National Guidelines for HIV Counseling and Testing in Clinical

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					  National Guidelines for HIV
Counseling and Testing in Clinical


               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
   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
 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
 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

 Couple counseling
 PICT in TB services
   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