2008
HIV and AIDS Voluntary Counselling and Testing Participant’s Manual UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
HIV and AIDS Voluntary
Counselling and Testing
Participant’s Manual
National AIDS Control Programme
February 2008
THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
HIV and AIDS Voluntary
Counselling and Testing
Participant’s Manual
National AIDS Control Programme
February 2008
HIV and AIDS Voluntary Counselling and Testing
Participant’s Manual
© MINISTRY OF HEALTH AND SOCIAL WELFARE 2008
National AIDS Control Programme
P.O. BOX 11857
DAR ES SALAAM
ISBN 978-9987-650-63-7
Extracts from this book may be reproduced by non-profit organizations with acknowledgement to
the Ministry of Health and Social Welfare (MOHSW)
Developed and published by MOHSW with support of
JICA/CDC/AMREF/WHO
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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Table of Contents
ABBREVIATIONS AND ACRONYMS ACKNOWLEDGEMENT
PREFACE
INTRODUCTION MODULE 1 Self-Awareness
Session 1
Session 2
Session 3
Session 4
Session 5
MODULE 2
Session1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Introduction Getting to Know Each Other
Values Self-Concept Language of HIV Basic Information on HIV and AIDS Counselling and Testing
Basic Information on HIV and AIDS
The Body Immune System and HIV
The Trends of HIV and AIDS Situation
Modes of HIV Transmission and Related Risk Factors HIV Prevention Strategies Myths and Misconceptions About HIV and AIDS
Terms Used in HIV Testing Introduction to HIV Testing The Role of Voluntary Counselling and Testing in HIV Prevention,
Care and Coping MODULE 3 Counselling Theories, Approaches and Techniques
Session 1 Counselling Theories: Overview
Session 2 Counselling Theories: Psychoanalytic
Session 3 Counselling Theories: Behavioural
Session 4 Counselling Theories: Cognitive
Session 5 Counselling Theories: Humanistic
Session 6 Basic Communication Skills: Overview Session 7 Basic Communication Skills: Effective Communication
Session 8 Processes and Practice of Counselling: Overview
Session 9 Process and Practice of Counselling: Basic Stages Session 10 Processes and Practice of Counselling: Supportive Counselling Skills
Session 11 Processes and Practice of Counselling: Counselling barriers
Session 12 Processes and Practice of Counselling: National VCT Guideline
Session 13 Characteristic of an Effective Counsellor
Session 14 Roles of an Effective Counsellor
Session 15 Counselling: Listening and Questioning Micro Skills Session 16 Counselling: Silence Micro Skills Session 17 Counselling: Non-verbal Behaviour Micro Skills Session 18 Pre-Test Counselling Overview:
Session 19 Pre-Test Counselling: Identification of Risk Behaviours Session 20 Pre-Test Counselling: Development of Risk Reduction Plan iii
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VIII
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1
2
3
5
6
7
9
11
12
13
14
15
16
17
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19
21
23
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27
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
Session 21 Pre-Test Counselling: HIV Test Results and Likely Reactions 45
Session 22 Post-Test Counselling: Provision of Negative HIV Test Results 46
Session 23 Post-Test Counselling: Adherence to Risk Reduction Strategies
47
Session 24 Post-Test Counselling: Provision of Positive HIV Test Results 48
Session 25 Post-Test Counselling: Coping
49
Session 26 Supportive Counselling 50
Session 27 Post-Test Counselling: Role Plays 100
MODULE 4
Session 1 Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Session 8
Session 9
Session10
Session 11
Session 12
Session 13
Session 14
Session 15
Session 16
Counselling for Specific Target Groups and Situations
Couple Counselling
The Role of VCT in Couple Counselling
Family Counselling
Psychosocial Support in Family Counselling
Youth Counselling Skills
Factors Promoting Youth Counselling
Overview of Children Counselling and their Legal Issues
Children Counselling Skills
Changes During Pregnancy and introduction to “ PMTCT” Programme
Factors Promoting Mother to Child Transmission of HIV Strategies for Prevention of Mother to Child Transmission of HIV (60min)
Pre-Test Counselling for “ PMTCT”
Post-Testing Counselling for “ PMTCT”
Crisis Counselling
Counselling for Loss, Grief and Bereavement
Supporting Client and Significant Others to Cope with Loss
MODULE 5 Counselling, Care and Treatment Session 1 Overview of HIV and AIDS care and Treatment Services Session 2 Counselling issues across the HIV disease continuum Session 3 Continuum of Care in HIV and AIDS Session 4 Counselling for treatment and drug adherence 1 Session 5 Counselling for Treatment and Drug Adherence 2 Session 6 Counselling for ARV/ART Session 7 The Role of a Counsellor in ART Session 8 Overview of TB/HIV Co-infection
Session 9 TB/HIV Related Counselling 1
Session 10 TB/HIV Related Counselling 2 Session 11 Overview of STI/RTI Session 12 The role of a Counsellor in STI/RTI Management Session 13 STIs Related Counselling Session 14 Overview of Opportunistic Infections Session 15 Management of Opportunistic Infections Session 16 Nutrition in the Context of HIV 1 Session 17 Nutrition in the Context of HIV 2 Session 18 Counselling for Nutrition in the Context of HIV Session 19 Stigma and discrimination in HIV and AIDS context Session 20 Stigma and Discrimination
Session 21 Legal and Human Rights Issues
Session 22 Legal and human rights issues for minors HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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MODULE 6
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
VCT Service Delivery and Programme Management
Establishing VCT Site
Models of VCT Service Delivery
Clients flow Management Referral and Network Development Monitoring and Evaluation of VCT Services Data Collection and Reporting Tools
Data management and Data flow
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MODULE 7 HIV Testing in VCT Service Delivery
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MODULE 8 Counselling Skills, Ethical Codes and Supervision of Counselling Practice
Session 5 Ethics in Voluntary Counselling and Testing
Session 6 Introduction to Ethics in VCT
Session 7 Counsellor Support
Session 8 Counsellor Supervision
Session 9 Field Practice
Session 10 Sharing Field Experiences
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ANNEXES
(ANNEX 1-1)
(ANNEX 1-2)
(ANNEX 1-3)
(ANNEX 1-4)
(ANNEX 2-1)
(ANNEX 3-1)
(ANNEX 3-2)
(ANNEX 3-3)
VCT TRAINING TIMETABLE (WEEK 1)
VCT TRAINING TIMETABLE (WEEK 2)
VCT TRAINING TIMETABLE (WEEK 3)
VCT TRAINING TIMETABLE (WEEK 4)
NATIONAL COUNSELLING TEST REGISTER
SITE MONTHLY SUMMARY FORM DISTRICT MONTHLY SUMMARY FORM
REGIONAL MONTHLY SUMMARY FORM
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C
D
E
F
H
I
J
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
ABBREVIATIONS AND ACRONYMS
AIDS
Acquired Immunodeficiency Syndrome
AMREF African Medical and Research Foundation
ARV
Anti-Retro Viral
CDC
Centres for Diseases Control
CD4
Cluster Differentiation Antigen 4
CD8
Cluster Differentiation Antigen 8
CHMT
Council Health Management Team
COUNSENUTH Centre for Counselling, Nutrition and Health Care
DNA
Diox-Nucleic Acid
DOT
Direct Observed Therapy (Treatment)
HAART
Highly Active Anti-Retroviral Therapy
HIV
Human Immuno-Deficiency Virus
IEC
Information Education and Communication
ITECH
International Training and Education Centre on HIV
JICA
Japan International Cooperation Agency
MOHSW
Ministry of Health and Social Welfare
MUHAS
Muhimbili University College of Health and Allied Sciences
MUHIC
Muhimbili University Health Information Centre
NACP
National AIDS Control Programme
NNRTIs
Non- Nucleoside Reverse Transcriptase Inhibitors
NRTIs
Nucleoside Reverse Transcriptase Inhibitors
NTLP
National TB and Leprosy Programme
ORCI
Ocean Road Cancer Institute
PIs
Protease Inhibitors
PITC
Provider Initiated Testing and Counselling
PLHIV
People Living with HIV
PMTCT
Prevention of Mother-to-Child Transmission
RHMT
Regional Health Management Team
RNA
Ribo-Nucleic Acid
STIs
Sexually Transmitted Infections
TACAIDS
Tanzania Commission for AIDS
TB
Tuberculosis
TFNC
Tanzania Food and Nutrition Centre
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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THIS
Tanzania HIV and AIDS Indicator Survey
UNAIDS
Joint United Nations Programme on HIV and AIDS
VCT
Voluntary Counselling and Testing
WHO
World Health Organization
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
ACKNOWLEDGEMENT
The Ministry of Health and Social Welfare (MOHSW), wishes to acknowledge with sincere
gratitude all those who contributed to the production of this Voluntary HIV Counselling and
Testing (VCT) Training Package.
We acknowledge, with special gratitude, the financial and technical support provided by
different Partners towards production of this package. These include:
• Japan International Cooperation Agency (JICA)
• African Medical and Research Foundation (AMREF)
• Centre for Disease Control (CDC)
• World Health Organisation (WHO)
We recognize with appreciation, the technical contribution of the three Consultants namely
Ms Ayako Nakazato (JICA), Mr. Benny Muga Lugoe (AMREF) and Mr. Boniface Magessa
(AMREF). Their contribution in preparing initial drafts and their guidance to the Technical
Working Group Teams made this document possible.
We specifically wish to thank the Technical Working Group who on various occasions
met with Consultants to enrich the document and make it much more users friendly. The
Technical Working Group Team comprised of experts from the following organizations:
• Tanzania Commission for AIDS (TACAIDS)
• Ministry of Health and Social Welfare (MOHSW)
- National AIDS Control Programme (NACP)
- National TB and Leprosy Programme (NTLP)
- Ocean Road Cancer Institute (ORCI)
• African Medical and Research Foundation (AMREF)
• Morogoro Zonal Training Centre
• Japan International Cooperation Agency (JICA)
• Bugando Medical Centre (Bugando School of Nursing)
• World Health Organization (WHO)
• Muhimbili National Hospital
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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• Centres for Diseases Control (CDC)
• Muhimbili University College of Health and Allied Sciences (MUHAS)
• Muhimbili University Health Information Centre (MUHIC)
• International Training and Education Centre on HIV (ITECH)
• Representatives from Regions and Districts
Finally, the Ministry of Health and Social Welfare thanks all those who contributed in one way
or another in the development of this manual, as it is not possible to mention them all here.
Dr. Deo M. Mtasiwa
Chief Medical Officer
Ministry of Health and Social Welfare
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
PREFACE
The need for comprehensive and standardized services for Voluntary HIV Counseling and
Testing (VCT) and a package for training has been felt for a long time. The training of service
providers on VCT has been conducted in this country for more than a decade by Ministry
of Health and Social Welfare (MOHSW) in collaboration with other Implementing Partners.
However, during this period there were no standardized Training Package creating diversity
in skills and knowledge for voluntary counseling and testing.
The newly developed VCT training package will be of significant help in several ways. Firstly,
it will provide standardization in the training and provision of VCT services in Tanzania.
Secondly, services providers will be able to offer high quality VCT services to the targeted
beneficiaries who include mothers who attend reproductive and child health, and family
planning services in order to prevent transmission of HIV from mother to child.
It is thus expected that this service provider manual will be effectively utilized in the efforts to
scale up provision of VCT services in the country.
Lastly, users of this training package are encouraged to provide the MOHSW with the
necessary feedback so that their comments and opinion forms part of the continuous
revision and updating.
