Rapid HIV TestingRapid HIV TestingRapid HIV TestingRapid HIV Testing

Jada Sims, MATEC Training ConsultantJada Sims, MATEC Training Consultant

September 15, 2009September 15, 2009

Learning Objectives

1. Review client‐centered counseling skills

2 Explain how the use of rapid tests affect

1. Review client‐centered counseling skills

2 Explain how the use of rapid tests affect2. Explain how the use of rapid tests affect the counseling process

3 Describe how to provide pretest and

2. Explain how the use of rapid tests affect the counseling process

3 Describe how to provide pretest and3. Describe how to provide pretest and post test counseling with rapid tests

4 Understand differences in

3. Describe how to provide pretest and post test counseling with rapid tests

4 Understand differences in4. Understand differences in implementation between STD clinic sites and HIV programs

4. Understand differences in implementation between STD clinic sites and HIV programsp gp g

Client-Centered Counseling ConceptsCounseling Concepts

• Focus on Feelings• Focus on Feelings

• Manage your own discomfort• Manage your own discomfort

• Set boundaries• Set boundaries

Counseling / Communication skillsCommunication skills

• Open‐ended questions• Open‐ended questions

• Attending• Attending

• Options not directives• Options not directives

• Give information simply• Give information simply• Give information simply• Give information simply

Closed-Ended Questions

• Do you know how HIV is transmitted?• Do you know how HIV is transmitted?• Do you know how HIV is transmitted?

• Do you use drugs?

• Do you know how HIV is transmitted?

• Do you use drugs?

• Do you know your partner’s HIV status?

• Do you use condoms to protect yourself?

• Do you know your partner’s HIV status?

• Do you use condoms to protect yourself?y p y

• Have you ever been diagnosed with an STI?

• Have you ever shared a needle with

y p y

• Have you ever been diagnosed with an STI?

• Have you ever shared a needle with• Have you ever shared a needle with another user?

D d t d t t lt ?

• Have you ever shared a needle with another user?

D d t d t t lt ?• Do you understand your test results?• Do you understand your test results?

Attending

• Good body language, eye contact, etc.

P h i

• Good body language, eye contact, etc.

P h i• Paraphrasing

• Summarizing

• Paraphrasing

• Summarizing

• Clarifying

• Reflective listening

• Clarifying

• Reflective listeningReflective listening

• Name the feeling

Reflective listening

• Name the feeling

Offering Options, Not DirectivesNot Directives

• Offer a menu of options• Offer a menu of options• Offer a menu of options

• Facilitate communication

• Offer a menu of options

• Facilitate communication

• Normalize and confirm potential client decisions

• Normalize and confirm potential client decisions

Give Information Simply

• KISS• KISS• KISS 

• Avoid jargon

• KISS 

• Avoid jargon

• Address specific needs, not HIV 101

(clarify critical, rather than general 

• Address specific needs, not HIV 101

(clarify critical, rather than general ( y gmisconceptions)

• Acknowledge what you don’t know

( y gmisconceptions)

• Acknowledge what you don’t knowAcknowledge what you don t know

• Check the client’s understanding

Acknowledge what you don t know

• Check the client’s understanding

Rapid Tests & the Counseling Processthe Counseling Process

• Requires more time with each client in a single day

• Counselors have less time to prepare to give

• Requires more time with each client in a single day

• Counselors have less time to prepare to giveCounselors have less time to prepare to give results

• Clients have less time to wait / prepare for results

Counselors have less time to prepare to give results

• Clients have less time to wait / prepare for results/ p p

• Clients do not have time to try their risk reduction plan or review it with the counselor  (HIV only)

/ p p

• Clients do not have time to try their risk reduction plan or review it with the counselor  (HIV only)

• Preliminary positive results require a follow‐up counseling session and confirmatory test results

• Preliminary positive results require a follow‐up counseling session and confirmatory test results

Pretest Counseling with Rapid Testing

Pretest Counseling with Rapid TestingRapid TestingRapid Testing

HIV PROGRAM STAFF:HIV PROGRAM STAFF: STD CLINIC STAFF:STD CLINIC STAFF:HIV PROGRAM STAFF:

• Introduce and orient the client

HIV PROGRAM STAFF:

• Introduce and orient the client

STD CLINIC STAFF:

• Introduce and orient the client

STD CLINIC STAFF:

• Introduce and orient the clientthe client

– Introduce yourself 

– Explain your role

the client– Introduce yourself 

– Explain your role

the client– Introduce yourself 

– Explain your role

the client– Introduce yourself 

– Explain your rolep y

• Assess client’s reason for testing OR screen 

p y

• Assess client’s reason for testing OR screen 

p y

• Explain that HIV testing will be done as 

p y

• Explain that HIV testing will be done as 

for risk and assess readiness for testingfor risk and assess readiness for testing

part of services, unless they refusepart of services, unless they refuse

Pretest Counseling with Rapid Testing

Pretest Counseling with Rapid TestingRapid TestingRapid Testing

D ib id t tiD ib id t ti• Describe rapid testing process

• Inform client of specimen involved and time expected for results

• Describe rapid testing process

• Inform client of specimen involved and time expected for resultsexpected for results

• Assess readiness to receive results same day

I f li t f il bilit f t ti

expected for results

• Assess readiness to receive results same day

I f li t f il bilit f t ti• Inform client of availability of anonymous testing sites, if desired

• Inform client of availability of anonymous testing sites, if desired

Pretest Counseling with Rapid TestingRapid Testing

E l th li t’ k l d fE l th li t’ k l d f• Explore the client’s knowledge of possible results

• Review the meaning of a negative result

• Explore the client’s knowledge of possible results

• Review the meaning of a negative result• Review the meaning of a negative result

