Female Condom

HIV COUNSELLING AND

TESTING(HCT), TREATMENT,
CARE AND SUPPORT

A.O. Adefolarin
Department of Psychiatry, College of Medicine ,
UI
Dr Akande
Department of Medicine, College of Medicine, UI
 LESSON OBJECTIVES
After completing this LESSON, the participants will be able to:

• Understand the integration of HIV Counselling and

Testing into HIV prevention programmes

• Discuss Health providers’ role in maintaining

confidentiality

• Provide information about HIV testing

• Explain the meaning of positive and negative HIV test

results

identify needs of the newly diagnosed HIV-positive

patients
 Introduction

• HIV/AIDS is one of the world most

devastating epidemics with physical,
social, psychological and economic
effects on individuals, families and society.
• The young people are particularly at risk
for HIV infection for a number of reasons:
– incorrect and incomplete knowledge about
the virus, the risk associated with its
transmission, its prevention/control measures
and available treatment and support services
in our society
 Definitions
• HIV counselling is an interaction between a
counsellor and a counsellee on HIV and AIDS
issues with the purpose of empowering the
counsellee to make informed decisions and face
the challenges associated with his/her HIV status.

• It is a Confidential discussion(s) between an

individual and the care provider to examine HIV
transmission risk and explore HIV testing

• Counselling can be:

– Pre-HIV test Counselling
– Post-HIV test Counselling
– On-going HIV counselling
 Guiding Principles for Counselling and
Testing

• Information on HIV status kept private

• Information shared only with providers directly

involved in care—and only on a “need to know”
basis

• Medical records kept in safe place

 Importance of HIV Counselling and
Testing (CT)
• Is vital for identifying HIV-positive persons to provide
services

• Provides an entry point to comprehensive HIV/AIDS

treatment, care and support

• Helps identify and reduce behaviors that increase HIV

transmission risks

• Becomes available to all Young people and women of

childbearing age and their male partners
 Counseling and Testing as an Entry Point to
MCH/HIV Prevention
Primary
prevention of new

Community action HIV infection Prevention of

to reduce Stigma unintended
& discrimination pregnancy

VCT
Post - delivery and its links Safer obstetric
care and support with other practices
services

Safer infant Antiretroviral

feeding prophylaxis
Components of HIV Counseling and Testing

• Informed Consent
• Pre-test Counselling /HIV Education
• HIV testing
• Post-test counselling
• Referral to HIV prevention and care services
 Informed Consent
• Counselling and testing must be truly
voluntary and individuals should be able to
opt out or refuse counselling or testing if
they do not think that it is in their best
interest.
 Guiding Principles for Counselling and
Testing

• Information on HIV status kept private

• Information shared only with providers directly

involved in care—and only on a “need to know”
basis

• Medical records kept in safe place

 Pre-HIV test Counselling
• This is a counselling session taken before HIV
test is performed

• This session provides the opportuinity to discuss

issues related to:
– Level of counsellee’s knowledge of HIV and AIDS
– Updating the counsellee’s knowledge of HIV and AIDS
– HIV risk assessment
– HIV test results and interpretation
– Assurance of confidentiality
– Management/coping strategies
– Linkage with service points and other support systems
– Consent to undergo the test
 Types of pre-HIV test counselling
technique
• ‘Opt-in’ technique
– The counsellee requests for the service

• ‘opt-out’ technique
– The counsellor offer the service
Process of Counselling and Testing
• Pre-test Group education

• ‘opt-out’ technique

• Identifies:

• Purpose of testing and processes involved

• Benefits and risks of testing
• Available treatment and support

• Respects Individual’s autonomy and right to

confidentiality
 Post-HIV test Counselling
• This session is influenced by the result of
HIV test which could either be positive or
negative.
 Process of Counselling and Testing