Wilson C. Mukama
Permanent Secretary
Ministry of Health and Social Welfare
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INTRODUCTION
Aims and Objectives of HIV Counsellor Training
Aims
To contribute to national efforts for the response towards HIV in the aspect of prevention
care and treatment and support through provision of client initiated voluntary counselling and
testing services
General Objectives
To equip service providers with knowledge and skills for providing high quality client initiated
voluntary counselling and testing services to enable everyone to know his/her HIV serostatus
Background
Since the first three AIDS cases were reported in Tanzania in 1983, the HIV and AIDS
epidemic has been growing steadily over the years. According to the NACP HIV and AIDS/
STI Surveillance Report No 19 of 2005 up to the year 2004, 1,840,000 (860,000 males and
980,000 females) were living with HIV and AIDS in the country Eighty per cent of them are
in the productive age group of 20-49 years. In tandem with this development, the availability
of HIV counselling and testing in particular Voluntary Counselling and Testing services has
increased gradually since 1995. Currently there are over 1072 VCT sites all over the country.
The Tanzania HIV Indicator Survey (THIS) shows that only 15% of the population has
accessed VCT services. This means that more work has to be done. Hence the effort for
standardized training material for training more HIV Counsellors
Voluntary Counselling and Testing provides an opportunity to access accurate and
comprehensive information on HIV and AIDS. It is a significant entry point to prevention,
care, treatment and support programmes. VCT enables a person to confidentially find
out and understand his or her risk of HIV infection. It also provides an opportunity to fully
understand the implications of one’s sero-status and learn about lifestyles for protecting and
preventing further spread of HIV infection to other non-infected persons. Also, VCT facilitates
informed decisions about HIV testing.
For those who test positive, counselling helps them to develop plans for coping with stress,
possible stigma, psychological, and social effects. Counselling also provides referrals to
appropriate facilities for care, support and treatment. Furthermore, VCT promotes more
informed choices for future actions.
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
Training of VCT Counsellors
Different training approaches with different durations and curricula have been used. This
training guide, which has been developed from a standard curriculum, is the answer to the
strong demand for training more Counsellors using standardized curricula in accordance to
the National Guidelines for Voluntary Counselling and testing. This training guide has been
developed to carter for candidates to be trained as Counsellors who are drawn from health
care workers and non-health care workers such as teachers, social workers and religious
workers.
How to use this manual
This manual complements the Trainers Guide used by the facilitator. In turn the manual itself
is complemented by the handouts, which will be given from time to time during training
The course participant is advised to use the manual for reflecting on the sessions of the day
by answering the questions given in each session. The participant is strongly advised to take
time for self-reflection and self-assessment in order to adapt to the counselling situation.
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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MODULE
Self-Awareness
1
Overview
Self-awareness is the explicit understanding that one exists; it includes the concept that one
exists as an individual separate from other people. Self-awareness requires honesty and
courage to get in touch with what one is thinking and feeling and to face the truth about
oneselfs. The starting point for self-awareness should be the knowledge of oneself as a unique
individual and how one relates to others and the environment around him/her. Self-awareness
depends on the clarity with which one can answer the questions:
• Who am I?
• Where have I been?
• Where am I going?
Clear answers to the questions will determine ones
capability to chart own destiny and realise ones
potential.
This module will build skills for self-awareness and
enable trainees to have self-esteem and realize
their role in influencing a counselling process. In
particular the module will cover
Session 1 Introduction (M1-1)
Session 2 Getting to Know Each Other (M1-2)
Session 3 Values (M1-3)
Session 4 Self- Concept (M1-4)
Session 5 Language of HIV (M1-5)
1
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE
M1-1 1
Session 1
M1-11
Module
Introduction (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Interact with other people through introductions
2. Acknowledge themselves and their influence to relations
3. Assert their self-esteem
Exercise questions:
As the introduction continue note down the experiences that you would like to share and the
names of the person who has that experience
Limit these to a minimum and set out how you will go about achieving the goal of sharing the
experience
Self-reflection guide for the session:
• Reflect on how you would feel if
• Every time you met a group of people you are not introduced
• Most times friends gave positive comments about you
• Most time friends gave negative comments about you
Summary of the important points to note:
• People always make an impression on each other in one way or another in the time that
we stay together.
• Every one has some positive things that we would like to say to each other, We should
always remember to tell each other the good things.
• Giving positive comments to a client can influence and enhance the counselling
process.
• Seeing a positive virtue in another person starts from self-awareness where one can
realize that being human has limitation. That every human being has own strengths and
weaknesses.
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
2
M1-2
Module
1 Session 2
(60min)
Getting to Know Each Other
MODULE
M1-11
Objectives:
At the end of this session trainees are expected to be able to
1. Assess themselves and their abilities
2. Identify their influence to a relationshi
Exercise questions:
1. List down the lessons you learn from the group as people continue to share their
experiences
2. Discuss with your neighbour what happens when a person shares a difficult experience/
situation
Self-reflection guide for the session:
Arrange for some private time to assess yourself critically using the following guiding
questions
1. What are my strengths?
2. What are my weaknesses?
3. How do other people describe me?
4. Do I agree with their description? Why or Why not?
5. What are two situations when I was most at ease?
6. What specific elements were present when I felt that way?
7. What type of activities did I enjoy doing as a child and now?
8. What motivates me? Why?
9. What are my dreams for the future?
10.What steps am I taking to achieve my dreams?
11.What do I fear most in life? Why?
12.What qualities do I like to see in people? Why?
13. Do I have many friends as I have described? Why or Why not?
3
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE
1
M1-2 M1-21
Module
14.What stresses me?
15.What is my typical response to stress?
16.When I disagree with someone’s viewpoint, what do I do?
Summary of the important points to note:
• Valuing other people starts with valuing yourself and therefore having a healthy selfesteem
• Healthy or good self-esteem is based on a person’s ability to asses himself/herself
accurately and still be able to accept and to value himself/herself unconditionally
• Healthy self esteem leads to a full and happy life
• Healthy self-esteem creates confidence when sharing with other people
• Experiences from childhood play a big role in the development of self-esteem
• Sharing difficult situations acts a pressure release valve and helps a person to feel
relived.
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
4
M1-3
Module
1 Session 3
MODULE
M1-31
Values (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify their preferences
2. Justify their choices
3. Accept other people’s values
Exercise questions:
List some of the value that you have which are guided by:
-- The family
-- Your community
-- Your client
-- Your church/mosque
Self-reflection guide for the session:
• How would you feel if a client offered you a present in appreciation of the good
counselling service?
• What would you do in response?
Summary of the important points to note:
• Values are your internal worth
• They guide what you stand for and what you do not like
• The family, religion, community, culture and environment influence the development of
a person’s values
• When a person makes decisions against his/her values, then his/her conscious haunts
his peace of mind
5
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MODULE
M1- 4 1
Session 4
M1-41
Module
Self-Concept (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe themselves in different ways e.g. self image, ideal self and self esteem
2. Explain ways of improving self-concept
Exercise questions:
• How does your physical figure contribute to how you behave?
• Have you aspired to become a personality that you have failed/succeeded to
achieve?
• How has this failure/success affected your performance in other issues?
Self-reflection guide for the session:
• How often do you feel ashamed/proud of the fact that you are tall/short/fat/slender/light
complexion/black?
• How have you faired in trying to achieve the good person you would like to be? Is it as
expected or not? Why?
Summary of the important points to note:
• Self-concept is ways people organize and interpret their inner world of personal
existence.
• Three major qualities of self-concept are that it is learned, organized, and dynamic.
• Individuals have within themselves relatively boundless potential for developing a
positive and realistic self-concept.
• This potential can be realized by people, places, policies, programs, and processes
that are intentionally designed to invite the realization of this potential
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MODULE 1
M1-5
Session 5
Language of HIV (60min)
Objectives:
At the end of this session participants are expected to be able to:
1. Discuss the challenges involved in sex and sexuality communication
2. Identify language for positive images of people living with HIV as portrayed in the
media
3. Identify language for negative images of people living with HIV as portrayed in the
media
Exercise questions:
Identify situations where it would be easy to talk about sex and sexuality and therefore about
HIV and AIDS
How can you take advantage of such situations to educate others about HIV and AIDS?
Self-reflection guide for the session:
How would you talk to a friend about HIV and sexuality without embarrassments?
Summary of the important points to note:
In most customs and cultures in Tanzania talking of sex and sexuality issues in public is a
taboo. As a Counsellor learn to move away from the taboo approach to open approach,
especially when you are dealing with clients
This will help clients to open up and finally make informed decisions for positive behaviour
change
7
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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MODULE
Basic Information on HIV and AIDS
Counselling and Testing
2
Overview
Increases in HIV and AIDS
prevalence over the last decade
further aggravate the health
status and future prospects of
Tanzanians. It undermines the
foundations of development and
attainment of the Millennium
Development Goals and national
targets. Knowledge available
has succeeded in raising
people’s awareness, but this
has not translated into required
behavioural changes.
The counsellor needs to know this situation and be well versed in basic information on HIV and
AIDS, testing and counselling. Testing and counselling opens the door to care and treatment.
Hence in order to help clients to assess accurately possible risks associated to their behaviour
a Counsellor need to be knowledgeable in basic facts about HIV and AIDS and the process
and advantages of testing and counselling
This module provides opportunity and activities to learn about these important issues which
are a tool for the Counsellor
This module therefore will cover the following topics
Session 1 Basic Information on HIV and AIDS (M2-1)
Session 2 The Body Immune System and HIV (M2-2)
Session 3 The trends of HIV and AIDS situation (M2-3)
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
M1- 4 Module 2
Session 4 Modes of HIV Transmission and Related Risk Factors (M2-4)
Session 5 HIV Prevention Strategies (M2-5)
Session 6 Myth and Misconception About HIV and AIDS (M2-6)
Session 7 Terms Used in HIV Testing (M2-7)
Session 8 Introduction to HIV Testing (M2-8)
Session 9 The role of Voluntary Counselling Testing in HIV Prevention, Care And Coping (M2-9)
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
10
M2-1
Module
2 MODULE
M1-52
Session 1 Basic Information on HIV and AIDS (60min)
Objectives:
At the end of this session trainees are expected to be able to
1.Define HIV and AIDS
2.Give the differences between HIV and AIDS
3.Discuss types of HIV
Exercise questions:
What do the acronym HIV represent?
Give the full form of AIDS.
Explain the difference between HIV and AIDS
Self-reflection guide for the session:
If the army of a country was killed and then invaders come to attack the country, what would
be the result?
Relate this situation to the defence mechanism of the body
Summary of the important points to note:
HIV is a virus that enters the human body and attacks the body immune system
Then all other diseases can attack the body easily and a person gets very ill and may die.
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE
M1- 4 2
Session 2
M2-22
Module
The Body Immune System and HIV (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the immune system
2. Describe how HIV destroys the immune system
3. Explain the WHO clinical staging
Exercise questions:
How does the HIV destroy the body immune system?
Can the CD4 cells reconstruct themselves after HIV has attacked them?
How does HIV multiply itself?
Self-reflection guide for the session:
Reflect on risk behaviours that you have been through that may have put you at risk of HIV
infection
If you were in the same situation today would you act the same way?
Summary of the important points to note:
The body immune system is body mechanism of fighting disease
White blood cells, called leukocytes, form the immune system
HIV enters the body system, it invades and destroys the CD4 Cell
When enough CD4 Cells are destroyed, all kinds of other diseases like tuberculosis (TB) germs
can enter without being stopped by the immune system.
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M2-3
Module
2 Session 3
MODULE
M1-52
The Trends of HIV and AIDS Situation (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss the global and regional situation of HIV
2. Explain the current disease, patterns and trends of HIV and AIDS spread in Tanzania
3. Discuss the impact of HIV and AIDS on individuals, families, society and institutions
Exercise questions:
What is the HIV prevalence in your Ward, district and regions?
What age groups are affected more by HIV infection?
List some of the impacts of HIV and AIDS that you have witnessed in your community
Self-reflection guide for the session:
What can be done by an individual like yourself in the response towards the spread of HIV ?