• Establish the client’s window period & review

• Review the meaning of a negative result

• Establish the client’s window period & review

• Review the meaning of a positive result

• Explain the need for confirmatory testing if t t i li i iti

• Review the meaning of a positive result

• Explain the need for confirmatory testing if t t i li i ititest is preliminary positivetest is preliminary positive

Pretest Counseling with Rapid TestingRapid Testing

• HIV Providers: Obtain consent per• HIV Providers: Obtain consent per• HIV Providers: Obtain consent per the requirements of IDPH and your program

• HIV Providers: Obtain consent per the requirements of IDPH and your programyour program

• STD Providers: Inform clients that th ill b t t d l th

your program

• STD Providers: Inform clients that th ill b t t d l ththey will be tested unless they refusethey will be tested unless they refuse

• Administer the test 

• Engage the client in prevention 

• Administer the test 

• Engage the client in prevention g g pcounseling while the test developsg g p

counseling while the test develops

Pretest Counseling with Rapid TestingRapid Testing

Provide prevention counseling:Provide prevention counseling:

• Assess the client’s personal risk behavior– “What have you done that could put you at risk

• Assess the client’s personal risk behavior– “What have you done that could put you at riskWhat have you done that could put you at risk for HIV?”What have you done that could put you at risk for HIV?”

Pretest Counseling with Rapid TestingRapid Testing

Provide prevention counseling:Provide prevention counseling:Provide prevention counseling:

• Identify safer goal behaviors

Provide prevention counseling:

• Identify safer goal behaviors• support any positive behavior change

• review other risk reduction options as needed

H l th li t d l i k d ti l

• support any positive behavior change

• review other risk reduction options as needed

H l th li t d l i k d ti l• Help the client develop a risk reduction plan• consider potential obstacles  

h t d d

• Help the client develop a risk reduction plan• consider potential obstacles  

h t d d• rehearse steps as needed• rehearse steps as needed

Post test Counseling: Non Reactive Results Non-Reactive Results

• Read / obtain the test result

Di l lt d li t’ ti

• Read / obtain the test result

Di l lt d li t’ ti• Disclose result and assess client’s reaction

• Review the meaning of the result

• Disclose result and assess client’s reaction

• Review the meaning of the result

• Discuss possible need for retesting• Discuss possible need for retesting

Post test Counseling: Non Reactive Results Non-Reactive Results

• Review the client’s risk reduction plan• Review the client’s risk reduction plan

• Offer referrals and support as needed• Offer referrals and support as needed

• Summarize and close the session• Summarize and close the session

Post test Counseling: Reactive ResultsReactive Results

• Read / obtain the test result• Read / obtain the test result

• Disclose result

• Assess client’s reaction

• Disclose result

• Assess client’s reaction• Assess client s reaction• Assess client s reaction

Post test Counseling: Reactive ResultsReactive Results

• Offer emotional support as needed– Validate the client’s feelings

• Offer emotional support as needed– Validate the client’s feelingsg

• Assess emotional stability and coping

• Offer additional resources as needed

g

• Assess emotional stability and coping

• Offer additional resources as needed• Offer additional resources as needed • Offer additional resources as needed 

MATECMATEC

Post test Counseling: Reactive ResultsReactive Results

• Explain the need for confirmatory testing

• Explain the need for confirmatory testing

• Initiate confirmatory testing

• Provide interim prevention 

• Initiate confirmatory testing

• Provide interim prevention pguidance 

• Offer referrals as appropriate

pguidance 

• Offer referrals as appropriate• Offer referrals as appropriate

• Schedule a return visit for confirmatory results

• Offer referrals as appropriate

• Schedule a return visit for confirmatory resultsconfirmatory resultsconfirmatory results

Post test Counseling: Invalid ResultsInvalid Results

• Read / obtain the test result

• Disclose the result and what it means

• Read / obtain the test result

• Disclose the result and what it meansDisclose the result and what it means

• Assess the client’s willingness to be retested

Ad i i if h li i

Disclose the result and what it means

• Assess the client’s willingness to be retested

Ad i i if h li i• Administer if the client agrees to retesting• Administer if the client agrees to retesting

•Introduce and orient client•Explain differences between rapid & standard test

•Tests and the meaning of the test results•Assess readiness for immediate test result

•Informed consent (HIV Programs only – STD clinics are OPT-OUT)

Test AdministrationTest Administration

Prevention Counseling while test developsAssess risk & Identify safer goal behavior

Result Interpretation

Preliminary Positive:Explain meaning of results

Emphasize must be confirmedFacilitate confirmatory test

Negative:Explain meaning of results

Explain importance of repeatTesting due to window period

Invalid:Explain need to

repeat testCheck QA IndicatorsFacilitate confirmatory test

Schedule follow-up visitTesting due to window period

(if applicable)Check QA Indicators

MATECMATEC

Summarize and Close:Risk reduction plan Support systems and referrals

Practice Cases

Test Counseling PracticumPracticum

• Groups of 3 will participate in counseling• Groups of 3 will participate in counseling• Groups of 3 will participate in counseling practice sessions

E h b ill i b i

• Groups of 3 will participate in counseling practice sessions

E h b ill i b i• Each group member will practice being a counselor with another group member as the ti t hil th thi d b b

• Each group member will practice being a counselor with another group member as the ti t hil th thi d b bpatient, while the third group member observes

– 10 minutes pretest time for each group member

patient, while the third group member observes– 10 minutes pretest time for each group member

– 5 minutes for constructive feedback

– 10 minutes for posttest counseling for each group 

– 5 minutes for constructive feedback

– 10 minutes for posttest counseling for each group member

– 5 minutes for constructive feedback

member

– 5 minutes for constructive feedback