• Post-test support and services

– Always give results in person

– Provide appropriate post-test information

– Offer counselling and referral

 Post-Test Counselling
• Provide the woman with her HIV test result

• Help her understand what the result means

• Provide Post-test counselling essential messages when

indicated

• Provide support, information, and referral when

indicated

• Encourage risk- reducing behavior

• Encourage disclosure and partner testing

 Post-Test Counselling

 HIV-negative

 Review window period if indicated

• Prevent future infection

• Review risk with new infection

• Educate partner and encourage partner testing

 Post-Test Counselling

 HIV-positive result
• Clarify understanding
• Acknowledge feelings
• Review benefits of knowing HIV status
• Address immediate concerns
• Schedule follow-up visit
• Provide support ,name and telephone number
of contact person
 Post-test Counselling
• For a positive HIV test result, post test
counselling must dwell on the issues of:
– Disclosure of result
– Coping with emotions and challenges
– Need for confirmatory test
– Need for healthy/positive living
– Regular counselling
– Linkage with support groups
– Management of opportunistic infections
– Drug therapy
 Pre-HIV test counselling-sexual
assault
• What constitutes sexual assault
– Rape is the most common form. Rape is
committed when a person’s resistance is
overcome by force or fear or under coercive
conditions
– Insertion of objects into genital openings
– Oral or anal intercourse
– Attempted rape 2
 Key differences in sexual assault
client presentation to HCT services
• Such client is:
– Highly emotional
– Anxious
– Depressed
– Non-communicative and in shock.
 Principles of HCT for sexual assault
client
• Counselling should be offered to the client but they
should not be pressured to undertake it

• Counselling is more effective when the person is ready for

it

• Counselling should be carried out as soon as possible by

health care professionals with appropriate training, e.g. in
the field of pre- and post- test counselling, where the client
has agreed to HIV testing, and crisis management

• Counsellors should practise active listening, all the time

respecting the survivor’s wishes and choices and
maintaining the survivor’s confidentiality Immediate
intervention can help to minimise the severity of
psychological trauma in the long-term
 Objectives of counselling for sexually
assaulted
• Help clients to develop a sense of control over their lives and to
overcome their feelings of guilt

• Help clients to realise they are not responsible for the attack, to
stop blaming themselves and to understand that they are not
alone and that many other people have overcome similar
experiences and still lead normal lives

• Help clients to understand feelings of anger and fear and to

help them express anger towards their attacker in order to
alleviate feelings of self-blame

• Help to break the client’s feelings of isolation by linking them to

support groups and networks and helping them to integrate into
community activities

• Support the survivor in resolving family and community

disputes (where appropriate)
Targeted HCT intervention – Youth

• Why target young people?

– Young people encompass a significant
demographic of the population affected by HIV
in any country.
– Young people aged 15 to 24 years old account
for more than 50% of all HIV infections
worldwide (excluding perinatal cases)
– More than 6,000 young people are newly
infected with HIV each day throughout the
world.
1
 HCT services for young people
• There is no one particular best practice
model for delivery of HCT services to young
people
– Integration into existing health care services
(e.g. primary health care, STI clinics and TB
clinics) with designated “youth-friendly corners”
– Integration into school and college health care
services
– Outreach/mobile with links to fixed site

– Youth friendly centres

– Mix of peer educator/support workers and
youth-friendly adult professionals
– Targeted “tribe” campaigns (soccer, disco, etc)
 Elements of youth-friendly services
• Offers a broad array of youth-oriented services, including
counselling services and life-skills training.

• This is to help with peer pressure, self-esteem, negotiation

skills, risk-taking and experimentation as related to
developing safer behaviours and setting limits

• Provides health education which is non-judgemental and

realistic. Asks few questions

• Offers free testing (and condoms). For youth who

generally do not have an income, cost can be an
important obstacle to accessing services and products

• .
Elements of youth-friendly services
• Convenient hours and location (public transport)

• Assures confidentiality

• Does not require parental consent

• Offers choice between oral/blood-drawn tests

• Enables participation of young people in

decision-making, planning and delivery of
services
 Barriers to VCT
• Fear
• No cure
• Stigma
• No need: I’m faithful
• Partner with a negative HIV result
• Gender inequalities
• Lack of perceived benefit
• Lack of access to care and support
services
 HIV testing
• HIV testing is a procedure that determines
the presence of antibodies and/or antigen to
HIV in the blood with a view to ascertaining
one’s HIV status