Summary of the important points to note:
The first three AIDS cases in Tanzania were reported in 1983 in Kagera region. By 1986, all
regions in Tanzania Mainland had reported AIDS cases
By December 2004 1,840,000 (860,000 males and 980,000 females) were living with HIV and
AIDS
The average prevalence rate is seven percent with women at a slightly higher rate (7.7) than
men (6.3)
It also varies between urban and rural settings
HIV AIDS has had tremendous impacts on individuals and the country.
13
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE 2
Session 4
(60min)
M2-4
Modes of HIV Transmission and related Risk Factors
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss modes of HIV transmission
2. Explain the relationship between STI and HIV transmission and STI/RTI
3. Identify risk behaviours in transmission of HIV transmission
4. Discuss the HIV progression
Exercise questions:
Identify risk factors for HIV transmission
Self-reflection guide for the isession:
Think of some risk factors that may have brought you on the verge of contacting HIV
Summary of the important points to note:
A person can get infected when there is interaction between his/her body fluid and that of an
infected person. It could be through any of the following means.
-- Unprotected sexual intercourse
-- Blood transfusion
-- Sharing sharp instruments
-- From mother to child during pregnancy, at birth or during breastfeeding
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
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MODULE 2
M2-5
Session 5 Prevention Strategies (60m)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss HIV prevention strategies
Exercise questions:
What preventive measures do you think are most effective? Why?
Self-reflection guide for the session:
• What part of the ABCDE principle for HIV prevention fits in my values?
Summary of the important points to note:
There are several HIV prevention strategies. The key strategies are around the principles of
(ABCDE) that is: abstain, be faithful, use a condom, disclose and empower.
They are:
• Control of STIs
• Advocating for correct and consistent use of condom
• VCT for behaviour change and entry to care and support
• Reduction of mother to child transmission
• Life skills and sex education to youth
• Instituting workplace programmes
• Paying special attention to vulnerable groups
• Providing safe blood and blood products
• Encourage male circumcision
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE 2
M2-6
Session 6 Myth and Misconception About HIV and AIDS (60m)
Objectives:
At the end of this session trainees are expected to be able to
1.Identify myths and misconceptions about HIV
2.Discuss myths and misconceptions about HIV
Exercise questions:
Discuss with you neighbour about the truth or falsehood of the statements in the table below
and complete the answers
SENTENCE/STATEMENT
CHOICE-TRUE/FALSE
You can be infected with HIV by hugging with a person who has the virus
You can be infected with HIV by sharing eating utensils with a person living with HIV and AIDS.
A person with STIs is at an increased risk for HIV
infection.
HIV can be transmitted by mosquito bite.
HIV positive pregnant woman can pass the virus to
her unborn baby before and after delivery.
The major means of HIV transmission is through
sexual contact.
One can be infected with HIV by eating food prepared
by a people living with HIV and AIDS.
If you are given blood transfusion with HIV positive
blood, you will automatically acquire the virus.
Self-reflection guide for the session:
Think carefully of some myths about HIV that have made you uneasy at one time or the
other
Summary of the important points to note:
Myths, rumours and misconceptions are often passed around as fact.
Session 7 Terms Used in HIV Testing (60m)
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MODULE 2
M2-7
Objectives:
1. At the end of this session participants are expected to be able to:
2. Define consent, informed consent, confidentiality, shared confidentiality and
anonymous
3. testing
4. Discuss the meaning of confidential and anonymous testing
5. Define the concepts of confidentiality and informed consent for HIV testing
Exercise questions:
Discuss with friends the advantages of
• Confidentiality
• Anonymity
• Shared confidentiality
Self-reflection guide for the session:
• How would you feel if everyone knew personal information that you do not want
known?
• Summary of the important points to note:
• Informed consent is deliberate permission given by a client to a health care provider to
proceed with the proposed HIV test procedure
• Due to the stigma that is often attached to HIV and AIDS, it is of critical importance that
clients who come out to be tested be treated with utmost confidentiality
• Shared confidentiality is the release of a client’s sero-status information to others with
the consent of the client
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MODULE 2
M2-8
Session 8 Introduction to HIV Testing (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define principles of HIV testing
2. Discuss assay characteristics (sensitivity, specificity, predictive value)
3. Explain the meaning of HIV test results including false positive and false negative
4. Describe the National HIV testing algorithm
Exercise questions:
• Describe how the rapid assay work in testing for HIV
Self-reflection guide for the session:
• How does a counsellor improve the accuracy in HIV testing?
Summary of the important points to note:
• The commonly used rapid tests use the principle of agglutination or immunobinding
(dot blot) or immunochromatographic (ICT) techniques of a diagnostic assay can have
two meanings:
• The ability of the test to detect very small amounts of the analyte (e.g. antibody).
• The ability to detect truly infected individuals (no false negative)
• Specificity of a test is the incidence of the analyte in the specimen that has it. Or the
ability of the test to identify all negative individuals correctly (no-false positive)
• Each biological assay has the potential to give false positive or false negative results. It
is therefore possible to have:
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MODULE 2
M2-9
Session 9 The role of Voluntary Counselling Testing in HIV
Prevention, Care and Coping (60min)
Objectives:
At the end of this session participants are expected to be able to:
1. Describe aims and objectives of voluntary counselling and testing
2. Discuss evidence that VCT reduces HIV transmission
3. Discuss evidence that VCT facilitates client behaviour change
4. Explain the role of VCT in partner notification
5. Discuss evidence that VCT reduces HIV transmission
Exercise questions:
• How does the existence of counselling and testing add value to HIV prevention
efforts?
• Self-reflection guide for the session:
• Is behaviour change possible within your community?
Summary of the important points to note:
The role of counseling and testing in HIV prevention and care is to achieve the following
• Access to early care and support
• Prevention of HIV Transmission
• Reduction of stigma and discrimination
• Planning for the future
• Increasing awareness and positive behavior change
• Adherence and compliance
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HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
20
MODULE
Counselling theories, Approaches
and Techniques
3
Overview
The Counselling Theory module
aims to give Counsellors
knowledge, skills and appropriate
attitudes from the different
approaches to counselling within
the therapeutic field. It aims
to locate these approaches
within their historical context,
and to develop Counsellors
understanding of a number of key
concepts and theories namely
Psychoanalytic theory, Behaviour
theory, Cognitive behavioural
theory and Humanistic theory It
aims to assist the Counsellors in
understanding that there are different approaches to working with clients, and to highlight
some of the ways in which the theories and clinical practices differ and may be similar. The
module will help the counsellor to develop the relevant knowledge and skills to perform their
work within the context of the theories.
The module will therefore cover the following topics
Session 1 Counselling Theories: Overview (M3-1)
Session 2 Counselling Theories: Psychonalytic (M3-2)
Session 3 Counselling Theories: Behavioural (M3-3)
Session 4 Counselling Theories: Cognitive (M3-4)
Session 5 Counselling Theories: Humanistic (M3-5)
Session 6 Basic Communication Skills: Overview (M3-6)
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Session 7 Basic Communication Skills: Effective Communication (M3-7)
Session 8 Processes and Practice of Counselling: Overview (M3-8)
Session 9 Processes and Practice of Counselling: Basic Stages (M3-9)
Session 10 Processes and Practice of Counselling: Supportive Counselling Skills (M3-10)
Session 11 Processes and Practice of Counselling: Counselling barriers (M3-11)
Session 12 Processes and Practice of Counselling: National VCT Guideline (M3-12)
Session 13 Characteristic of an Effective Counsellor (M3-13)
Session 14 Roles of an Effective Counsellor (M3-14)
Session 15 Counselling: Listening and Questioning Micro Skills (M3-15)
Session 16 Counselling: Silence Micro Skills (M3-16)
Session 17 Counselling: Non-Verbal Behaviour Micro Skills (M3-17)
Session 18 Pre-Test Counselling Overview (M3-18)
Session 19 Pre-Test Counselling: Identification of Risk Behaviours (M3-19)
Session 20 Pre-Test Counselling: Development of Risk Reduction Plan (M3-20)
Session 21 Pre-Test Counselling: HIV Test Results and Likely Reactions (M3-21)
Session 22 Post-Test Counselling: Provision of Negative HIV Test Results (M3-22)
Session 23 Post-Test Counselling: Adherence to Risk Reduction Strategies (M3-23)
Session 24 Post-Test Counselling: Provision of Positive HIV Test Results(M3-24)
Session 25 Post-Test Counselling: Coping (M3-25)
Session 26 Supportive Counselling: (M3-26)
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MODULE 3
M3-1
Session 1 Counselling theories: Overview
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Explain the four counselling theories
2. Describe an area within which counsellors can make sense of the clients, problems, issues
and behaviour
Exercise questions:
• What is it necessary to develop various theories in counselling?
• Do the theories have any relationship with the practice of counselling?
• How do the knowledge of the theories help a Counsellor in performing his/her duties?
Self-reflection guide for the session:
Will the theories help me select the correct counselling methods for my clients?
How do these theories help me to assess myself in relation to my clients?
Summary of the important points to note:
Counselling theories traditionally have been grouped according to their common underlying
principal, this theory includes;
-- 1.Psychoanalytic theory
-- 2.Behaviour theory
-- 3.Cognitive theory
• Theories tell us why people do what they do
• Theories provide the justification for Counselling and a basis on which practice is
founded
• Counsellors deal with people, their emotions and feelings and their vulnerabilities
• Counsellors have a responsibility to inform their clients about when they can help and
they cannot help - Counselling is a helping service, but it cannot help in all cases
• Counselling as profession depends on established theories to develop counselling
methods which area:
-- Person/client -centred/non-directive method
-- Clinical/Counsellor-centred/directive method
-- Eclectic method (Eclecticism)
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MODULE 3
Session 2
M3-2
Counselling Theories: Psychoanalytic (60min)
Objectives:
At the end of this session trainees are expected to be able to
1.Relate Psychoanalytic theory components to counselling
2.Apply the components of Psychoanalytic theory in counselling
Exercise questions:
How does the Psychoanalytical theory help a Counsellor in helping the client
Does application of the theory lead to identifying issues of denial, transference and countertransference?
How does transference affect the relationship of a Counsellor to the client?
Self-reflection guide for the session:
How should I act if my client treats me as if I were another person in the client’s present or past
life and develop feeling of affection?
What would be the effect if I treated the client in the same manner and developed feelings of
affection?
Summary of the important points to note:
Sigmund Freud; an Australian psychiatrist (1856-1939) developed the Psychoanalytical
theory
His work centred on the unconscious mind and investigated the drives and impulses for
behaviour
This theory rely on Counsellor or therapist, who is the major player, directs the client to do
what he/she feels can help in solving the client’s problem
The theory works on four assumptions
That the motivation for behaviour comes from the unconscious mind and from the body.
That individual’s problems are rooted in early childhood experiences and that are invariably
sexual in character.
The therapist is an expect who　listens to the ``patient` and treats the patient as if he or she
were in need of help.
That psychoanalysis involves a long and time and time-consuming commitment.
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MODULE 3
M3-3
Session 3
Counselling Theories: Behavioural
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Relate behavioural theory components to counselling
2. Apply the components of behavioural theory in counselling
Exercise questions:
• Is change in general behaviour possible for an adult?
• What factors would an adult consider in order to make sexual behaviour change?
Self-reflection guide for the session:
• What sacrifices would I have to make in order to change my current sex behaviour?
• What sacrifices would my sex partner have to make in the same behaviour change?
Summary of the important points to note:
• Behavioural theory is based on the premise that preventing HIV transmission requires
either reinforcing safe behaviours changing unsafe ones.
• Behaviour Counselling; the Counsellor takes a directive role, believe that he/she is there
to help the client and that the Counsellor has something to offer to help the client solve
a problem
Benefits and limitations of applying behavioural theory in relation to VCT:
• In VCT, behaviour change is an important goal. Behaviour theory of Counselling can be
very significant.
• Behavioural theories emphasize the responsibility of the client and focus on action
planning and self – management. This emphasis is strongly relevant to planning riskreduction strategies.
