provider initiated counseling and testing thato farirai birchwood hotel august 10,2010 national...
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PROVIDER INITIATED COUNSELING AND TESTING
THATO FARIRAIBIRCHWOOD HOTEL
AUGUST 10,2010
National Guidelines for HIV Counseling and Testing in
Clinical Settings:
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What is PICT? Why PICT?
HIV counseling and testing initiated and recommended by 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
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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.
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Intended users of the guidelines
HCP involved in the clinical care and management of patients
Providers in both public and private facilitiesNeed for supportive health system
Trained personnel Logistics supply at community and facility level
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Who Should be offered Testing?
All patients attending health facility as part of medical care;
Measures for rational use of resources by prioritizing:
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
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PICT Principles
Informed consentConfidentialityCounseling
As prescribed by the HCT policy
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PICT Process
Health EducationPre-test counselingInformed consentPost test counseling
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Health Education
Can be provided to patients as a group or individualsProvide information about HIVPromote PICTPrepare patients for the CT processAll 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
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Pre Test Counseling
Provided to individuals not to groupsProvider to be guided by the patient’s needsIf lengthy counseling is anticipated then patient is
referred to the lay-counselor
It should cover the following:Evaluating the patient’s understanding of HIV
informationReinforce messagesExplain the testing processProvide an opportunity for patient to ask questionsObtain consentPerson responsible: HCP
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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
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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 negativeMinimum content for HIV positive
Person responsible: HCP
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PICT Protocol
Recommended testing algorithmPICT protocol for out patient settingsPICT protocol for inpatient settings
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Other issues covered
ConfidentialityDisclosure of results ( patient and HCP)Referrals and linkagesIssuing of written resultsFrequency of testing
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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 flowCaring of carersOccupational exposureInfection controlStigma and preventionQuality assuranceSocial mobilizationMonitoring and evaluationSupervisionART
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THANK YOU