Tools for Evaluating HIV Voluntary Counselling and Testing (UNAIDS, 2000, 59 p.): Appendix

Tools for Evaluating HIV Voluntary Counselling and Testing (UNAIDS, 2000, 59 p.)

		(introduction...)
		Acknowledgements
		Acronyms
		Further reading from UNAIDS
		Introduction
		Cautions, difficulties and limitations with the VCT evaluation tools
		Section 1. National preparedness for and commitment to VCT implementation
		Section 2. Evaluation of operational aspects of the sites and services
		Section 3. Counsellors’ requirements and satisfaction
		Section 4. Evaluation of counselling quality and content
		Section 5. Counselling for special interventions
		Section 6. “Group counselling”/Group education
		Section 7. Client satisfaction
		Section 8. Costs of VCT
		Appendix

Appendix

Modified tool for reviewing quality of VCT associated with MTCT interventions

The following checklist can be used where VCT is offered as part of interventions to reduce MTCT of HIV. In some of the pilot projects being developed for MTCT interventions a model of group pre-test information/discussion followed by individual or couple counselling is suggested⁶⁸. The following checklists suggest minimum contents and quality of pre- and post-test counselling.

⁶⁸ UNAIDS/UNICEF/WHO. Local monitoring and evaluation of the integrated prevention of mother to child HIV transmission in low income countries. Abidjan, May 1999.

Reviewing quality and content of HIV counselling associated with MTCT interventions

1. Background information

respondents = VCT managers

What is the VCT setting?
ANC clinic
Hospital VCT services
Free-standing VCT service
Other

What is the uptake of VCT by the antenatal women attending the service?
100%
90-99%
70-89%
50-69%
<50%

What is the return rate to collect HIV test results by the antenatal women attending the service?
100%
90-99%
70-89%
50-69%
<50%

2. Observational study of pre-test content

*GROUP EDUCATION TOPICS*	*INDIVIDUAL COUNSELLING TOPICS*

1. HIV-related issues
Knowledge about HIV and transmission	Assessment of personal risk of HIV exposure and how to avoid it (e.g. safer sex)
Misconceptions about HIV transmission	Capacity to cope with a positive result
The HIV testing process	Potential needs and possible support
The “window period”	Clarification of understanding about information given
The meaning and possible implications of HIV-positive and HIV-negative results	Time to think through issues and for answering questions
The value of getting partner/father involved	Informed consent/dissent given freely
Potential needs and available support	Follow-up arrangements after counselling session

2. MTCT-related issues
Full information about HIV in pregnancy and risk of transmission to the infant	Implications of a positive result for the baby and for future children
Possible benefits of knowing HIV status and interventions available if positive	Implications of a positive result for decisions about infant feeding
Testing is not mandatory and antenatal care and other services will not be denied if mother decides not to be tested	Implications of a positive result for the relationship with the baby’s father
ARV therapy for MTCT is not a cure/treatment for mother	Desirability of getting partner/father involved
The need to attend maternity services regularly	Options for termination of pregnancy (if available legally and safely)
Known adverse effects and drug interactions	Previous ARV use
	Check for understanding

Post-test counselling

As with post-test counselling in other circumstances, results should always be given individually or to couples who were tested together. The following checklist suggests minimum contents of post-test counselling.

3. Observational study of post-test content

INDIVIDUAL COUNSELLING TOPICS

1. Breaking the news

Results given simply and clearly

Time allowed for result to sink in

Checking for understanding

Discussion of the meaning of the result for the client

Discussion of personal, family and social implications

Who to tell, and how to tell them

Managing immediate emotional reactions

Checking for immediate follow-up support outside the clinic

Review options and resources

Immediate plans, intentions and actions reviewed

2. MTCT-related issues

Explanation of the delivery processes (e.g. maintaining confidentiality through ARV administration in labour)

Implications of the positive result for the baby and for future children

Implications of the positive result for decisions about infant feeding (e.g. benefits and risks of breastfeeding) and information on feeding options

Information on family planning

Previous ARV use

Explanation of the ARV regimen and the role of ARVs

The need for medicines to be taken regularly and according to the regimen

3. HIV-related issues

Implications of sharing the positive result for the relationship with the baby’s father, and the family

Desirability of getting the father involved in counselling and follow-up

Information about safer sex and using condoms to prevent transmission of HIV and STIs

Options for termination of pregnancy (if available legally and safely)

Information about care of the child (including nutritional advice, seeking early treatment for illnesses)

Information on support services in the community

Check for understanding

Next appointment made (possibly with partner)

4. Counsellor skills

The following checklists suggests a minimum quality for pre- and post-test counselling skills.

FUNCTION	SKILLS
1. Interpersonal relationship	Introduces self
	Listens actively and supportively
	Non-judgemental
2. Gathering information	Uses open questions
	Seeks clarification
	Summarizes appropriately
3. Giving information	Clear and simple
	Gives time to respond
	Checks for (mis)understanding
	Summarizes appropriately
4. Special circumstances	Appropriate and sensitive discussion
	Prioritizes issues with the client
	Manages client distress sensitively and appropriately
	Flexible in involving partner

5. Assessing acceptance of counselling in MCH settings with exit interviews

This is a semi-structured interview. It aims to help assess client satisfaction in counselling, and should be administered by a trained researcher. It should be used on a convenience sample of, for example, all people receiving counselling within a specific period (e.g. one week), who have agreed to be interviewed in this way when asked previously by their counsellor. If the numbers are too large, random sampling may be used at specific periods each day through the week. The exit interview should be voluntary, undertaken in privacy and confidentiality assured.

Have you talked to your counsellor today about (you may answer more than one):
	Having an HIV test	Yes	No
	Receiving test results	Yes	No
	Issues associated with having been tested some time ago	Yes	No
	The health of your baby	Yes	No

Did you come specifically to discuss testing for HIV?		Yes	No

Did you come specifically to discuss receiving treatment to protect your baby from HIV?		Yes	No

How long did you wait for your first appointment to visit the clinic? _____________		days

How long did you wait before someone talked with you in the clinic? ___________		mins

How much time did you spend with your counsellor today? ___________________		mins

How many visits have you made to your counsellor at this clinic? ______________		visits

Did you feel comfortable with your counsellor?	Yes	No
Was there enough privacy during your counselling?	Yes	No

What were the good things about your counselling?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

What were the bad things about your counselling?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

What information did you receive from the counsellor?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

Did you see the same counsellor before and after the test?	Yes	No

Did you want to see a particular counsellor this time
(a specific person)?	Yes	No

Would you recommend using this service to a friend
or family member?	Yes	No

Why?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________