• Behavioural theory is not focused on the emotional responses of the client or the
way in which the past will influence the present. It can therefore feel a little cold and
mechanical.
• Behaviour theory works much faster than psychoanalysis, behavioural therapists usually
see clients for a number of sessions whereas the majority of clients for VCT are seen
only once.
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MODULE 3
Session 4
M3-4
Counselling Theories: Cognitive
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1.Relate cognitive theory components to counselling
2,Apply the components of cognitive theory in counselling
Exercise questions:
• How does behaviour change relate to adaptation and growth?
• Does the environment of a person contribute to behaviour change especially in sexual
issues?
Self-reflection guide for the session:
• How does my environment help or hinder me in implementing changes for sexual
behaviour at all times?
Summary of the important points to note:
• The cognitive theory concludes that development is a process of adaptation and active
seeking to understand the environment
Benefits and limitations of applying cognitive theory in relation to VCT:
• As with behaviour Counselling, cognitive behaviour focuses on behaviour change,
which is the key aim of VCT.
• It allows for wide interpretation than behaviour Counselling and allows for childhood’s
influences to be considered.
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MODULE 3
M3-5
Session 5 Counselling Theories: Humanistic (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Relate humanistic theory components to counselling
2. Apply the humanistic theory in counselling
Exercise questions:
• How does relationship building help the counselling process?
• In the counselling flow which depends on the humanistic theory, who makes the
decisions for action plan?
Self-reflection guide for the session:
• How effective would my counselling be if I did not build a relationship with my client but
instead went on straight into the exploration stage?
Summary of the important points to note
• The humanistic theory believes in the basic goodness of human nature and inherent
desire of individuals to achieve higher level of functioning.
• The humanistic theory leads to the client-centred counselling and suggests a particular
Counselling process with the following four stages
• Relationship building
• Exploration-Counsellor facilitates client to look at the issues that concern him or her
• Understanding: It occurs after the issues have been identified and prioritised for
action.
• Action plan-Counsellor and client have drawn up a plan of action that the client can
implement.
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MODULE 3
Session 6
M3-6
Basic Communication Skills: Overview (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define communication
2. Identify types of communication
3. Explain the components of communication
4. Explain principles of an effective communication
Exercise questions:
• Why is communication necessary in any relationship?
• Discuss the importance of communication to a Counsellor.
Self-reflection guide for the session:
• Do I communicate effectively with other people in my daily encounter?
• What do I have to do in order to improve my communication skills?
Summary of the important points to note:
• Communication is a means of getting your feeling to reach the other person. It may
build or break a relationship
• It may build or break a relationship
• Communication can be either Verbal: Uses words in such applications as speaking,
writing, listening and reading or Nonverbal: Employs gesture expressions, movements
and actions and reactions.
• Effective communication is communication that ensures the correct message from the
sender reaches the receiver. It involves the ability to listen, pay attention, perceive and
respond non-verbally and/or verbally. It also involves seeking for clarification and getting
the answers.
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MODULE 3
M3-7
Session 7 Basic Communication Skills: Effective Communication
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss communication barriers and bridges
2. Identify effective communication skills
Exercise questions:
• How does interrupting contribute to communication barriers?
• What are the skills that are needed for effective communication?
• Why does counselling encourage the use of open-ended questions?
• Self-reflection guide for the session:
• What are the situations when I have contributed to communication barrier?
• Could I have acted differently in those situations?
• In what situations can I use patience as a bridge to communication?
Summary of the important points to note:
• Barriers may hamper effective communication. It is important that you identify the
barriers and build abilities to overcome them
• Barriers are what people do or say that will hinder communication. Therefore as
counsellor it is important to identify the barriers and build abilities to overcome them
• Barriers may be due to perception, semantics, means of communications and other
interferences
• Bridges are things that people do or say that help to enhance effective communications.
Bridges are used to overcome barriers to effective communication.
• In life communication will always contain barriers and bridges. It is those who are
communicating to increase the bridges in order to improve communication.
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MODULE 3
Session 8
(60min)
M3-8
Processes and Practice of Counselling: Overview
Objectives:
At the end of this session trainees are expected to be able to
1. Define Counselling
2. Define concepts: guidance, counselling, advising and health education
3. Describe the importance of counselling to clients
4. Identify types of counselling
5. Differentiate counselling from health education
Exercise questions:
• Give the differences between counselling and guidance
• How does counselling differ from health education?
• In what situations does a Counsellor decide to apply health education instead of
counselling?
Self-reflection guide for the session:
• How did I feel the last time I had a burning issue and went to a friend for advice?
• What did he/she tell me?
• What did I do in response to what he/she told me?
• Was this advice or counselling
Summary of the important points to note:
• Guidance is a process of helping an individual achieve the self-understanding and selfdirection necessary to make maximum adjustment to their life at home, school, work
or in the community.
• Counselling is a professional helping relationship of trust that aims at helping the client
to make informed choices
• Is a helping relationship or helping interaction which occurs, between a counsellor and
a client, families and couples which is initiated and maintained as a means of facilitating
change in the behaviour of the client(s).
• Is a social of providing/giving individual general information without taking into
consideration whether the information is needed? Normally a senior individual offers
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MODULE 3
M3-8
advice or peer based on experience.
• Advices come from a kind of superiority complex. “I know your problem; if you do as
I tell you, you will be o.k.” This is the attitude behind advice giving. Sometimes, an
individual may
• find it difficult to follow the advice. In some cases advising may cause a state of
inferiority, frustration and resentment for an individual.
• Is a process of giving health information to individual or group families and community
aiming at a behaviour change (one is expert on the subject)
• Health education is an important tool for counsellors where a counsellor teaches
constantly giving new information, separating fact from myth and informing clients
about available resources
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MODULE 3
M3-9
Session 9 Processes and Practice of Counselling: Basic Stages
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify the four basic stages of counselling (REUNDA)
2. Apply the basic stages of counselling
Exercise questions
• Why does a Counsellor need the basic skills?
• How does the additional social skills improve the counselling?
• Does the sitting posture and welcoming face have to anything do with the comfort of
the client?
Self-reflection guide for the session
How would I feel if someone wanted some personal information from me without getting to
have a close relationship with me?
Summary of the important points to note
There are four basic stages in counselling process
• Relationship building
• Exploration
• Understanding
• Action plan
The four stages in the counselling process is remembered by the acronym “REUNDA”
R – Relationship building
E – Exploration
Und – Understanding
A – Action plan
Additional social skills include respect, trust and sense of psychological comfort warmth,
questioning and summarization, nodding.
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MODULE 3
M3-9
In attending to a client it is important to sit in a welcoming posture described by the
summary
S- Sit squarely, sits down near the door and sitting in a V shape position is considered a
posture of involvement. The quality of your presence is most important
O - Open posture should be adapted. Crossing the leg and arms can be sign of lessened.
L – Lean forward towards the client at times is a natural sign of involvement.
E - Eye contact should be maintained. (Eye contact with the person)
R – Relaxed
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MODULE 3
M3-10
Session 10 Processes and Practice of Counselling: Supportive
Counselling Skills (60min)
Objectives:
At the end of this session trainees are expected to be able to
1.Identify supportive counselling skills
2.Apply supportive counselling skills
Exercise questions:
• Why are the basic skills not used alone in a counselling session
• How do the supportive counselling skills help to get information from the client
Self-reflection guide for the session:
• In any communication encounter what factors would make me feel uneasy?
• What would happen if I applied the same factors to someone else?
Summary of the important points to note:
Specific supportive counselling skills are tools a counsellor uses in order to get information
from a client in order to build a relationship, assess the presenting problem understand the
problem and be able to lead a client reach a solution. They include
• Attending behaviour
• Empathy
• Warmth
• Trust
• Respect
• Genuineness
• Concreteness
• Questioning
• Summarization
• Self-disclosure
• Paraphrasing
• Confrontation
• Reflection of feelings and the use of minimal encouragers.
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MODULE 3
M3-11
Session 11 Processes and Practice of Counselling: Counselling
Barriers (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify counselling barriers
2. Use appropriate strategies to overcome counselling barriers
Exercise questions:
• What factors cause resistance from a client?
• What forms would resistance from a client take?
Self-reflection guide for the session:
• If I developed a feeling of affection towards my client would I tell my immediate supervisor,
my colleague or just keep silent about it and continue with the counselling?
Summary of the important points to note:
• The counselling process is not always smooth, sometimes the process is block or
hindered by various factors.
• Resistance can occur at any time in the helping relationship. It typically surfaces when
the client does not appear to collaborate in developing the helping relationship or
striving towards goals.
• When resistance occurs it should be dealt with from a client’s understanding. The client
should never be accused of being restrictive.
• Developing a feeling of affection towards a client or from a client towards a counsellor
causes transference or counter-transference
• When transference is diagnosed it must be dealt with adequately in order to facilitate
healthy growth during counselling.
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MODULE 3
M3-12
Session 12 Processes and Practice of Counselling: National
VCT Guideline (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss the National VCT guideline
2. Relate the guideline to HIV counselling
Exercise questions:
• Why do we need guidelines in voluntary counselling and testing for HIV?
• What are the advantages of the VCT guidelines in the practice of providing the
service?
Self-reflection guide for the session:
• What guidance do I need from the VCT guidelines?
Summary of the important points to note:
• The national VCT guidelines have been developed to provide VCT services with a
framework within which to operate
• Discusses all the factors, conditions, and requirements for VCT operation
• Full details are available in the National Guideline for Voluntary Counselling and Testing,
2005 (NACP)
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MODULE 3
M3-13
Session 13
Characteristic of an Effective Counsellor (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define a Counsellor
2. Identify qualities/characteristics of an effective counsellor
3. Describe the values and attitudes of an effective counsellor
Exercise questions:
• Who is a Counsellor?
• What are the qualities of an effective Counsellor?
• Why doe a Counsellor need to have good attitude towards people
Self-reflection guide for the session:
• Do I have the right qualities, attributes and attitudes to make an effective Counsellor?
• Where do I lack some of the qualities, attributes and attitudes?
• Where do I need to change and adjust?
Summary of the important points to note:
• A counsellor is a person who cares and is interested in helping others in need and is
knowledgeable about counselling, with positive regard to fellow human beings.
• In particular a Counsellor is a change agent in HIV and AIDS and is responsible
for influencing and sustaining behaviour change among individuals, couples, and
communities.
• In order to perform his/her duties the Counsellor must have acceptable qualities,
attributes and attitudes
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MODULE 3
Session 14
M3-14
Roles of an Effective Counsellor (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify the roles of an effective counsellor
2. Describe the impact of Counsellor’s values and attitudes on client
Exercise questions:
• How do the values of a Counsellor affect his/her duties as counsellor?
• What measures does a Counsellor have to take in order to isolate his/her values from
his/her carrying out of the duties?
Self-reflection guide for the session:
• How often have I judged other people using my values as the yardstick?
• In such situations have I been fair to the individuals in question?
Summary of the important points to note:
• Roles of a counsellor are based on the goals of counselling, which are to counsel
people for behaviour change and coping
• A Counsellor should not judge people according to his/her values
• A counsellor should distinguish his/her problems from those of the client
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MODULE 3
M3-15
Session 15 Counselling: Listening and Questioning Micro Skills
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Use listening and questioning skill in counselling
2. Utilize silence as a communication tool in counselling
3. Interpret non-verbal behaviour in a counselling session
Exercise questions:
Why is it important to listen actively to the other person?
• Does listening involve close watching?
Self-reflection guide for the session:
• Evaluate your listening skills using the checklist below
S/N
NOMENCLATURE
YES/NO
When the other person starts to talk I always guess what they want to say
When the other person talks I always wait
until they finish then I reply
I normally get bored to listen for a long
time
I always save time during discussion by
interrupting the other person carefully
When I want a person to internalise a point
I keep silent for a while and then continue
to talk.
Summary of the important points to note:
• For effective communication listen actively and seek clarifications though asking
questions.
