TRACE INITIATIVE: Returning of Recency Test Results

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RETURN OF RESULTS

Returning Results from Recency Testing Several options for returning results: Give result of POC only without viral load – presumptive recent HIV infection Wait to give POC result until viral load results confirm RITA – confirmed recent HIV infection Give community results – explain the proportion of people in the catchment area who have recent HIV infection for context (no individual-level results)

No Return of Results It is also an option to not return any results The test is not diagnostic and does not change the health care management of the client In some cases countries may opt to not return any result to the client

Return of Results Give result of POC only without viral load: Presumptive recent HIV infection- explain to the client that this preliminary test indicates that you may have been recently infected; however, it is not confirmed. It doesn’t change anything for their care. They should bring partners and children in to get tested.

Return of Results Wait to give POC result until viral load results confirm RITA: Confirmed recent HIV infection- explain to the client that to get their final results they need to return to the clinic within the specified time period and present their Participant ID number. The confirmed result comes back from the laboratory combining the POC and viral load results. It doesn’t change anything for their care. They should bring partners and children in to get tested.

Rationale for Returning Individual-Level Results Participants may want to know their result. Belief that individuals have a right to their own data and can deal with their result. Additional information about current state of infection may: Enhance counseling with additional information and impact individual’s decision to seek treatment sooner Reinforce reduction in risk behaviors that lead to onward transmission Improve partner elicitation process within index testing services Clinics and providers may use results as one of multiple factors to triage index cases for partner notification services, where there are limited resources.

Return of Results Give community results: Do not return individual-level results of the POC test. Explain why results will not be returned – because they cannot currently be meaningfully interpreted at the individual client-level. Explain the broader benefit that will be gained from their results to understand population-level information on recent HIV infection, and consider returning alternative population-level information (e .g., aggregated surveillance results describing proportion testing recent from that HTS site or geographic area).

Return of Results at the Community-Level Aggregate results of recency testing will be shared widely with communities and stakeholders Purpose: To inform the HIV response and guide public health prevention and control measures What will be shared: Aggregate data describing where and among whom recent infections are occurring among newly diagnosed PLHIV

Rationale for Returning Community-Level Results Community-level results will be provided for the client’s community (e.g. sub- county). Early implementation phase (e.g. first six months), the client may return to the health facility in approximately 1-2 months and receive information from the latest recent HIV infection surveillance report. In later implementation phases, community-level results from testing for recent infection may be available to clients the same day they enroll in recent HIV infection testing. Example: One in ten persons who were HIV-positive and had a test for recent infection in your sub-county had a recent HIV infection, meaning they were likely infected with HIV in the past 12 months.

Rationale for Returning Community-Level Results Individual-level test for recent infection results will not be returned to clients for several reasons: the test is not being used in a point-of-care (POC) format at the clinic without confirmatory testing the result will not be recorded in the client’s medical file the result will not impact the clinical care or treatment of the client the test has not yet been approved in country for return to clients RTRI results will primarily be used for surveillance purposes, interpreted at the population-level. Currently, RTRI results cannot be meaningfully interpreted at the individual client level (e.g., for clinical use).

POST-TEST COUNSELING

Communicate Clearly at the Patient’s Level Avoid technical terms, jargon, or words the client may not understand Clearly explain medical and technical terms, as appropriate Provide accurate information on recent HIV infection testing Correct the client’s misconceptions After giving factual information, use open-ended questions to make sure the client understands what you have just said Offer options, not directives

Recency Post-Test Counseling Procedures 1. Preparing the client: Ask client how he/she is feeling what will they do if they have a positive diagnosis or recent diagnosis whether he/she has social support or disclosed he/her status to anyone what he/she will or is doing to cope with her/his diagnosis what other resources are needed including referrals for psycho-social support Ask patient whether she/he has any questions regarding recency testing and whether ready to receive recency results. Ask the client to summarize what you have just discussed to ensure understanding.

Recency Post-Test Counseling Procedures 2. Sharing test results: Disclose recency test result and allow time to process Use the Return of Recency Results Post-Test Counseling Guide Anticipate an emotional reaction from a client who was told that he or she was recently infected and its implications. He or she may express anger, shock, confusion, or distrust Use counseling skills: listen to him/ her and support accordingly Redirect client to focus on taking care of themselves and the benefits of ART Review the status of notified or current sexual partners and family testing.

