5. Counseling and HIV Testing

Challenge Actions CQI Teams Took to Address the Challenge
No privacy during HIV counseling and testing (HCT)
  • Work with the health unit administration to identify a room that can be used for counseling. If this is not available, work with the IP to procure a tent that be portioned and used for many services including counseling.
No HCT register
  • Identify the missing registers and make requests for them from the District Health Office and IP
No individual and couple counseling & testing for HIV during VMMC
  • Orient counselors on the importance of conducting individual and couple HIV counseling and testing during VMMC
  • Identify the required resources such as the personnel to do it, the space, and other supplies
  • Include HIV counseling and testing in the client flowchart
Elements of VMMC not discussed during individuall counseling and testing for HIV
  • Develop a list of key talking points for HTC using guidance in the assessment tools and go through them with the entire team to have a common understanding
  • Ensure a copy of these points is available at all counseling points
No HIV test kits
  • Assign a staff member to track stock levels of the required supplies and monitor them using a stock card
  • Request for more supplies when stock reaches the minimum stock levels
Poor referrals and linkage systems for HIV-positive clients
  • Sensitize staff on the importance of linkage with other HIV prevention, treatment and care services
  • Develop a system to document and track the linkage with other treatment centers
  • Physically escort referred clients to other service points in the health facility
Clients do not understand the content of group education and counseling sessions
  • Crosscheck the client’s understanding of the information given to them
  • Ask the client to repeat the information
Lack of condoms or condoms not offered to clients; no demonstration of condom use
  • Assign staff member to track stock levels of condoms
  • Orient staff on the importance of condoms in HIV prevention
  • Conduct refresher training on proper use of condoms
  • Add use of condoms to the counseling checklist for the sexually active
  • Distribute condom at each visit (including follow-up visits)
Informed consent not obtained
  • Hold a staff meeting to reinforce the importance of obtaining informed consent prior to circumcision
  • Develop a standard operating procedure (SOP) for obtaining consent; the SOP should include discussion on benefits and risks of circumcision and crosschecking the understanding of the information given to the clients
No couples counseling and testing offered for couples who want it
  • Work with staff to make sure quality couples counseling and testing is available for couples who want it
Some guardians do not come with their children for VMMC
  • Have community health workers and VMMC mobilizers inform clients in the community on the importance of guardians/parents coming to health unit with their children to provide informed consent