear
• Practical attachment for under-graduate and
  post-graduate students
• Provide training to other medical areas
• Community outreach



                                                5
                    Case attendance
  • Total attendance 3018 cases per year

  • 50% -Symptomatic for STIs

  • 75% -Fijian ethnic

  • 64% -Male

                                           6
STI Clinic Suva, 2006
               HIV testing
• Screening test was done at the clinic,

• Pre test counseling: done on one to one
  basis

• Approach for HIV test to all attendance
  cases

                                            7
         4. HIV testing procedure

                      Serodia HIV ½ PA

                       _                                            At the clinic
                                     +


Report Negative                _ Repeat Serodia X 1
• Counseling, give
  negative result
• Follow up/re-test
                                                 +
                                   Follow by:                         Reference
                                   • Vironistika and                     Lab
                                   • Enzygnost
                                            _          +

                      • Counseling, give        •Counseling, give
                        negative result          positive result
                      • Follow up/re-test       •Follow up
                                                                            8
                         Refuses cases

  • 0.003% (11/3018):
         - refused to have HIV test
         - All of them are male (5 cases were in the hurry, and
     6 cases were not ready for the test)


  • 0.00% refused screening for STIs


Source: STI Suva, 2006                                        9
    STI cases (symptomatic & asymptomatic)
Providing

•   Assessment
•   Counseling on STI,
    HIV..according to the risk
•   Provided according to
    the need
                                      • At the time of consultation
Offering
                                      •At the same place
•Pap-smear (for female)
•Screening: STIs                      •With the same health care team
•Counseling+offer HIV test
•VCCT
•Tx. and Referral: if needed
•Follow up                       Turn around time for the test results:
•Contact tracing                    3-7 days (except for pap smear)

                                                                          10
Service providing

                                                VCCT
         Counseling for
          HIV testing
                                             Physical examination




                             
   Counseling: behavior,
       HIV, STIs….                           Collection of specimen

                            STI screening
     risk assessment                             Syndromic/M
                                                   for STIs



                           Contact tracing
                             if needed
                                                                      11
      Procedure for HIV testing
• Average time for waiting: 15 min
• Average time spent with staff: 15-20 min
• Person involved: nurse, doctor and Lab-
  staff
• Information provided to reach consent:
  Offer services



                                             12
    Pre and post test counseling
• Verbally consent is obtained and patient is
  requested to sign in the file
• Pre and Post test counseling (negative
  result): Check list
• Time for pre-test counseling: ~15 minutes
• Positive result: given with closely follow up



                                              13
           Future planning

• Measures to scale-up counselling and
  testing to the peripheral level

• Support needed for the scaling-up




                                         14
                Challenges
•   Time
•   Human resources
•   Clinic space: privacy issues
•   Re-infected cases for STIs




                                   15
                  Conclusion
PITC is a Gateway for:

- Provision of correct information
- Opportunity for client to review his/her own risk
   behavior
- Reducing the risk
- Adjustment life style
- Enter for HIV care and treatment (>50% of
   positive cases in Fiji were from STI clinic)
                                                      16
             Acknowledgements

         Prof. Ahmed Latif, WHO WPRO
Dr. Seng Sopheap, WHO HIV and STI Focal Point,
                  South Pacific


                Thank you


                                                 17
HIV testing strategy




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