HIV Counseling and Testing
MTN-003
Study-Specific Training
Overview of Presentation


HIV C&T at screening (brief check-in)
HIV C&T at follow-up
 Scenarios highlighting HIV testing
algorithm and associated counseling
messages
 Role
play
 Review of forms


Risk reduction counseling
Documentation
HIV Testing at Screening
STOP. Report to participant as
HIV-infected
+ /+
START
sample 1
2 different
rapid tests
-/ -
STOP. Report to participant as
HIV-uninfected
+/ Discordant/requires
additional testing.
Notify The MTN Network Laboratory
+
Sample 1
WB
-
ind
Sample 2
2 different
rapid tests
Repeat testing, beginning at “START” in
approximately one month.
HIV C&T at Follow-Up: Scenario #1
START
Sample 1
rapid test
-
STOP. Report to participant as
HIV-uninfected
+
-
Requires
additional testing.
Sample 1
WB
+
Consult the MTN
Network Laboratory
for further testing and follow up
- or ind
Sample 2
WB
+
STOP. HIV infection confirmed
Report to participant as
HIV-infected
- or ind
Sample 1
HIV viral load
+
HIV C&T at Follow-Up: Scenario #2
START
Sample 1
rapid test
-
STOP. Report to participant as
HIV-uninfected
+
-
Requires
additional testing.
Sample 1
WB
+
Consult the MTN
Network Laboratory
for further testing and follow up
- or ind
Sample 2
WB
+
STOP. HIV infection confirmed
Report to participant as
HIV-infected
- or ind
Sample 1
HIV viral load
+
HIV C&T at Follow-Up: Scenario #3
START
Sample 1
rapid test
-
STOP. Report to participant as
HIV-uninfected
+
-
Requires
additional testing.
Sample 1
WB
+
Consult the MTN
Network Laboratory
for further testing and follow up
- or ind
Sample 2
WB
+
STOP. HIV infection confirmed
Report to participant as
HIV-infected
- or ind
Sample 1
HIV viral load
+
HIV C&T at Follow-Up: Scenario #4
START
Sample 1
rapid test
-
STOP. Report to participant as
HIV-uninfected
+
-
Requires
additional testing.
Sample 1
WB
+
Consult the MTN
Network Laboratory
for further testing and follow up
- or ind
Sample 2
WB
+
STOP. HIV infection confirmed
Report to participant as
HIV-infected
- or ind
Sample 1
HIV viral load
+
HIV Counseling


By the time of the first VOICE follow-up visit,
participant will have undergone HIV C&T twice
and risk reduction counseling three times
With monthly C&T throughout follow-up, care
must be taken to avoid rote repetition of the
same information each month
 What are your thoughts on discussion of
“standard” HIV education and pre-test
information at each visit?
Risk Reduction Counseling


A client-centered and case-management type of
approach should be used to make risk reduction
counseling as effective as possible
Relies on four Ps


Quality of participant-provider relationship
 Partnership in a shared goal
 Mutually respectful
 Non judgmental
Personalized strategies to try to address
barriers to risk reduction
Client-Centered Approach


Counselor’s role is to ask questions,
actively listen to participant’s responses,
and guide participant toward next steps
Outcome should be participant identifying



Her barriers to risk reduction
Her strategies and action plans to try to
address the barriers
Supported and facilitated by the counselor
Client-Centered Approach









Greet client and establish rapport
Describe purpose of the session
Emphasize confidentiality of the session
Listen effectively, allow client to speak, avoid
interruptions
Communicate effectively, verbally and non-verbally
Communicate at client’s level of understanding
Use open-ended questions
Clarify misconceptions
Provide positive reinforcement
Closed-Ended vs Open-Ended
 Do you know how HIV is passed from one
person to another?
 Do you understand what your test results
mean?
 Do any of these risk factors apply to you?
Client-Centered Approach

Strategies and action plans should:




Reflect the participant’s current risk
assessment
Be realistic and practical, yet challenging
toward risk reduction
Be agreed upon by the participant
Be documented, with copy available to
participant if desired
Client-Centered Approach

Participant’s risk reduction issues/barriers
may be significant


Strategies may need to be incremental
Participant’s risk reduction issues/barriers
may change over time

Strategies may need to evolve over time
Client-Centered Approach

Counselor should also
 Offer skills building



How to use male and female condoms
(hands-on demonstrations)
How to talk to partners (role play)
Offer couples counseling and/or other
counseling with influential persons
Risk Reduction Counseling

Each month, risks/issues/barriers and
action plans identified at the previous
counseling session should be reviewed
and discussed with the participant



What was her experience over the past
month?
Was she able to carry out her plan?
What was the outcome?
Risk Reduction Counseling

Action plans for the coming month should
build on the past month’s experience




Successful strategies should be continued
Additional strategies may be identified to
achieve further risk reduction
Alternative strategies may be identified if
strategies tried over the past month were not
successful
All as identified and agreed upon by the
participant with the counselor’s guidance and
support
Risk Reduction Counseling

For this type of approach to be successful


Issues/barriers/strategies/action plans
discussed at each session must be
documented
Documentation must be accessible for
review at the next session
HIV Counseling Worksheet


General
HIV education and pre-test
counseling

HIV post-test counseling

Risk assessment




Risk factors and barriers to risk
reduction
Risk reduction plan – experience
and outcomes since last visit
Risk reduction plan – strategies
for the coming month
Additional notes page
Referrals


Referrals are expected components of risk
reduction plans (when indicated)
Referrals should be actively followed up at
subsequent visits to determine




If participant sought the services to which she was
referred
The outcome of the referral
If additional referrals are needed
Document all referrals, outcomes, and follow-up
plans and actions
What Are
Your Questions
Thoughts and
Reactions?