• Checking understanding
• Use questioning Skills effectively
• Answer questions correctly using verbal and non-verbal languages
• Interpret body language correctly
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MODULE 3
Session 16
M3-16
Counselling: Silence Micro Skills (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Use silence as a communication tool in a counselling session
Exercise questions:
• Does silence send any message to the listener?
• What effects does silence produce in a conversation?
Self-reflection guide for the session:
• How do I react when someone who is talking to me suddenly keeps silent?
Summary of the important points to note:
• A counsellor should not be afraid of “silences,” It gives time to think and reflect.
• Silence can be used to indicate contemplation and giving tie for a point to sink home.
• The Counsellor should also understand tat silence can serve many other functions in a
conversation and should be able to check them
• Effective communicators can allow silence when it’s effective or needed; can avoid
being pressured into “spilling” when silence is used manipulatively; offer silence as a
gift or sign of respect.
• Interpret the silence of others appropriately; understand how other cultures use silence;
mindfully regulate the use of silence; and are comfortable with silence and understand
its many uses.
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MODULE 3
M3-17
Session 17
(60min)
Counselling: Non-verbal Behaviour Micro Skills
Objectives:
At the end of this session trainees are expected to be able to
1. Interpret non –verbal behaviour in a counselling session
Exercise questions:
• What part does non-verbal language play in a counselling session?
• Does change of tone of a client send a message to the Counsellor?
• What signs would you watch for in a client during counselling session?
Self-reflection guide for the session:
• Do I control my body reactions in various situations?
• Are there efforts I need to do towards messages from my body language?
Summary of the important points to note:
• You must be aware of the message, which is not spoken, like the speaker’s tone of
voice, facial expression and body language.
• They can all communicate a message to you.
• Some body reactions that appear during communication vary from one person to
another
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MODULE 3
M3-18
Session 18 Pre-Test Counselling Overview (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define pre-test counselling
2. Establish a relationship of trust with a client and significant others
3. Assess clients knowledge on HIV and AIDS/STI/TB/ARV
Exercise questions:
• Why is it important to establish a relationship of trust with a client in pre-test
counselling?
• What would you do if you found out that the client has excellent knowledge of HIV and
AIDS, TB, STIs, ARV and family planning?
Self-reflection guide for the session:
• How do I start to get close to a new person I have just met?
• Do I have problems introducing myself to strangers?
Summary of the important points to note:
• Pre-test Counselling is the Counselling provided before an HIV antibody test
• During pre-test counselling a client is prepared psychologically for either a negative, a
positive and indeterminate test result
-- The first three steps in pre-test counselling are
-- Establish a relationship of trust.
-- Get to know your client better.
-- Assess client’s knowledge on HIV and AIDS, TB, STIs, ARVs and Family
planning.
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MODULE 3
M3-19
Session 19 Pre Test Counselling: Identification of Risk
Behaviours (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Help the client to identify risk behaviours HIV infection
2. Facilitate client to link HIV and risk behaviours
Exercise questions:
When a Counsellor is leading a client to assess risk behaviours and finds that the situation is
almost similar to his/her behaviour does the Counsellor conclude the expected result?
Self-reflection guide for the session:
• Do I feel bothered by getting knowledge which is very personal to a new person I have
just met?
• How much do I normally feel attached to other people’s information that comes to my
knowledge?
Summary of the important points to note:
• After the Counsellor has begun exploring various issues with the client, and after the
client has become more familiar with the subject, the Counsellor needs to assess the
client’s risk
• This involves the client sharing very personal information that the client may never have
shared with anyone else before;
• The Counsellor must show a great deal of sensitivity.
• Facilitate the client to link his/her knowledge of how HIV and AIDS with her/his risk
behaviours (Individualised risk assessment)
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MODULE 3
M3-20
Session 20 Pre-Test Counselling: Development of Risk Reduction
plan
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Facilitate the client to form a risk reduction plan
2. Assess ability of client for coping with the plan chosen
Exercise questions:
• How would you lead a client to form a doable risk reduction plan?
• Would you declare the client that a plan is not good if you felt it was not realistic?
Self-reflection guide for the session
• How would I feel if I saw that the plan chosen by the client is not realistic but he/she
chose to stick to it?
Summary of the important points to note:
• A personalized risk reduction plan is a key element of behaviour change-oriented HIV
Counselling
• The Counsellor assists the client in developing a specific risk reduction plan
• Finally the Counsellor elicits a commitment from the client to try to implement specific
behavioural changes before the next Counselling session.
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MODULE 3
M3-21
Session 21 Pre-Test Counselling: HIV Test Results and Likely
Reactions
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss various HIV test results with the client
2. Discuss clients likely reaction to test result
3. Discuss benefits of testing with the client
4. Get clients consent for testing
Exercise questions:
• What reactions would you expect from an HIV positive/negative client?
• Do you think everyone who gets a negative HIV test result is happy or overjoyed or
surprised or none of these?
Self-reflection guide for the session:
• What would be my reaction if a client told me that “If I get negative result I will henceforth
abstain from sex.”
Summary of the important points to note:
-- The Counsellor should initiate the conversation by asking the client what he/she
knows about
-- HIV test
-- Positive HIV test result
-- Negative HIV test results
• Discuss likely reaction of client to results
• Discuss benefits of testing for HIV
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MODULE 3
M3-22
Session 22
Post-Test Counselling: Provision of Negative HIV
Test Results (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define post-test counselling
2. Review clients knowledge on HIV and AIDS and meaning of HIV test results
3. Provide negative HIV test results and review window period
Exercise questions:
• Why do we need to do post-test counselling?
• What would happen if a client were given HIV test results without post-test
counselling?
• Self-reflection guide for the session:
• What would I do if a client presented a sad or indeterminate reaction after receiving
negative HIV test results?
Summary of the important points to note:
• Post-test counselling is a dialogue between a client and a counsellor when the HIV test
results are ready, and are about to be given to the client.
• The aims of post-test counselling are to discuss HIV test result, to help clients accept
their HIV test results, cope with their sero-status, to provide appropriate information,
• It also aims at helping the client to focus on the behaviour choices that they had made
during the pre-test counselling, encourage use of chosen risk reduction plan, support
and referral.
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MODULE 3
M3-23
Session 23 Post-Test Counselling: Adherence to Risk
Reduction Strategies (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Empower client to adhere to selected risk reduction strategy
2. Provide required referral for client
Exercise questions:
• Why do clients stray away from their plans?
• What would you do to help a client stick to his/her plan?
Self-reflection guide for the session:
• Will it be easy for me to help a client reinforce plans for remaining negative?
Summary of the important points to note:
• Discuss the challenges of staying negative and facilitate client to review plan of reducing
risk. (It helps to remind client that “Consider everyone else to be HIV positive except
you; unless proven otherwise! So challenges of staying HIV negative are real).
• Assess the internal and external barriers to change e.g. intention to tell their partner/
partners that they were tested, how, what may prevent the client from following their
plans
• Discuss whether the risk reduction plan is adequate and appropriate, (reinforcing the
ABC message; where A is abstinence; B is be faithful to one uninfected partner; and C
is correct and consistent use of condoms).
• Acknowledge and support the client’s strengths
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MODULE 3
M3-24
Session 24 Post-Test Counselling: Provision of Positive HIV test
Results (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Review clients knowledge on HIV and AIDS and meaning of HIV test results
2. Provide positive HIV test results
1. Discuss psychosocial support and significant others with client
Exercise questions:
• What preparation do you need to do before you call a client for post-test counselling
and the results are positive?
• How would you handle a crisis after giving positive results to a client?
Self-reflection guide for the session:
• Do I have the willpower to watch emotional reactions after providing positive results to
a client?
Summary of the important points to note:
• Review difference between being HIV positive and having AIDS.
• Review modes of HIV transmission and methods of prevention.
• Review meaning of HIV test results (HIV negative, HIV positive).
• For Counsellors, telling someone that you are HIV positive can be difficult and
uncomfortable
• Results should only be given to a client after a thorough preparation, which can be
achieved by conducting a sensitive pre-test and post-test Counselling.
• Counsellors should remember that almost always clients are not prepared for a positive
test results, no matter how prepared they might look, or reported to be
• Follow the relevant steps in giving positive HIV test result
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MODULE 3
M3-24
Session 25
Post-Test Counselling: Coping
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Facilitate client for reinforcement of coping strategies
2. Empower client for sex partner notification
3. Discuss benefits of early medical treatment and proper nutrition with the client
4. Discuss possible referrals with the client
5. Provide required referral for client
Exercise questions:
• Why is it important for empowering a client for partner notification?
• Why should you discuss with the client about possible referrals, nutrition and early
medical treatment of opportunistic infections?
Self-reflection guide for the session:
• Imagine yourself in the place of the client and think of the information you will require
at that time
Summary of the important points to note:
• Once the client knows his/her HIV status, the Counsellor must work with him/her to
revise the risk reduction plan discussed during pre-test Counselling
• Discuss practical actions for behaviour change
• Discuss the implication with the client and inform him that he/she has to adopt changes
in his/her lifestyle in order to remain “healthy” and prevent infecting others
• Discuss benefits of early medical treatment and proper nutrition with client
• Discuss possible referrals with the client
• Provide required referral for client
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MODULE 3
Session 26
M3-26
Supportive Counselling
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define supportive counselling
2. Discuss issues that can lead to a client to seek supportive counselling
Exercise questions:
• Why should a Counsellor provide supportive counselling?
• What issues would force a client to seek supportive counselling?
Self-reflection guide for the session:
• What attitude do I need to have in order to provide effective supportive counselling?
Summary of the important points to note:
• Supportive counselling is the long-term support for people living with HIV (PLHIVs). It
involves seeing a client on a regular basis, which can take a short time but also be over
a year.
• One important function of VCT in HIV is to link people who test positive with related
services, such as care and support options, skills training, and income generating
mechanisms
• Counsellors need to encourage HIV positive clients to explore ART where available and
feasible
• HIV positive clients can be referred to services that offer medical prevention and
treatment of OIs such as TB and pneumonia
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MODULE
Counselling for Specific Target
Groups and situations
4
Overview
The aim of sessions under
this module is to equip
trainees
with
special
counselling skills that will be
applied when counselling
clients
from
special
populations of clients who
differ in experiencing and
comprehending
events.
The sessions will empower
trainees to discuss and
explore counselling for
special needs of clients like
couples; family; children;
parents of HIV positive
children; pregnant women;
people with crisis and
people who are grieving.
After completion of this module, the trainees are expected to acquire knowledge, skills and
appropriate attitudes on assisting clients to find ways of coping with various situations, create
an action plan for establishing a support system and provide appropriate referral for specialized
services
The exposure of the trainees to own experience and emotions make them be reformed by
identifying coping styles that worked and that didn’t work for them. Trainees are also enabled
with skills to identify their limitations in working with different target groups during counselling
sessions. The module will cover the following sessions- Couple counselling; Family counselling;
Youth counselling; Children counselling; Pregnant women counselling; Crisis counselling; and
Loss, grief and bereavement.
The module tackles the following major topics
Session 1 Couple Counselling (M4-1)
Session 2 The Role of VCT in Couple Counselling (M4-2)
Session 3 Family Counselling (M4-3)
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Session 4 Psychosocial Support in Family Counselling (M4-4)
Session 5 Youth Counselling Skills (M4-5)
Session 6 Factors Promoting Youth Counselling (M4-6)
Session 7 Overview of Children Counselling and Their Legal Issues (M4-7)
Session 8 Children Counselling Skills (M4-8)
Session 9 Changes During Pregnancy and Introduction to “ PMTCT” Programme (M4-9)
Session 10 Factors Promoting Mother to Child Transmission of HIV (M4-10)
Session 11 Strategies for Prevention of Mother to Child Transmission of HIV (M4-11)
Session 12 Pre-Test Counselling for “ PMTCT” (M4-12)
Session 13 Post-Testing Counselling for “ PMTCT” (M4-13)
Session 14 Crisis Counselling (M4-14)
Session 15 Counselling for Loss, Grief and Bereavement (M4-15)
Session 16 Supporting Client and Significant Others to Cope with Loss (M4-16)
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MODULE 4
M4-1
Session1 Couple Counselling (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the term ‘couple’
2. Identify types of couples
3. Explain the importance and advantages of couple counselling
4. Describe the influence of culture in couple counselling.
5. Demonstrate the couple counselling skills
Exercise questions:
• Why is couple counselling important?
