1. HIV Counseling

2. HIV Counseling Requirements
Required at all study visits:
Pre-test counseling
Post-test counseling
Risk reduction counseling
Occurs as part of HIV Prevention Options Counseling except at Screening and Study Exit/Termination
Offer Condoms

3. HIV 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, like all counseling in HOPE, this 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?

4. A Better Question Than…
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?

5. A Better Question Than…
Do you know how HIV is passed from one person to another?
Is:
Tell me what you know about HIV transmission.
What do you know about 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?

6. 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, and must be conducted face-to-face.
Provide and explain test results, per protocol appendices II and III
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

7. A Better Question Than…
Do you understand what your test results mean?

8. A Better Question Than…
Do you understand what your test results mean?
Is:
What is your understanding of these test results?
How do you feel about these test results and what they mean?

9. Risk Reduction Counseling
At Screening and Study Exit/Termination, may occur as stand-alone session or part of pre- or post-test counseling
Assess risk
Discuss any recent changes in risk
Probe on factors associated with higher versus lower risk
Discuss previous month’s risk reduction plan
Develop risk reduction strategies moving forward
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

10. 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 (+)?

11. A Better Question Than….
Do any of these risk factors apply to you?

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

13. 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?

14. Providing HIV Rapid Test Results
-/-
Test results indicate that you are not infected with HIV.

15. Providing HIV Rapid Test Results
-/+
Test results are unclear
Additional testing is needed
This testing will be done today from a new blood sample
This process will take [SITE TO INSERT TIME].
You may wait for confirmatory results or schedule a new appointment
If at screening visit, discordant results will be followed until confirmation of HIV status. This is different from ASPIRE.

16. Providing HIV Rapid Test Results
+/+
Test results indicate that you are infected with HIV.

17. Additional messages at Screening or Enrollment:
+/+
Additional messages at Screening or Enrollment:
You are not eligible for MTN-025.
If site is providing confirmatory testing as a service to the participant (not required per protocol):
Additional testing from a new blood sample may be done today to confirm this result.
The testing is to give you information about your health and is not part of the study.
It is unusual for the testing to show a different result.
You may wait and receive confirmatory results today, or schedule a separate visit for results.

18. Additional messages at Follow-Up:
+/+
Additional messages at Follow-Up:
Additional testing will be done from a new blood sample today to confirm this result.
It is common for HIV prevention studies to do additional testing for study purposes in this situation.
It is unusual for the testing to show a different result.
Drawing a new blood sample and running the test will take approximately [SITE TO INSERT TIME]. You may wait and receive confirmatory results today, or schedule a separate visit for results.
Note: If at screening and enrollment, participant is not eligible to join the study. Additional post-test counseling and referrals should be provided. Confirmatory testing may be provided as a service, per site discretion, but is not required per protocol. If testing will not be done, skip the rest of these messages.

19. Providing HIV Rapid Test Results
If HIV rapid results require Geenius confirmatory testing:
Explain this testing, what it is for, how it will be conducted
Document participant understanding and readiness for testing
How long do you anticipate Geenius testing will take?
Do you anticipate most participants staying to receive these results or scheduling a new appointment?

20. Providing HIV Confirmatory Test Results
Results interpretation and sample counseling messages available in SSP Table 12-2 and 12-3
Interpretation of HIV test results reference sheets also available on the MTN website
Lab Center always available to answer questions!

21. HIV Counseling Tools
Interpretation of HIV test results reference sheets
HIV Counseling Worksheet
Will you be using this tool? Have you modified it or do you have a site specific tool that is similar? Are there any challenges to using these tools?
What do you think of the counseling worksheet? Will you be using this or developing your own tool? Do you like that there’s one long note or do you prefer that there are boxes for each component?

22. 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?