1. Provider Initiated HIV Counseling and Testing Unit 2: Introduction and Rational for PIHCT

2. 2-1 Objectives Discuss the rational, and benefits in providing PIHCT Explain how PIHCT should be offered to patients. Discuss the challenges in providing PIHCT Describe the different models of HIV counseling and testing services. Explain the difference between Voluntary Counseling and Testing and Provider Initiated HIV Counseling and Testing

3. 2-2 PIHCT – Definition Routine testing of all patients who need an HIV test for medical reasons Test is usually offered by a health care worker as part of regular medical care Confidential test is performed unless the patient declines the test

4. 2-3 Routine HIV testing should be offered to the following: -Patients with clinical signs and symptoms of HIV/AIDS -Pregnant women attending antenatal clinics -Patients with sexually transmitted diseases (STDs) -Any healthy individual going for general medical examination Since TB is one of the defining illnesses of AIDS, all TB patients should be tested for HIV. Routine Offer for HIV Testing

5. 2-4 Importance of Routine HIV Testing HIV-infected patients can be identified for diagnosis, counselling, and follow-up HIV-infected patients can be referred to appropriate treatment and care services Data can be used to monitor trends in HIV infection of TB and other HIV related diseases by clinic, region, sex, age, etc.

6. 2-5 Rationale for PIHCT Increase individuals’ access to HIV testing, and therefore increase the number of people who know their status Increase uptake of ARVs Many people prefer to be tested by a health care provider during a regular visit to the clinic PIHCT takes less time

7. 2-6 Pre-Test Information Give enough pre-test information about the testing process to enable patients understand why an HIV test is needed Pre-test information should be brief and include the following: -clinical and preventive benefits of testing -medical care service that is available -that the patient has the right to refuse the test

8. 2-7 Key Points Patients who agree to be tested do not need pre-test counselling before their HIV test is done Can use either ELISA or rapid test kits Repeat routine testing should be offered to HIV negative individuals at least once per year, or at request of patient

9. 2-8 When to Offer Repeat HIV Testing Offered to HIV negative individuals at least once per year At request by patient Within twelve weeks depending on patient’s exposure to risk sexual behavior.

10. 2-9 Confidentiality on HIV Data All health records and registers should be stored in a safe and secure location Health information should only be made available to those who need to know this information for patient care

11. 2-10 Some of the Challenges in Providing PIHCT The integrity of TB services and DOT program be preserved Dual stigma eroding the gains made by the TB program might be mentioned. Lack of resources (and may be infrastructure) in TB/STI/OPD clinics to provide this extra service may be an issue. HIV screening and ARV treatment of TB clinic staff The clinic staff, particularly clinicians, may feel uncomfortable talking with patients about HIV testing, and may not have been tested themselves. They may also feel uncomfortable about discussing sexual behavior.

12. Slide 2 - 11 Prevention of Mother to Child Transmission Voluntary Counseling and Testing Couple HIV Counseling and Testing Counseling and Testing Services for Youth Counseling and Testing for Vulnerable Populations Routine Diagnostic and Clinical Testing Different: Purposes and Objectives Messages Psychosocial, Clinical, Developmental and Risk Issues Emphasis Target Populations Protocols Skills and Training Requirements Service Delivery Options: Multiple Models Single Setting Integrated Services Stand Alone Services Outreach and Mobile Services Clinic Based Services Counselor Health Care Worker Multi-disciplinary Team Family Based Counseling and Testing Multiple Models of HIV Counseling and Testing Services

13. Slide 2-12 Differences between VCT and PIHCT VCTPIHCT Clients/Patients Come to clinic specifically for HIV test Expect to get tested More likely to be asymptomatic Come to clinic because they have TB/STI or any of the opportunistic infections suggestive of HIV Not necessarily expecting HIV test Providers Usually trained counselors, not necessarily trained as health care providers Health care providers trained to provide counseling/education Purpose of HIV counseling and testing Primary purpose is on preventing HIV transmission through risk assessment, risk reduction and testing Primary purpose focus is on diagnosing HIV for appropriate opportunistic and HIV management, particularly by referral for HIV care

14. Differences between VCT and PIHCT VCTPIHCT Pre-test encounter Client centered - counseling Usually a one – a – one encounter As important to discuss results with negatives as positives because the focus is on prevention Provider recommending test as routine for anyone coming to this clinic Limited discussion about need for HIV testing Little time spent with those who test negative Primary focus on those who test positive with emphasis on their medical care. Follow Up HIV positive clients referred to medical care services and other support services, some in community. Care of HIV positive patients coordinated between TB and HIV providers, referred for other support services, some in community.