• Can each one of the couples receive his/her own results separately
• Is it a must for a person to share his/her test results with the partner?
Self-reflection guide for the session:
• Each couple have their behaviours and attitudes. Can I have the ability to be impartial
and help them both to change behaviour?
Summary of the important points to note:
Couple” means two people normally of opposite sex these people maybe:
-- Married
-- Cohabiting (not married but a man and woman staying together)
-- Friends
• “Couple Counselling” is where two individuals normally of opposite sex who have had
or who intend to have sexual relations, wish to discuss issues concerning HIV infection
and disease together and look for ways to cope with the situations.
• Partner notification is a process of individual sharing messages on HIV and AIDS with
partner and later possibility of accepting to come for counselling. It is also a process of
an individual giving HIV result to a partner.
• Gender roles and relations have significant influence on the course and impact of HIV
infection
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MODULE 4
M4-1
• Counsellor to understand the influence of gender roles and relations in couple’s ability
to protect them from HIV and effectively cope with the impact of AIDS
• Understanding both gender and culture issues within communities is crucial for effective
counselling and testing in the promotion of behaviour change among couples
• Understanding of the psychological context of gender will help the counsellor to be
sensitive and impartial and not to attribute relationship problems to male counterparts
alone.
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MODULE 4
M4-2
Session2 The Role of VCT in Couple Counselling (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe the role of VCT in disclosure of HIV status between couples/
2. Describe the role of VCT in HIV prevention between couples
3. Apply skills for couple counselling
Exercise questions:
• How does VCT become important in disclosure?
• Why should couples disclose their HIV sero-status to each other?
Self-reflection guide for the session
• How can I help when one of the couples is reluctant to disclose especially in a discordant
case?
Summary of the important points to note:
• Counselling helps the infected and affected couples by HIV to live fully and productively
by enabling them to set strategies and plan over their lives to prevent transmission or
re-infection.
• Encourage beneficial disclosure of HIV status and an environment should be created in
which couples to be willing and able to get tested for HIV
• Let the couple be empowered and encouraged to change their behaviour according to
the results
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MODULE 4
M4-3
Session 3 Family Counselling
(60min)
Objectives:
1. At the end of this session trainees are expected to be able to
2. Define the family
3. Discuss the role of culture on family counselling.
4. Discuss the role of the family in HIV prevention, care, treatment and support
Exercise questions
• What is the role of culture and traditions in family counselling?
• Is there a need for family counselling? Why?
• What role should the family play in prevention of HIV infection?
Self-reflection guide for the session
• What is my role as a Counsellor to a family that is has one or more of their member
living with HIV?
Summary of the important points to note
• Family refers to a group consisting two or more people living together with same
interests and goals. They share responsibilities and obligations.
• In normal situations such a group would consist of a husband, wife, children and
relatives.
• In the Tanzanian context a family may be composed of:
-- Husband, wife/wives, children and relatives.
-- It also can be a single mother or father, living with all her/his children and some of
her relatives.
-- The goal for family counselling is to involve family members to support the affected
-- Individual or couple
• Culture and tradition therefore influence how people interpret, explain and respond to
HIV infection and AIDS it plays a big role in family counselling
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MODULE 4
M4-4
Session 4 Psychosocial Support in Family Counselling
(60min)
Objectives:
1. At the end of this session trainees are expected to be able to
2. Describe the psychosocial reactions for both infected and affected persons
3. Assist family members to provide care and support for family members infected by
HIV and AIDS
Exercise questions:
• How do the psychological reactions of the family of a PLHIV relate to those of the
PLHIV?
• What is the role of the family in care and support?
• How does the family become the nucleus of care around a PLHIV?
Self-reflection guide for the session:
• How do I get a family of a PLHIV to accept me as a family counsellor?
• Do the different family norms create a hindrance to my counselling?
Summary of the important points to note:
• The family might experience psychosocial reactions upon hearing the news of someone
in the family being infected with HIV and AIDS
• Family members are the first and important people the patient has
• Because of the perception that HIV is transmitted through immoral sex or otherwise
deviant behaviour, families are often inclined to blame PLHIV for their ill health
• The family need help to be aware of all the facts surrounding HIV and AIDS in order to
be able to give care and support to infected member (s) of family.
• The counsellor should be aware of the dynamics of family members and deal with them
accordingly to achieve an effective helping process
• Family members need to know that there is no vaccine or cure for HIV and AIDS so
far. However, maintaining proper health status and management of accompanied
symptoms can improve the general health status of an individual
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MODULE 4
M4-5
Session 5 Youth Counselling Skills
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the terms youth, adolescent and young people
2. Identify reasons for targeting youth in relation to HIV infection
3. Explain the need to adapt VCT to the specific needs of young people.
4. Identify VCT strategies to reduce HIV risk behaviours of youth
5. Identify challenge in counseling youth
Exercise questions:
• Why is it important to target youth in HIV counselling?
• List the challenges that exist in counselling youth
• How does one deal with communication issues with youth?
Self-reflection guide for the session:
• Do I like young people enough to become an effective counsellor for them
Summary of the important points to note:
• Youth is the period between 10 years and 24 while adolescence is the period from 13
to 19 years.
• Normally the terms youth and young people are used interchangeably
• Young people face barriers in receiving health services and tend to use services less
than adults do
• Confidentiality and consent issues are more complicated when working with
adolescents. For adults, the choice to be tested is their own, and the process and
results are confidential.
• For young people, guidelines vary on the age at which they can decide for themselves
to be tested, as well as on when, or if, their parents or guardians must be notified of the
test and the results.
• The counselor must understand that there are many challenges when dealing with
youth
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MODULE 4
M4-6
Session 6 Factors Promoting Youth Counselling (60min)
Objectives:
1. At the end of this session trainees are expected to be able to
2. Describe skills and attitudes that promote good communication with youths.
3. Identify elements for youth friendly services
Exercise questions:
• What considerations must a counsellor look at when counselling youth
• List down the elements of youth friendly services
• What adjustments should the present facilities do to make the services youth friendly?
Self-reflection guide for the session:
• Do I have the ability to put myself in the position of the youth so as to become an
effective counsellor for youth?
Summary of the important points to note:
• In Counselling adolescents and young people, a counsellor needs to observe the basic
principles of counselling
• Counsellor needs to remember the other attributes of adolescence and young persons
that makes them somehow different from other age groups
• Remember that a decision for an adolescent or young person to seek HIV counselling
may come from many reasons including pressure from parents or need for marriage
• Remember that whatever reason has, it takes a lot of courage for a young person to
seek help, regardless of the reasons behind
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MODULE 4
M4-7
Session 7 Overview of Children Counselling and Their Legal
Issues (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the terms child, legal age to consent
2. List children’s rights
3. Explain the need to adopt VCT to the specific needs of children
4. Explain reasons for targeting children in HIV and AIDS counselling
5. Identify issues related to legal age of consent
Exercise questions:
• List down the rights of the child
• Relate these rights to the need for counselling for children
• How can VCT services be adopted to the needs of the children?
Self-reflection guide for the session:
• Do I have enough love for children to care and counsel them effectively?
Summary of the important points to note:
• A child is a person who has not become and adult.
• In the context of child counselling there is a difference between youth and child. Hence,
in this context a child is a person between the age of 5 years and 14 years
• A child has rights, and they have been stipulated by the United Nations and the African
Union
• It is these rights that give the child the mandate to receive counselling.
• More often than not, children get in difficult situations or are infected or affected by HIV
and AIDS.
• Counselling for children can help children alleviate their fears and anxieties, helping
them overcome and tolerate their traumatic experiences of life.
• The Counselor should be able to identify children in difficult situations.
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MODULE 4
M4-8
Session 8 Children Counselling Skills (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe skills and attitudes that promote good communication with children.
2. Discuss strategies to be used in helping parents to know their children’s HIV status
3. Support parents to cope with their emotional reaction when having HIV positive
children
4. Describe effective communication strategies for grieving children
Exercise questions:
• What strategies can be used to communicate with a child?
• Discuss the trauma that apparent will go through after learning that their child is HIV
positive
Self-reflection guide for the session:
• How difficult can it be for a parent to reveal his/her HIV positive status to the children?
Summary of the important points to note:
• HIV and AIDS Counseling for children is a communication process aimed at exploring,
identifying and managing psycho-socially related concerns of children in general and
especially those living under difficult circumstances of HIV AND AIDS infection.
• The process of counseling children involves supporting the child to identify his/her
concerns, their causes and effects and available options in addressing them thus
working out realistic solutions
• It is an on-going process that utilizes child friendly approach and good communication
skills to help the child participate in exploring the issues related to his/her life
• The process of counseling children develops in four stages
-- Establishing rapport
-- Exploring for the information about the child
-- Helping the Child form relevant strategies
-- Making plans
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MODULE 4
M4-8
• Younger children may find it difficult to talk, because they do not know the right words
or cannot talk to strangers or are scared of adults a Counsellor should help them to
talk
• As Child Counselling depends greatly on effective communication skills, there are many
reasons that may bar effective communication with the child a Counsellor should watch
out for them and avoid them
• It is important for a Counsellor to help parents to cope with the HIV positive status of
their children or disclose their HIV positive status to children
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MODULE 4
M4-9
Session 9 Changes During Pregnancy and Introduction to
“ PMTCT” Programme (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify physical, physiological and psychological changes during pregnancy.
2. Explain the goals of PMTCT Programme
3. Discuss the magnitude of mother to child transmission
Exercise questions:
• Why is it important to offer all women of childbearing age counselling and testing for
HIV?
• What is mother to child transmission?
• What programme is in place to counter mother to child transmission?
Self-reflection guide for the session:
• What mechanisms should be in place to enable the community to access the PMTCT
programme?
Summary of the important points to note:
• During pregnancy changes occur in all the body systems of the mother
• These changes result in the suppression of the immune system. HIV infection decreases
the immunity of the pregnant woman even further
• Hence, need for counselling of pregnant women for HIV testing to reduce mother to
child transmission of HIV
• Prevention of mother-to-child transmission programme is a strategy aimed at reducing
the number of children born with HIV infection. Transmission of HIV may occur during
pregnancy, delivery through breastfeeding
• The PMTCT programme targets pregnant women and those of reproductive age and
their sexual partners, children, families and communities
• The goals of the programme are to reduce MTCT of HIV and to improve care for infected
parents and children
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MODULE 4
M4-10
Session 10 Factors Promoting Mother to Child Transmission of
HIV (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe modes of HIV transmission from mother to child
2. Identify factors associated with mother to child transmission of HIV infection
Exercise questions:
• Discuss the factors that increase the risk of transmission of HIV from mother to child
during labour and delivery
• What can be done to reduce the rate on transmission from mother to child?
Self-reflection guide for the session:
What traumas does a pregnant woman who has tested HIV positive experience knowing that
there is a possibility, however remote, of infection her baby?
Summary of the important points to note:
• Factors that increase the risk of transmitting HIV to the infant during labour and delivery
include:
-- Viral load factors
-- Maternal factors:
-- Obstetric factors:
-- Fetal factors
-- Postnatal factors
• 60 – 70% of babies born to HIV positive mothers are not infected.
• 30 – 40% of babies of HIV positive mothers are infected with HIV.
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MODULE 4
M4-11
Session 11 Strategies for Prevention of Mother to Child
Transmission of HIV
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe strategies for reducing possibility of mother infecting the child
Exercise questions:
• Why should we have specific strategies for reducing mother to child transmission?