• The process that determines whether a

person is infected with HIV or not

• This can be:

– Screening
– Confirmatory
 Selection of the HIV Test

• Is site-specific based on:

– National/local policies
– Availability of supplies and laboratory support
– Availability of trained personnel
– Evaluation of specific tests in the country
– Costs
 The Testing Process
• Test sample
• Blood, saliva, urine

• Process the sample, on-site or in lab

• Obtain results
• Keep confidential
• Method determined by clinic protocols and client

• Provide results to client

• Provide post-test counselling, support and referral
 The Testing Techniques

• Antibody testing
• Rapid HIV test
• ELISA
• Western blot

• Antigen testing and viral assays

 What is the “Window Period”

A period of 4-6 weeks after HIV exposure when

antibodies to HIV are not detectable in the blood

A person at high risk who initially tests negative

should be retested at 3 months to confirm
diagnosis
 ELISA vs Rapid Tests for HIV

ELISA Rapid Tests

blood from finger prick,

Sample blood from arm
saliva swabs

Lab special equipment limited facilities

Ease trained technician minimal training

Result
up to 1 weeks less than 30 minutes
time
 HIV Antigen Tests and Viral Assays

• HIV antigen tests detect the presence of HIV in

blood and
• must be done by laboratory personnel

• Types
– PCR (polymerase chain reaction ) tests detect DNA or
measure RNA (viral load) in the blood
– P24 antigen tests measure one of the proteins found
in HIV

• Require trained personnel and specialized

laboratory
 Diagnosing HIV in HIV-Exposed Infant
• ARV prophylaxis reduces but does not eliminate Mother
to child transmission of HIV infection

• Since maternal antibodies cross the placenta, antibody

testing is not recommended prior to 18 months of age

• Infants who are breastfeeding require additional testing

6 weeks after complete cessation of breastfeeding

• HIV PCR is used for diagnosis of HIV infection in the

infant
 HIV Disclosure
• In the context of HIV/AIDS, UNAIDS and WHO
encourage beneficial disclosure of HIV/AIDS status

• The disclosure should be:

– voluntary;
– respects the autonomy and dignity of the affected
individuals;
– maintains confidentiality as appropriate;
– leads to beneficial results for the individual, their sexual
and drug-injecting partners, and family;
– leads to greater openness in the community about
HIV/AIDS;
– meets ethical imperatives so as to maximise good for
both the uninfected and the infected.
 Disclosure of HIV status

• Ensure confidentiality

• Respect woman’s choices

• Encourage partner testing

• Review prevention of transmission

• Identify support
 Treatment of HIV/AIDS

• In the early years of the HIV/AIDS epidemic,

people with HIV/AIDS were not likely to live
longer than a few years mainly because their
suppressed immune system could not fight
opportunistic infection.
• Although, there is currently no cure for HIV or
AIDS, medications are available to effectively
fight HIV and its complications.
• Treatments are designed to reduce the
quantity of HIV in the body, keep the immune
system as healthy as possible and decrease
the occurrence of opportunistic infections.
 Antiretroviral drugs (ARVs)
• Antiretroviral drugs are medications for the treatment
of infection by retroviruses, primarily HIV

• As at today, there are over 30 antiretroviral drugs

(ARVs) approved by the Food and Drug
Administration of the United States of America to
treat HIV infection

• To treat HIV several of such drugs, typically three or

four, are taken in combination
– This approach is known as Highly Active Antiretroviral
Therapy, or HAART.
– The advantage of HAART over mono/single drug treatment
is the ability to maximally suppress the virus because each of
the drugs in the combination interferes with different points
of the virus replication (multiplication) thereby increasing
response to treatment.
 Classes of ARVs and some
examples
Nucleoside Nucleotide Non- Protease Integrase inhibitors
reverse reverse nucleoside inhibitors
transcriptase transcriptase reverse
inhibitors inhibitors(NtRTIs) transcriptase
(NRTIs/NtRTIs) inhibitors
(NNRTIs):
3TC (lamivudine) tenofovir efavirenz atazanavir raltegravir

abacavir nevirapine darunavir

AZT (zidovudine) fosampren

avir
ddI (didanosine,) lopinavir/rit
onavir
emtricitabine) ritonavir ,
used as a
boosting
agent
Stavudine saquinavir
 List of some HIV/AIDS treatment
Centres in Nigeria.
State Location Name of Centre State

