Module_3_Part_2__Pre_Post_Test_Counselling_Process.pptx
- 1. 3-2: Counselling Process: Pre-test Information & Post Test Counselling
- 2. Module 1 Contents - HIV Status Slides 1. Pre-test Information/ Counselling 2. Post Test Counselling 3. Dealing with Emotions 4. Disclosure of Results
- 3. Pre- Test HIV Counselling • Pre-test counselling is given to an individual before an HIV test, to make sure that the individual has sufficient information to make an informed decision about having an HIV test. • These sessions are aimed at providing information rather than individual counseling. • During the session the individual must be given an opportunity to make a decision on whether he or she wishes to undergo the HIV test.
- 4. Pre-test counselling should include discussions on: • Assessment and awareness of personal risk, and the transmission of HIV infection. • What an HIV test is and the purpose of the test. • An opportunity for decision making about taking the HIV test. • The meaning of both a positive and negative result, including the practical implications such as medical treatment and care, sexual relations, psycho-social implications, etc. • Safer sex and strategies to reduce risk. • Coping with a positive test result, including whom to tell and identifying needs and support services.
- 5. Pre-test Information/ Counselling Session Group Information sessions can be used prior to provision of both client Initiated Testing and Counselling and PITC services. These sessions are aimed at providing information rather than individual counseling. The goal of these sessions is to discuss general information about HIV and AIDS including HTS specifically, prior to rapid HIV testing. This is then followed by quality individual post-test counselling sessions Always refer to VCT cheque card/ checklist guide
- 6. Summary of Pre-test information and Post-test counseling approaches . Pre-test information approach Post-test counseling approach Establish a relationship with the client Find out reason for visit or wanting to be tested Check understanding of HIV Correct misconceptions Do risk assessment and risk reduction Plan Explain the HIV test Talk about test advantages and disadvantages Discuss disclosure For purpose of mobilizing support Client comes up with an informed decision! Give results promptly after checking whether client still wants to know results Deliver results in a neutral tone of voice After giving results, allow time for it to sink in and for expression of emotions Check whether client understood what the results mean Assess the client’s emotional state and discuss disclosure of results
- 7. Key Points to remember • The guiding principles of HTS are consent, confidentiality, competence in counseling, correct results and connections to HIV care, treatment and prevention services. • Effective counseling is a blend of skills, techniques, and other key elements, such as possessing the basic attitudes and beliefs about people and the ability to help others successfully. • HCWs need to have self-awareness to better understand themselves and be able to provide clients treatment with dignity and respect. • Discuss referral options
- 8. 1. Pre-test Information/ Counselling 2. Post Test Counselling 3. Dealing with Emotions 4. Disclosure of Results
- 9. Post Test Counselling Sessions • The counselling provided when an individual receives his or her HIV test result is called post test counselling, and includes one or more sessions. • A second post-test counselling session would be valuable for clients who may need more time to ask questions, or who may be in shock due to a positive result. • The individual post-test counseling is provided for both HIV positive and HIV negative clients. • This session assesses the clients’ readiness to receive results and confirm their readiness. Confirm clients’ identity.
- 10. Post Test Counselling • The counselling session should include feedback and understanding of results, and discussions on: • If the result is negative: • Strategies for risk reduction • Possibility of infection in the 'window period', dependent on when a person may have been at risk and the type of test used • If the result is positive: • Immediate emotional reaction and concerns • Personal, family and social implications • Difficulties a patient may foresee and possible coping strategies • Who the client wants to share the results with, including responsibilities to sexual partners • Immediate needs and social support identification • Immediate referral to ART services • Follow up with supportive counselling
- 11. Post-Test Counseling • Post-test counselling is important and should be tailored to individual test results, risk behaviour and needs • This session assess clients readiness to receive results • Assess clients risk if from group session and conduct or review their risk reduction plan • Review post-test support and psychological support
- 12. Post-Test Counseling…cnt’ • Discuss disclosure of HIV results and support to disclose and to encourage partner/family members to be tested for HIV • Provide condoms and information on how to use them or if not available at the facility, where to get them • Counsel on condom negotiation skills • Counsel for disclosure, partner testing and support • Provide linkage to HIV prevention, care, treatment and support services
- 13. Post Test Counselling summary for both negative and positive results Negative Positive Provision of Result Provision of Results Check the client’s understanding of the result Check the client’s understanding of the result Risk Assessment & Risk Reduction Risk Assessment & Risk Reduction Partner referral for HIV test Discuss disclosure and schedule Discuss disclosure and schedule Discuss disclosure and Partner referral for HIV Subsequent counseling session and re test for those with on-going risk of exposure Discuss rapid adherence preparation and support during pregnancy Emphasis is on “Staying Negative” Schedule subsequent counseling sessions Emphasis on Treatment Adherence & Support
- 14. Follow up Counselling and Referrals Follow up Counselling must be provided to both HIV negative and HIV positive clients. It empowers the HIV negative clients to continue with the risk reduction strategies so as to remain HIV negative.