• Discuss male involvement in the reduction strategy
Self-reflection guide for the session:
• What is my role as a Counsellor in enhancing male involvement in such a male dominating
society?
Summary of the important points to note:
The components of an essential package for the prevention of mother to child transmission
are:
• Prevent HIV infection in young women
• Provide family planning counselling for HIV positive women
• Improve maternal health and nutritional status during pregnancy
• Screen for STIs in pregnant women and treat them
• Use malaria chemoprophylaxis
• Use antiretroviral drugs in the antenatal /labour period for HIV positive women
• Clean vagina with 0.25 % Chlorhexidine procedures during labour and delivery
• Counsel about option for breast feeding
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MODULE 4
M4-12
Session 12 Pre-Test Counselling for “ PMTCT” (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Provide pre-test counselling to a pregnant woman
2. 2.Refer HIV positive pregnant woman for infant feeding options.
Exercise questions:
• Discuss reasons for proper choice of infant feeding well before the child is born
• What roles do other family members play in correct infant feeding?
Self-reflection guide for the session:
• What is my responsibility as a counsellor in decision for infant feeding options in the
Tanzanian context?
Summary of the important points to note:
• Without intervention, 5-20% of infants breastfed by their mothers become infected with
HIV.
• Options for infant feeding include:
-- Exclusive breastfeeding (EBF): Feeding infant ONLY breast milk and no other liquids
or solids, with the exception of drops or syrups consisting of vitamins, mineral
supplements or medicines prescribed by a health care worker.
-- Replacement feeding (RF): Feeding infant something OTHER THAN breast milk.
-- Mixed feeding (MF): Feeding both breast milk and other liquids (such as water, tea,
formula, animal milk) or foods (such as porridge or rice).
-- Complementary foods: Any food, whether manufactured or locally prepared, that
is added to a child’s diet when the child reaches 6 months of age. Complementary
foods are needed because breast milk or replacement foods alone do not satisfy
the child’s nutritional requirements after this age.
• The Counsellor should take time to counsel an HIV positive mother to make informed
choice for feeding her baby before birth.
• The choice should take into consideration all environmental and social issues around
the mother
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MODULE 4
M4-13
Session 13 Post-Testing Counselling for “ PMTCT”
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Provide post-test counselling to pregnant woman
2. Empower an HIV positive pregnant woman to make informed choice for child feeding
option
Exercise questions:
What is the role of infant feeding counselling in prevention of mother to child transmission?
What factors does the Counsellor need to observe in infant feeding counselling?
Self-reflection guide for the session:
How effective can I be in getting an HIV positive mother to adhere to the feeding option
selected?
Summary of the important points note:
• Women who are HIV-positive need infant feeding counselling, and those who do not
know their sero-status have to be encouraged to know their sero-status
• Infant feeding counselling is a process of helping pregnant mother who is HIV positive
to make an informed choice on feeding options and decide on an option to use.
• Infant feeding counselling may be needed or take place:-- Before a woman is pregnant
-- During pregnancy
-- Soon after the baby is born
-- When baby is older
-- When a woman is fostering baby whose mother is very sick or has died.
• Apply the normal counselling skills but go a step further and build the confidence of the
mother
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M4-14
Session14 Crisis Counselling (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define crisis
2. Define crisis in relation to HIV and AIDS counselling
3. Discuss types of crisis and crisis counselling
4. Perform crisis counselling
Exercise questions:
• Discuss the role of counselling in averting crisis for an HIV positive person
• What are the factors the Counsellor addresses in crisis counselling
Self-reflection guide for the session:
• Crisis counselling involves patience, do I have the ability to carry it through?
Summary of the important points to note:
• It is a sudden or unexpected event that throws an individual completely off balance
emotionally.
• Crises are not usually predictable or expected. It is this unexpectedness that can
intensify the reaction to a crisis.
• A person in crisis feels at a loss of control and power over his/her life.
• Crisis falls into two major categories. They are either developmental or situational.
• Factors contributing to crisis are
-- Knowing the sero status
-- Getting an illness e.g. skin rashes, herpes zoster, unexplained diarrhoea.
-- Sudden death of her/his child or spouse
-- Loss of a person who is giving all the support to the infected person
-- Loss of accommodation / employment
• Crisis counselling focuses on the clients’ feelings due to the threat that HIV and AIDS
poses to survival and social stigma involved
• It is the process of helping someone who is experiencing a crisis to come back to
the state at which he/she was functioning before the crisis. It is a helping service that
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occurs all the time
• It is a process of helping someone who is experiencing crisis to come back to the state
of which he/she was functioning before crisis.
• Purposes of crisis counselling:
-- To help the client gain some sense of control over the immediate threatening
situation.
-- To help the client deal with other secondary issues connected with the problem.
-- To help the client accept all that is happening to him/her
-- It helps the client to face reality and be willing to live with the situation
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MODULE 4
M4-15
Session15 Counselling for Loss, Grief and Bereavement (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Explain the concepts: Loss, Grief, and bereavement
2. Describe stages of grieving and bereavement
3. Define emotional stages a client may go through
4. Describe strategies of dealing with loss
5. Describe different fears which accompany death
Exercise questions:
Why do people feel at a loss when the find out that a member of the family is infected with
HIV?
How can a counsellor help in the reducing the feeling of guilty in the person who is HIV
positive?
Self-reflection guide for the session:
What is my role as a Counsellor to a grieving family?
Summary of the important points to note:
• Loss is the state of being deprived of or being without something on has had and
valued.
• Major categories are:
-- Loss of a significant,
-- Loss of loved or valued person
-- Loss of part of the self
-- Loss of external objects
-- Death of a loved one.
• Bereavement is a response that follows the loss and can be seen as being made of two
components grief and mourning. It refers to the mourning period people go through as
a result of loosing a person who is in most cases depended upon.
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• Bereavement counselling is emotional practical support offered to persons who are
experiencing feelings of loss or have lost a family member.
• Grief is the intense emotional suffering caused by loss disaster or misfortune. It is
expressed by deep sadness when the loss is perceived as inevitable or acute grief the
intense sadness, which immediately follows a loss.
• Grief is tears, an overwhelming sense of loss a desire to be alone due to the social
contacts served or restricted.
• Feelings of guilt are common, reactions such as “why didn’t I” if I had treated him better
or I had not met her/him this might not have happened.
• Stages of grief that individual pass through are normal and can be immediate or
postponed, but the underlying principle is that people should be encouraged to grief.
• Grief is a long process, which for most people can take up to two years.
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M4-16
Session 16 Supporting Client and Significant Others to Cope
with Loss(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Explain the importance of keeping the communication open between the dying person
and significant others.
2. Support client and significant others to cope with loss
Exercise questions:
• What are the factors that affect a person when responding to loss?
• Explain how to go about dealing with loss and bereavement counselling
Self-reflection guide for the session:
• How can I help a grieving child?
Summary of the important points to note:
• Counselling for grieving counselling is offered to the client, their children, spouses and
caregiver.
• In counselling for grief the counsellor should
• Perform active listening and listen for meaning with use of silence, nodding, rephrasing
etc
• Showing compassion because clients need permission to express their feelings without
fear of criticism and to experience hurt, sorrow, anger, fear, anxiety or pain without
concern for what is acceptable
• Avoiding such phrases as “You’re holding up so well”; “Be happy he/she is out of pain”;
“He is in better place with our creator”. Counsellor should offer simple solutions to
difficult realities
• Understanding the uniqueness of grief by keeping in mind that each client’s grief and
method of handling grief is unique. Though there are fundamental similarities in grieving
process, people do not respond to death or loss of health in the same way
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MODULE
Counselling, Care and Treatment
5
Overview
Care entails a number of components
in the context of HIV. Counselling
should address itself to issues that
affect people living with HIV in one
way or the other. These issues include
drug adherence, co-infection of TB
and HIV, The relationship between
STIs and HIV, the management of
opportunistic infections, the need
for proper nutrition, stigma and
observance of legal issues and
rights. The Counsellor has a major
role to play in all these issues. Hence
this module treats these issues in
the context of the counsellor and
Client relationships. In particular the
module will address the following
sessions
Session 1 Overview of HIV and AIDS Care and Treatment Services (M5-1)
Session 2 Counselling Issues Across the HIV disease Continuum (M5-2)
Session 3 Continuum of Care in HIV and AIDS (M5-3)
Session 4 Counselling for Treatment and Drug Adherence 1 (M5-4)
Session 5 Counselling for Treatment and Drug Adherence 2 (M5-5)
Session 6 Counselling for ARV/ART (M5-6)
Session 7 The Role of a Counsellor in ART (M5-7)
Session 8 Overview of TB/HIV Co-Infection (M5-8)
Session 9 TB/HIV Related Counselling 1 (M5-9)
Session 10 TB/HIV Related Counselling 2 (M5-10)
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Session 11 Overview of STI/RTI (M5-11)
Session 12 The Role of a Counsellor in STI/RTI Management (M5-12)
Session 13 STIs Related Counselling (M5-13)
Session 14 Overview of Opportunistic Infections (M5-14)
Session 15 Management of Opportunistic Infections (M5-15)
Session 16 Nutrition in the Context of HIV 1 (M5-16)
Session 17 Nutrition in the Context of HIV 2 (M5-17)
Session 18 Counselling for Nutrition in the Context of HIV (M5-18)
Session 19 Stigma and Discrimination in HIV and AIDS Context (M5-19)
Session 20 Stigma and Discrimination (M5-20)
Session 21 Legal and Human Rights Issues (M5-21)
Session 22 Legal and Human Rights Issues for Minors (M5-22)
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Session 1 Overview of HIV and AIDS Care and Treatment Services
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Identify HIV and AIDS care and treatment services
2. Discuss the link between VCT and HIV and AIDS Care and Treatment
Exercise questions:
• What care and treatment services for HIV are available in Tanzania?
• How do family members get involved in care and treatment services?
• Discuss the role of VCT in the treatment and care of PLHIV
Self-reflection guide for the session:
• Reflect on your role as a Counsellor in the care and treatment services in your
community.
Summary of the important points to note:
• HIV and AIDS care and treatment services are the services based on an active concern
for the well being of people living with HIV and AIDS
• The aim of comprehensive HIV and AIDS care, support and treatment is to provide
quality services to improve the quality of life of people with HIV, their families and
communities
• People living with HIV, their families and communities are also involved.
• VCT is the entry point to all other services provides an opportunity to access accurate
and comprehensive information on HIV and AIDS
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M5-2
Session 2 Counselling Issues Across the HIV Disease Continuum
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Explain common psychological issues experienced by people living with HIV
2. Explain common social issues experienced by people living with HIV
Exercise questions:
• List the emotional experience that PLHIVs face in their daily life
• What social issues do they experience in additional to the emotional experiences?
Self-reflection guide for the session:
• What is my personal view towards PLHIVs deep inside?
• Am I judgemental on their moral standing?
Summary of the important points to note:
• HIV has had profound medical, psychological and social ramifications
• Counsellors need to view the client in holistic manner within the context of their social
environment.
• How clients with HIV adapt to their condition is also unique to each client
• Counsellors should view each client with HIV as an individual and not anticipate what
a client will or will not do on the basis of their experience with HIV and AIDS clients as
a group
• PLHIV experience stigma and discrimination when they feel ashamed or are made to
feel ashamed about HIV
• Judgemental attitudes towards PLHIVs is in contrast to so called principals of morality
especially in religious settings
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M5-3
Session 3 Continuum of Care in HIV and AIDS
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the concept of continuum of care
2. Discuss components of continuum of care
3. Discuss possible interventions used in the continuum of care
4. Discuss the role of a Counsellor in the continuum of care
Exercise questions:
• What are the advantages of continuum of care for PLHIVs and the community at
large?
