Tools for Evaluating HIV Voluntary Counselling and Testing (UNAIDS, 2000, 59 p.): Section 5. Counselling for special interventions: 5b Counselling for MTCT interventions: Tool 5.2: For evaluation of counselling content for MTCT interventions

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

Section 5. Counselling for special interventions

5b Counselling for MTCT interventions

		(introduction...)
		Tool 5.2: For evaluation of counselling content for MTCT interventions

Tool 5.2: For evaluation of counselling content for MTCT interventions

How to do

Respondents = observers of counselling sessions

An external assessor, counselling supervisor or counsellor who has had training should complete this section. It is aimed at assessing the standards of the counselling of individuals taking place in the various contexts of HIV testing, care and support services. The standards assessed are based on the performance skills of the counsellors and these are best assessed through the observation of real counselling situations. Not more than three to five sessions need to be observed at each counselling site. Where there are many counsellors, a random sample (three to five) should be selected from among them. For each selected counsellor an observation could be made on the first counselling session conducted on the day of monitoring. When only one or two counsellors exist, three to five counselling sessions could be selected at random. Before the observer sits in, the client is informed about the observation and its purpose. Consent is sought. The observer must ensure that he/she is as unobtrusive as possible and does not disrupt the counselling session. Assurance of confidentiality must also be given. Immediate feedback to the counsellor by the trained supervisor is advised, with an opportunity for the counsellor to express his/her opinions and concerns.

Occasionally counsellors feel unhappy about a supervisor observing their session. Where there are irreconcilable concerns about observations by supervisors, alternative evaluation methods include using peer counsellors as observers, role play or audio-taped consultations (see Introduction).

During the session have the following occurred?

In early pregnancy:

Have the following areas been adequately covered?
	Client’s views on pregnancy explored	Yes	No
	Full information about HIV in pregnancy and the risk of transmission to the infant given	Yes	No
	Possible benefits of knowing her status and interventions available if the result is positive (including making it clear that ARV therapy cannot be given to women whose status is not known)	Yes	No
	Implications of a HIV-positive result for her baby	Yes	No
	Implications of a HIV-positive result for future children	Yes	No
	Implications of a HIV-positive result for decisions about infant feeding	Yes	No
	Implications of a HIV-positive result for her relationship with the baby’s father	Yes	No
	Discussions around the benefits of testing together with her partner/her baby’s father	Yes	No
	Implications and benefits of sharing a HIV-positive result with her partner/her baby’s father	Yes	No
	Explaining that testing is not mandatory and that she will not be denied access to antenatal care or other services if she chooses not to be tested	Yes	No
	Options for termination of pregnancy (TOP) (if available legally and safely)	Yes	No

Post-test counselling for HIV-positive women attending maternity services

In addition to the general issues that should be covered in post-test counselling, counselling for pregnant women who are HIV seropositive should include:

Information on ARVs, if available	Yes	No
Information on infant feeding options and the benefits and risks of breastfeeding	Yes	No
Information on family planning	Yes	No
Information about treatment, care and support services available and referral	Yes	No
Discussion of potential benefits and risks of sharing information about their HIV status with partner, family	Yes	No
Information about safer sex and using condoms to prevent transmission of HIV and STIs	Yes	No
Information about care of the child (including nutritional advice and seeking early treatment for illnesses)	Yes	No
Planning for the future (including emotional, spiritual and legal support)	Yes	No
Options for referral if required	Yes	No

Have specific questions about MTCT and ARV treatment been covered?

Previous ARV use		Yes	No
Not a cure		Yes	No
Need to attend maternity services		Yes	No
Need to take ARVs as prescribed		Yes	No
Understanding checked for		Yes	No
Contraindications and cautions to ZDV discussed
	Drug reactions	Yes	No
	Other medicines being taken	Yes	No

Explanation of ZDV therapy for prevention of MTCT adequately given including:

The regimen explained	Yes	No
The need to take medicines continually according to the regimen and the dangers of taking ZDV erratically	Yes	No
The possible side-effects and when to seek medical help	Yes	No
Understanding checked for	Yes	No

Post-test counselling for HIV-negative women attending maternity services

Information about safer sex and using condoms to prevent infection (especially during pregnancy and breastfeeding)	Yes	No
Explain about discordancy	Yes	No