- 15. Adherence Counselling This process aims at reducing the impact of stressors, develop coping strategies as well as prepare and support clients during management of chronic conditions.
- 16. 1. Pre-test Information/ Counselling 2. Post Test Counselling 3. Dealing with Emotions 4. Disclosure of Results
- 17. Dealing with emotions arising from positive results Discuss how you would deal with emotions resulting from HIV positive results. BLAMING CRYING ANGER NO RESPONSE DENIAL
- 18. Suggestions of dealing with the emotions CRYING ANGER If the client breaks down and starts crying, it is important to let them and give them space to ventilate their feelings. Offering the client some tissues is a way of telling them it is okay to cry. Reflect their feeling: “This must be difficult for you….” The client might start swearing or exhibit outbursts of anger. Do not panic, stay calm and give the client space to express their feelings. Acknowledge that their feelings are normal and let them say what makes them angry
- 19. • This could be verbal or non verbal. The Counselor should ‐ acknowledge that the client is facing difficult in accepting the result. Let them talk about their feelings. intimate partners, sometimes leading to GBV: Post-test counselling for individuals and couples should emphasize the meaning of HIV test results and the importance of linkage to treatment, care and where possible referral for couple counselling. This could be due to shock, denial, helplessness, disbelief etc. Check that the client understands the result. Be on the alert for suicidal thoughts. Find out immediate plans before they leave the room. NO RESPONSE DENIAL BLAMING
- 20. Helping clients with information and support for behaviour change • Clients must receive the necessary support (whether emotional, social, or financial) to carry out the Counsellor’s recommendations. • Counsellors should address lack of knowledge, denial, misinformation. • Clients will need to make a plan for action. • Clients will need praise and encouragement. • Clients may not always be successful at following recommendations at first.
- 21. Negotiation of Disclosure & Partner Referral (HIV Positive Result) . - Explore clients feeling about disclosing HIV status - Remind client that his or her result does not indicate the partner’s HIV status - Identify partners that are risk and need to be informed of their risk of HIV infection - Discuss possible approaches to disclosure of zero-status to partners - Support client to refer partner and other family members for testing - Practice and role play different approaches to disclosure - Anticipate potential partner reactions -Provide client with support - Assess client’s plan to reduce risk of transmission to current partner and re- infection - Explore client’s plan for reducing the risk of transmission to future partners - Address disclosure of HIV status to future partners - Encourage the client to protect others from HIV and protect him/herself from re-infection
- 22. Definition of positive living in the context of HIV PLHIV: Positive living with HIV is the adoption of a lifestyle in which one delays the onset of AIDS symptoms or improves the quality of life for those already with AIDS. • Positive living assists in ensuring better health and with fewer episodes of ill health through: • Good nutrition • Stress reduction • Protection from opportunistic infections • Prompt treatment of OIs and adherence to treatment
- 23. COMPONENTS OF POSITIVE LIVING . - Good nutrition -Family Planning -Physical exercises and rest -Emotional, physical and spiritual support -Prevention of Opportunistic infections Appropriate, early treatment of Opportunistic infections i) Inform about the link between HIV and TB as one of the most common and most serious opportunistic infections -ii) Explain importance of TB screening, if client is a TB suspect and refer to the TB diagnostic centre iii) Importance of Treating STIs and link between HIV and STIs - Antiretroviral Therapy - Seeking other forms of support when client need them such as seeking counseling services and joining PHHIV support groups
- 24. Definition of positive living in the context of HIV (2) HIV Negative: the adoption of a lifestyle that aims to maintain their negative status. • This may be done by developing patterns of behavior, including sexual behavior, that eliminate their risk of contracting HIV. • Positive living for the uninfected can also mean positive and caring attitudes and behavior towards PLHIV.