Example: Providing the test results to patients who have recent infection Use the Return of Recency Results Post-Test Counseling Guide: Your blood was tested for recent HIV infection, which is a test that tells you which is more likely, that 1) you were recently infected within the last 12 months, or 2) you have had your infection for more than a year and possibly for several years Your recency result was “recent infection,” which means that you were probably infected within the last year However, the test cannot tell you exactly when you were infected. Take your time, we have plenty of time to talk about your results. How do you understand this result? How are you feeling about this result?

Example: Providing the test results to patients who have long-term infection Use the Return of Recency Results Post-Test Counseling Guide: The test result tells you which is more likely, that 1) you were recently infected within the last 12 months, or 2) you have had your infection for more than a year and possibly for several years Your recency result was “long-term infection,” which means that it is likely that you have had your infection for more than a year and possibly for several years. Take your time, we have plenty of time to talk about your results. How do you understand this result? How are you feeling about this result?

Post-Disclosure for Both Long-Term or Recent Infection Whether “long-term” or “recent,” answer any questions the client may have about recency test result.

Discuss and reinforce HIV prevention messages and partner testing for all HIV-infected persons. If client is willing, discuss options for notifying partner(s) about HIV and getting their children tested. Your result does not reflect your partner(s) HIV status. You need to ask your partner(s) to be tested. If you were recently infected, you have a high HIV viral load and are more likely to transmit the virus to others. You can pass HIV on to your loved one(s) by having unprotected sex. Disclosing your HIV status to your loved ones may help you discuss ways that you can protect them from HIV. The best way to assure that your partner does not get HIV is not to have sex. If you do have sex, you need to use a condom every time you have sex. The best way to keep yourself healthy and to keep your partner(s) and unborn children healthy is to start taking ART. Once you start ART, it is critical that you continue taking it every day without missing any doses.

If Viral Load Testing will be Conducted… For clients who test recent on the assay: Tell the client that the test result is preliminary and may need to be confirmed through additional testing (i.e. viral load testing) Additional testing will be conducted at a laboratory Collect contact information so that the final results (recent or long-term) can be returned to the client at a follow-up visit

PARTNER NOTIFICATION

How to Tell Your Partner to Get Tested: Part 1 Make a Plan: Pick a good time and place to tell your partner and think about how you would like be told this information. Start the Conversation: “I have something important to tell you. I went to the doctor the other day and I learned I have HIV. I wanted you to know so that you could also get an HIV test. There are medicines for treating HIV that can help us live a long time.” “HIV is very common in our community. I went for an HIV test. It turns out that I am HIV-positive. I already started on treatment. I think it is important that you also get tested for HIV so you can know your HIV status.”

How to Tell Your Partner to Get Tested: Part 2 Anticipate Reactions: Think about how your partner may react. Your partner may: Offer you support or comfort you Not believe it’s true Feel confused or sad Feel angry Think about how you will respond to these reactions. What questions may your partner ask you? How will you answer these questions? Encourage Your Partner to Get Tested for HIV: Tell your partner that it is important they get tested for HIV. If they are HIV-positive, they can get medicines to treat their HIV. These medicines will help them live a long life and reduce the chance they will pass HIV onto others. If they are HIV-negative, there are things they can do to help them remain negative, like use condoms or get circumcised (if they are male).

Options for Notifying Your Partner about HIV Client Referral = You tell your partner about your HIV and encourage him or her to come to the health facility for an HIV test. Provider Referral = A counsellor or other health care provider will call or visit your partner and inform them that they need to test for HIV. Contact Referral = You and the counsellor will work together to notify your partner.

OTHER KEY CONSIDERATIONS

Give the Participant a Copy of the Information Sheet “Understanding HIV and Recent HIV Infection”

Referral to Support Services Recency counseling messages should include strong referral and linkages to HIV treatment and prevention services. Ask client what resources are needed, including referrals for psychosocial support. Use the country standard procedure for referrals and linkages.

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