Oyo State Ibadan University College Hospital Oyo State

Ibadan Adeoyo Maternity

Ibadan St. Mary Catholic Hospital

Ibadan Oluyoro Catholic Hospital

Ogbomosho Oy o Sta te Sp ecia list

Hospital
Ogbomosho Baptist Medical Centre

Saki General Hospital

Saki Baptist Medical centre

Oyo town State Hospital

Nation wide State Capitals Federal Teaching Hospitals Nation wide

and Medical Centres
 Antiretroviral drugs (ARVs)
• These drugs do not cure people of HIV or AIDS.
• Rather, they suppress the virus, by preventing its
rapid multiplication, even to undetectable levels,
• By suppressing the amount of virus in the body,
people infected with HIV can now lead longer
and healthier lives.
• However, they can still transmit the virus and
must continuously take antiretroviral drugs and
practice other secondary preventive measures in
order to maintain their health quality.
Who qualifies for antiretroviral therapy?
• It is not everyone who is HIV positive that
requires anti-retroviral drugs.
• There are criteria that a person with HIV must
meet before initiating (starting) ARVs.
– Willingness and readiness of the patient to begin
therapy
– The stage of the infection
– Presence of other health problems
• Presence or absence of co-infection with other pathogens
like Hepatitis B, Hepatitis C and Tuberculosis will
determine which drug regimen and when to commence
• Knowledge of the state of the liver, bone marrow and
kidney will contribute whether to start or not the ARVs,
the type of regimen to use, when to reduce or withhold
the ARVs
Treatment as a prevention measure

• The principle of antiretroviral therapy is to interfere with the
replication (multiplication) cycle of HIV reducing the
number of new virus produced and thus reducing the
quantity of virus circulating in the blood.

• The drugs are capable of decreasing the virus load to an

undetectable level.

• Studies have shown that when the virus level is so low, the
chance of transmitting the virus is also low.
– Hence HIV therapy in addition to its benefit to PLWA is of great
public health importance in preventing HIV transmission in the
public.

• However, this should not mean people should disregard the

“ABC” of primary HIV prevention bearing in mind that
treatment as a prevention measure is not 100% proven to
be protective.
 Care and Support for PLWAs

• Care and support for PLWAs have broader
scope and covers many elements including the
following:
– policy to prevent, protect, treat and care for PLWAs
and their families,
– medical care (treatment of and prophylaxis against
opportunistic infections, and use antiretrovirals),
– HIV nursing care
– laboratory services,
– pharmacological services
– counselling, social support
– self-help group activities,
– home and community-based care
– health promotion
The role of Youths in HIV Prevention,
Treatment, Care and Support
• The youths and the youngs ones are
disproportionately affected by HIV.
• They are the disadvavntage of having to
cope with this epidemic in the society for
a longer period.
• As such they need to play important roles
in preventing, control and care for the
people living with HIV in the society. The
following are some of the ways by which
the youths can contribute to the preventive
measures of HIV/AIDS:
 The role of Youths in HIV
Prevention, Treatment, Care and
Support
• The following are some of the ways by
which the youths can contribute to the
preventive measures of HIV/AIDS
– Be informed and act responsibly
– Respect others
– Show care and support
–
 Conclusion
• HIV PEVENTION IS BETTER THAN CURE

• PREVENTION BEGINS WITH KNOWING

ONES STATUS

• SO, KNOW YOUR HIV STATUS AND

PROTECT YOURSELF FROM HIV
INFECTION.
THANK YOU FOR
LISTENING