- 25. 1. Pre-test Information/ Counselling 2. Post Test Counselling 3. Dealing with Emotions 4. Disclosure of Results
- 26. Counselling Guidelines for Disclosure • Disclosure is a process, and it is not an event. • The counsellor should assist the client in carefully thinking through the pros and cons of disclosing their HIV status and planning ahead before they do. • Clients should decide if they want full disclosure i.e. publicly/openly revealing their status, or partial disclosure i.e. only certain people – spouse, relative or friend. •
- 27. Disclosure of HIV Positive Status • Whether or not to disclose their HIV-positive status is a difficult decision for HIV infected individuals to make because disclosure (or non-disclosure) is often followed by major and lifechanging consequences. • Counsellors should help their clients to carefully consider the benefits as well as the negative consequences disclosure may have for them
- 28. Potential Benefits of Disclosure • Could help the client to accept their status and reduce the stress of coping on their own. • Could help the client to access the medical services, care and support that they need. • Could help the client to protect themselves and others. Openness about HIV status may help women to negotiate safer sex practices. • It could help to reduce the stigma, discrimination and denial that surround HIV/AIDS. • Disclosure promotes responsibility – it may encourage the client’s loved ones to plan for the future. Possible Negative Consequences of Disclosure • Lack of support from family and friends, leaving the client to deal with everything on their own. • Being subjected to angry partners, family or friends, and/or abusive or violent responses • Placing others at risk of infection, particularly sexual partners and increasing the risk of re-infection for the client. • Not being able to access appropriate medical care, counselling or support groups. • People may become suspicious of the clients’ actions and behaviour.
- 29. Disclosure support steps • Allow the client to develop trust in you and feel at ease. • Discuss the implications of disclosure fully, to help the client consider in advance, the reactions of family, friends, work colleagues and others. • Help the client to develop a plan. This should include whom they will inform first, how and where they will disclose and the level of disclosure. • Prepare the client for an emotional, shocked, or a hostile reaction from other people. • Reassure clients that people close to them will probably learn to accept their HIV status over time. • Assess the client’s ability to cope and establish their sources of support
- 30. Discuss Disclosure of Results . Disclosure is the act of telling someone something that they did not know before why its best to disclose- cope better with your HIV. One can join a support group for psychosocial support. To protect your partner from being infected with HIV during sexual intercourse. ACTIVITY: Why is that people do not disclose their status?
- 31. Discuss Disclosure of Results . - Establish whom the patient would like to inform about their positive HIV result, focus on when and how they will disclose, the reactions they anticipate from these people - Emphasize the importance of disclosure to current and future partner or partners, children and other family members -Discuss how to deal with disclosure issues - Discuss the risk of intimate partner violence - Discuss possible steps to ensure physical safety of patients particularly women who are diagnosed HIV
- 32. Persons Disclosing • Disclosure by the individual to a sexual partner, family member or friend. – beneficial to disclose but it takes time for client to deal with the new status and need additional counseling. • As Providers & counselors assess the risk of intimate partner violence in the individuals and couples you dealing with • Disclosure by a health worker to a sexual partner of the individual.-controversial but HCW need to be aware that some clients are more susceptible to adverse outcomes of disclosure of HIV status such as discrimination, violence, abandonment or incarceration. • additional counseling needed to ensure informed consent before testing as well as to support appropriate disclosure after testing.
- 33. Persons Disclosing…cnt’ • Disclosure by a health worker to other health workers involved in the client’s care- Providers need to inform people who test positive that, in order to assure appropriate medical care, the diagnosis will be shared with other medical workers as needed. • This disclosure should respect the basic client right to privacy and confidentiality of all medical information.
- 34. Providers Should Discuss Risk Reduction Issues with clients . • Discuss plan for minimizing re-infection and reducing risk of transmitting HIV to current and future partner or partners • Assess clients plan for positive Prevention of Transmission to current partner/(s) or future partner/s highlight issue of re- infection • Break down risk reduction plan into concrete steps, what first, when etc. • Identify possible challenges/barriers to the positive prevention plan • Confirm plan as reasonable, acceptable and attainable, go over strengths and weaknesses • Re-emphasise importance of disclosure to current and future partner • Recap on condom use and skills and do condom demonstration (male and female condom)
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