Check counseling skills with rapid HIV tests

Will your facility soon be implementing the OraQuick Rapid HIV-1 Antibody Test? If so, there are several resources to help you get up to speed in offering this new service.

The Atlanta-based Centers for Disease Control and Prevention (CDC) recently has released revised guidelines for HIV counseling and testing, which are available on its web site. The guidelines include information about HIV testing and its importance, tips on specific counseling to help reduce HIV risks, and information about post-test counseling for persons tested with rapid HIV tests.

Make sure when you deliver the news of a reactive rapid HIV test result that the patient understands that the test result is preliminary and further testing must be done to confirm the result. Persons who have a negative rapid test but have had a recent risk exposure must be counseled to obtain another test at least three months after the possible exposure to account for the possibility of a false-negative test result.

If a patient has a negative rapid HIV test, you definitively can report that the test result is negative and that they are not infected, unless they have had a recent (within three months) known or possible exposure to HIV.

For patients who have reactive (preliminary positive) test results, further testing is required to confirm the result. In giving preliminary positive results, the CDC recommends that clinicians:

  • explain the meaning of the reactive test result in simple terms, avoiding technical jargon;
  • emphasize the importance of confirmatory testing and schedule a return visit for the confirmatory test results;
  • underscore the importance of taking precautions to avoid the possibility of transmitting infection to others while awaiting results of confirmatory testing.1

How can you accomplish this communication? Try a simple message, such as, "Your preliminary test result is positive, but we won’t know for sure if you are infected with HIV until we get the results from your confirmatory test. In the meantime, you should take precautions to avoid transmitting the virus."

A counseling protocol for providing prevention counseling during one visit for clients receiving rapid test results, as well as other related material, has been developed by Project Respect-2. A multicenter trial, Project Respect-2 is working with rapid HIV testing in looking for ways to provide HIV testing and counseling that are more effective at reducing clients’ risk of becoming infected with sexually transmitted infections than current methods.

Address both components

According to the CDC, HIV counseling must include two components: provision of information and prevention counseling. If you provide a rapid HIV test, give the patient information about the rapid test and obtain informed consent for testing. Also offer prevention counseling.

Be prepared to provide the same type of information with a rapid HIV test as you use with a standard enzyme immunoassay. Information can be provided in a face-to-face meeting, or in a pamphlet, brochure, or video. The information should include:

  • highlights about the HIV test, its benefits, and its consequences;
  • ways HIV is transmitted and how it can be prevented;
  • the meaning of the test results in explicit, understandable language;
  • directions on where to obtain further information and, if applicable, HIV prevention counseling;
  • where to obtain other services including treatment, if applicable.1

Seize the moment

For patients with preliminary positive rapid HIV test results, remember that you will have two opportunities for prevention counseling: one on the day they have the rapid test, and one when they return for their confirmatory results. However, when your patients test negative with the rapid test, you will have only one test-associated opportunity to get across your prevention message.

When discussing prevention, keep in mind the following suggestions from the CDC:

  • Keep the session focused on HIV risk reduction.
  • Include an in-depth, personalized risk assessment.
  • Acknowledge and provide support for positive steps already made.
  • Clarify critical rather than general misconceptions about HIV risk.
  • Negotiate a concrete, achievable behavior-change step that will reduce HIV risk.
  • Seek flexibility in the counseling technique and process, avoiding a "one-size-fits-all" approach.1

Reference

1. Centers for Disease Control and Prevention. HIV Counseling with Rapid Tests. Accessed at: www.cdc.gov/hiv/pubs/rt-counseling.htm.