National Guidelines for HIV
Counseling and Testing in Clinical
Settings:
PROVIDER INITIATED COUNSELING AND
TESTING
THATO FARIRAI
BIRCHWOOD HOTEL
AUGUST 10,2010
What is PICT? Why PICT?
 HIV counseling and testing initiated and recommended by
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health care providers (HCP) to persons attending health
care facilities as a standard component of medical
care
Voluntary service, patients may decline the test without
being denied medical services
HCPs are best suited to provide patient centered care to
empower their patients
Providers to make clinical decisions or medical services
based on the knowledge of the patient HIV status
Approach to scaling up HCT
PICT Objective
 To assist HCP to expand quality HCT services in
clinical settings to reduce the impact of HIV among
individuals, families and communities by reducing
HIV transmission.
Intended users of the guidelines
 HCP involved in the clinical care and management of
patients
 Providers in both public and private facilities
 Need for supportive health system
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Trained personnel
Logistics supply at community and facility level
Who Should be offered Testing?
 All patients attending health facility as part of medical
care;
 Measures for rational use of resources by prioritizing:
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Pregnant women
Patients with TB symptoms and those diagnosed with TB
STI patients
Patients for SRH including FP&TOP
Male patients presenting for SRH
All inpatients
MMC patients
Patients requiring non-occupational PEP
Patients reporting history of IDU
Sexual partners and children of HIV positive patients
PICT Principles
 Informed consent
 Confidentiality
 Counseling
As prescribed by the HCT policy
PICT Process
 Health Education
 Pre-test counseling
 Informed consent
 Post test counseling
Health Education
 Can be provided to patients as a group or individuals
 Provide information about HIV
 Promote PICT
 Prepare patients for the CT process
 All patients should be offered the test and those who
accept must receive pre-test counseling
 Person responsible: the facility manager is responsible
for implementing and overseeing the QA procedures
Pre Test Counseling
 Provided to individuals not to groups
 Provider to be guided by the patient’s needs
 If lengthy counseling is anticipated then patient is referred to
the lay-counselor
It should cover the following:
 Evaluating the patient’s understanding of HIV information
 Reinforce messages
 Explain the testing process
 Provide an opportunity for patient to ask questions
 Obtain consent
Person responsible: HCP
Informed Consent
 HCPs do not have a right to test patient’s without
informed consent
 PICT requires verbal consent for HIV testing
documented in the patient records
Person responsible: HCP
Post- Test Counseling
 Content to be informed by the results of the test
 Results to be given to individuals not group except in
the case of couples
 Minimum content for HIV negative
 Minimum content for HIV positive
Person responsible: HCP
PICT Protocol
 Recommended testing algorithm
 PICT protocol for out patient settings
 PICT protocol for inpatient settings
Other issues covered
 Confidentiality
 Disclosure of results ( patient and HCP)
 Referrals and linkages
 Issuing of written results
 Frequency of testing
Special Considerations
 PICT for children
 Obtaining consent and assent
 Abandoned babies
 Disclosure in children
 Appropriate HIV tests for children
 PICT in ANC
 Couple counseling
 PICT in TB services
 PICT in SRH
 PICT in MMC
 Integration on PICT in MMC
 Incapacitated patients
 Testing in the context of sexual offences
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Special Considerations
 Patient flow
 Caring of carers
 Occupational exposure
 Infection control
 Stigma and prevention
 Quality assurance
 Social mobilization
 Monitoring and evaluation
 Supervision
 ART
THANK YOU