HIV Counseling Tab 7 of the binder.

Required at all study visits Pre-test counseling Post-test counseling Risk reduction counseling Condom Provision Will you incorporate risk-reduction counseling before or after the test results are given? Will the same person conduct pre- and post-test counseling?

Pre-test counseling Review difference between HIV and AIDS Review modes of HIV transmission and methods of prevention Review HIV tests to be done today and tests to be done if today’s tests indicate possible infection Review window period and how it may affect test results Correct any misconceptions or myths Verify readiness for testing General Greet client and establish rapport Review purpose and nature of today’s session Emphasize confidentiality Address any immediate issues or concerns   Remember that, should be individualized, client centered, etc. How will you assess these things? What kinds of questions might you ask to assess ppt. understanding? Since HIV testing will occur at each visit, how will you avoid repetition? For example, would the counselor verbally state the standard information each month no matter what? Might she ask the participant to describe her understanding? Do site staff feel that this information MUST be covered every month no matter what?

A Better Question Do you know how HIV is passed from one person to another? Sometimes it becomes difficult to think of open ended questions to ask in the middle of a counseling session. It would be nice to get some practice during this training session, so there are several questions sprinkled throughout this presentation to help you get some practice. What is another way to ask this/get at this information? Tell me what you know about HIV transmission. What do you know about how HIV is passed from one person to another?

Risk Reduction Counseling Assess risk Discuss changes in risk since last visit Probe on factors associated with higher versus lower risk Discuss previous month’s risk reduction plan Develop risk reduction strategies moving forward As participants to brainstorm some of the important components of the risk reduction counseling session. These can just be discussed as a group or someone can keep track of these on flipchart paper. Use open-ended questions to assess client’s HIV risk factors Discuss whether risk factors have changed since the last visit Probe on factors associated with higher versus lower risk (e.g., what was different about the times when you were able to use a condom compared to times when you were not?) Discuss previous month’s risk reduction plan and develop risk reduction strategies with the participant moving forward Successful strategies should be continued Additional strategies may be identified to achieve further risk reduction Alternative strategies may be identified if strategies tried since the last session were not successful

A Better Question Do any of these risk factors apply to you? Based on the risks that we’ve discussed, which of them do you feel are particularly relevant in your life?

Partner counseling and testing What are your site policies and procedures regarding partner counseling and testing? If partners want counseling and testing, will they be provided to the participant and her partner as a couple or as individuals? What are some of the pros/cons to each? What are some of the challenges you might encounter? In couples counseling, there is a relationship between the counselor and the couple, the counselor and each individual, and each individual in the couple. How might you need to alter your counseling technique or questions for couples vs. an individual? A better question: Have you made any changes in the last month that might alter your possible risks of exposure to HIV?

Post-test Counseling Explain test results Describe any additional testing that may be required Assess client understanding Provide further information and counseling relevant to client’s test results Test results and post-test counseling must occur on the same day rapids are done. Provide and explain test results, per protocol Explain additional testing that may be required per protocol Assess client understanding of results and next steps Provide further information and counseling relevant to client’s test results per site SOP

A Better Question Do you understand what your test results mean? What is your understanding of these test results? How do you feel about these test results and what they mean?

[Insert protocol specific HIV testing algorithm: go through step by step]

Next steps How might a risk reduction plan change based on the HIV test results? What are the next steps for participants who test HIV (+)? What are the next steps for pregnant participants who test HIV (+)?

Documentation Should occur after the counseling session. Use chart notes or HIV counseling worksheets. What information is important to document for each aspect of HIV counseling? What is the purpose of documentation? Each part of the counseling needs to be initialed and dated. Each should be able to stand alone and should lead into the next part of counseling. If a different counselor will be doing post-test counseling, he/she should be able to pick up where the pre-test counseling left off. Ask what information is important to document? Keep track on a flip chart. questions raised about HIV and HIV testing participant’s personal risk factors for HIV exposure experiences with the risk reduction strategies employed since the last visit any barriers to risk reduction risk reduction plan for the coming month participant understanding of HIV test results Participant understanding of next steps Initials and date after each entry What systems are in place to easily locate counseling notes from previous visits?

Practice Pass out counselor reference sheets for interpreting HIV test results. Now participants will get the opportunity to practice an HIV counseling session. Each trainee will draw a different participant profile to guide discussions during the pre-test and risk-reduction counseling. One partner will start as the counselor and one as the participant. In the first five minutes of the activity, the counselor should practice the pretest counseling (and risk reduction, if this is done before testing at the site). Once this is completed, the trainer will pass out slips of paper that contain the test results and the counselor will practice post test counseling (and risk reduction, if this is done after testing at the site). Once the role play is completed, partners can switch roles. If there is extra time in the session or some partners finish before the others, the time can be used to practice documentation (counseling worksheets are located in tab 7 of the binder). 15 minutes for each full counseling session before partners switch roles.