• List down the services that would be available through the continuum of care
Self-reflection guide for the session:
• How do I, as a Counsellor, fit in the continuum of care for PLHIVs in my community?
Summary of the important points to note:
• Continuum of care can be defined as a mechanism of pooling together of medical and
other services within the community to accommodate the needs of PLHA and their
families, which goes beyond clinical care and treatment. Continuum of care starts right
from the time someone is tested HIV positive until death.
• Continuum of care includes care provided from home and community to institutional
services and back and is provided over the cause of the patient’s illness.
• Establishment of referral systems will ensure that, people living with and affected by
HIV and AIDS can benefit from the variety of services at the community and institutional
levels throughout the course of infection and disease.
• VCT is an entry point for HIV and TB prevention, treatment care and support. It helps
individuals make informed decisions on HIV testing and TB screening. It also emphasizes
on the efforts to change behaviour, reduce stigma and discrimination, and also seeks to
normalize community perceptions of HIV and AIDS/TB infection
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M5-4
Session 4 Counselling for Treatment and Drug Adherence 1
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define ARV treatment adherence
2. Explain the importance of treatment adherence
3. Describe strategies for good adherence
Exercise questions:
• Discuss the difference between drug compliance and drug adherence
• Why does treatment move from compliance to adherence?
Self-reflection guide for the session:
• Does a Counsellor have any role in the strategies for drug adherence?
Summary of the important points to note:
• The extent to which a client’s behaviour coincides with the prescribed health care
regimen as agreed upon through a shared decision making process between the client
and the health care provider.
• To be successful ARV medications must be taken 95 % of the time
• This is because the virus rapidly multiplies in the absence of the drugs. With the
increasing viral load, more mutations will occur that cause resistance to the drugs
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Session 5 Counselling for Treatment and Drug Adherence 2
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss possible strategies for improving adherence.
2. Explain barriers clients face in adhering to treatment
3. Assist clients to develop strategy for treatment adherence
Exercise questions:
• Develop a plan for empowering a client for ARV adherence
Self-reflection guide for the session:
• How can a Counsellor contribute to the adherence of a client?
• Summary of the important points to note:
• Strategies for ARV adherence include:
• Patient related strategies
• Regimen-related strategy
• Clinician and health team
• Strategies for adherence include
• Disclosure so that there is someone to remind you
• Use of mind aids like alarm clock and calendars
• Use of support groups
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MODULE 5
M5-6
Session 6 Counselling for ARV/ART (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe the goals of ARV therapy
2. Classify antiretroviral drugs
3. Explain how the different classes of ARV drugs work
4. Describe side effects of ARV drugs
5. Describe the evaluation to be done before initiation of ART
6. Describe the ARV combination regimen in Tanzania
7. Describe the protocol for utilization of ARV drugs
Exercise questions:
• What would you tell a client who came to you complaining of side effects due to
ARV?
Self-reflection guide for the session:
• What are my limitations in counselling for nutrition in the context of ARV?
Summary of the important points to note:
Primary goals of antiretroviral therapy therefore are:
• Maximal and durable suppression of viral load
• Restoration and/or preservation of immunologic function
• Improvement of quality of life
• Reduction of HIV-related morbidity and mortality
Secondary goals are to decrease the incidence of HIV through;
• The increased uptake in voluntary testing and counselling with more people then
knowing their status and practicing safer sex,
• The reduction of transmission in discordant couples
• Reducing the risks of HIV transmission from mother to child.
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Classification of ARV drugs
• Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
• Protease Inhibitors (PIs)
NNRTI’s
NRTI’s
PI’s
D4T/ AZT+3TC
EFV or NVP
First line
D4T/ AZT+3TC
EFV or NVP
Second Line
DDI (200mg on empty stomach)+ ABACAVIR (300mg BD) + KALETRA
(LPV/RTV 3tab BD)
There are criteria for adult and children PLHIV that have been set for initiation of ARV. Even
before initiation certain medical investigation have to be done.
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M5-7
Session 7 The Role of a Counsellor in ART (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss the role of a Counsellor in ARV/ART Counselling
Exercise questions:
• What issues does a counsellor address when counselling for ARV?
• How does counselling for ARV relate with counselling for HIV?
Self-reflection guide for the session:
• What do I need to do to empower my client for adherence to ARV
Summary of the important points to note:
• Roles of a VCT Counselor in ARV therapy:
99
To give knowledge on ART services to clients
99
Briefly to explain the process of initiating ARV
99
To refer the client who are HIV positive to ART clinic
99
To refer client with ARV complication to ART clinic
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MODULE 5
M5-8
Session 8 Overview of TB/HIV Co-Infection (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define TB
2. Describe the magnitude and distribution of TB globally and Tanzania
3. Identify modes of TB transmission and risk factors
4. Explain the relationship of HIV/TB incfection
Exercise questions:
• What are the general symptoms of TB?
• Mention the common symptoms of lung TB
Self-reflection guide for the session:
• What would be my reaction to a client who has all symptoms of TB?
Summary of the important points to note:
• Tuberculosis is a chronic infectious disease caused mainly by Mycobacterium
tuberculosis.
• The germs are expelled into the air when a person with TB of the lung coughs, or
sneezes,
• Thus it is easier to spread to other people who share the same breathing space such
as family members, friends, co-workers, roommates, people in overcrowded situations
such as public transport, prison cells and markets
• People with chronic diseases such as diabetes and malnourished children are also at
risk of contracting TB
• Workers in certain occupations such as miners, textile workers, workers in the tobacco
industry, and prisoners are prone to TB
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M5-9
Session 9 TB/HIV Related Counselling 1 (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. 1.Describe current Challenges faced by TB programme.
2. 2.Describe the management of TB
Exercise questions:
• How does a Counsellor take part in the collaborative efforts of TB and HIV
programmes?
Self-reflection guide for the session:
• Do I really know where I stand in the treatment system of HIV and TB?
Summary of the important points to note:
• TB and HIV are overlapping epidemics. HIV is fueling the TB epidemic in many parts of
the world including Tanzania.
• TB is the commonest opportunistic infection and leading cause of death among HIV
and AIDS patients.
• HIV is the strongest risk factors for development of TB it increases the rate of recurrent
TB
• About 50% of TB patients are infected with HIV (NTLP) and TB is the leading cause of
death among PLHIV.
• Government of Tanzania has adopted the approach of “One patient, two diseases” So
- Controlling TB and HIV should be the priority of HIV and AIDS and TB programmes:
• Goal of TB/HIV Collaborative Services is to decrease the burden of TB and HIV in
populations affected by both diseases
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M5-10
Session 10 TB/HIV Related Counselling 2 (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe principles of TB management
2. Describe TB treatment categories
3. Identify TB treatment regimens and Challenges in TB control
4. Identify the role of a counsellor in TB control
Exercise questions:
• What are the aims of the first phase of TB treatment?
• What is the second phase of TB treatment intended to do to a patient?
Self-reflection guide for the session:
• What is my role as a counsellor in TB treatment?
Summary of the important points to note:
• Early case finding and adequate treatment is the corner stone of tuberculosis control.
• The aim of Anti-TB treatment is to:
• Cure TB patients
• Prevent death
• Avoidance of relapse
• Prevent drug-resistant organisms
• Prevent transmission of TB to the community
• TB regimens are divided into initial phase (intensive) and continuation phase.
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MODULE 5
M5-11
Session 11 Overview of STI/RTI (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define STI/RTI
2. Describe major types of STIs in Tanzania
3. Describe major signs and symptoms of common STIs
4. Explain the main modes of transmission of STIs
5. Explain STI preventive measures
Exercise questions:
• List the common STIs in Tanzania
• Identify symptoms and signs of STI in men, women and children
Self-reflection guide for the session:
• How d my values guide me in judging a client who admits to me that he/she has STI?
Summary of the important points to note:
• STIs are infections transmitted thorough unprotected sexual intercourse
• Causing organisms could be bacteria, virus. Fungus, protozoa or parasites
• In some case signs and symptoms differ between men and women
• Preventive measures include fidelity, safer sex and consistent and correct use of
condom
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MODULE 5
M5-12
Session 12 The Role of a Counsellor in STI/RTI Management
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe management of STIs/RTI
2. Explain the roles of a Counsellor in the management of STIs
3. Discuss the importance of partner notification
4. Discuss the importance of referral
Exercise questions:
• How does the referral system for STI work from the VCT site?
• In your opinion, is the existing system efficient? Explain
Self-reflection guide for the session:
Where do I fit as a Counsellor in the whole system of STI management?
Summary of the important points to note:
Control of STIs in the population calls for concerted efforts to ensure that all health care
workers are trained in the correct management of STIs, effective drugs are provided on a
continuous basis, general public education is delivered to promote appropriate STIs care
seeking behaviour and an effective system of supervision are instituted. These efforts will
include
• Prevention and management of sexual transmitted infections:
• Creation and sustaining an increased awareness of STIs:
• Reliable system of partner notification:
• Established system of referral
• Friendly service for dealing with STIs
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MODULE 5
M5-13
Session 13 STI Related Counselling (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe the relationship between HIV and STIs
2. Explains preventive measures.
Exercise questions:
• Why is partner notification and treatment so important in the treatment of STI?
Self-reflection guide for the session
• What are my roles in the completing the treatment and care continuum in this
relationship?
Summary of the important points to note:
• Relationship between HIV and STIs
• HIV and AIDS and other STI’s share the major transmission route such as unprotected
penetrative sex.
• Share the same risk behaviour predispose to infection with HIV and AIDS and other
STI’s.
• Having STI’s increases the risk of acquiring and transmitting HIV infection.
• Prevention measures used for STI’s are the same to those used to prevent HIV and
AIDS.
• It has also been found that there is high frequency of dual infection between syphilis
and HIV.
• Neuro-syphilis should be considered in the differential diagnosis of neurological disease
in HIV infected individuals.
• In case of congenital syphilis the mother should be encouraged to undergo testing for
HIV.
• Syphilis can also be transmitted from mother to child.
• Another possible mode of transmission of syphilis is through blood transfusion.
• It is also possible to be infected with syphilis by non-penetrative contact with ulcers and
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M5-13
rashes of an infected person.
Prevention will involve advocacy for positive behaviour change and practicing safer sex with
appropriate precautions.
• Routine screening and treatment of pregnant women
• Routine screening and treatment of people who are HIV sero-positive
• Routine screening and treatment of patients with other STIs
• Routine screening of blood
• Adherence to standard precautions in order to avoid nasocomial (self and other person)
infection
• Treatment of the sexual partner of the infected person
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MODULE 5
M5-14
Session 14 Overview of Opportunistic Infections (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define opportunistic infection
2. Explain the common diseases in people living with HIV
3. Describe clinical management of common diseases in people living with HIV
4. Describe nursing care of common diseases in people living with HIV
Exercise questions:
• Discuss the relationship between opportunistic infections and the decline of the body
immune system due to HIV
Self-reflection guide for the session:
• How do I empower a client to treat OIs as soon as possible?
Summary of the important points to note:
Opportunistic infections are diseases/infections, which arise due to compromised or
suppressed immune system as a result of HIV Infection. They include:
Tuberculosis (TB)
• Malaria
• Pneumocystis pneumonia (PCP)
• Candidiasis
• Herpes zoster (Varicella-zoster virus: Herpes zoster or shingles)
• Kaposi’s sarcoma
• Toxoplasmosis (Toxoplasma encephalitis)
• Cryptococcus neoformans (Cryptococcal meningitis)
• Fungal infections
• Opportunistic Infections should be treated as soon as possible
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M5-15
Session 15 Management of Opportunistic Infections (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Explain the role of the Counsellor in management of opportunistic infections
Exercise questions:
• Is it necessary to counsel for treatment of OI for an HIV negative client?
• Do you need to offer counselling for treatment of OIs to an HIV positive client?
• At what point of the counselling session do you counsel for treatment of OIs?
Self-reflection guide for the session:
• How would I empower a reluctant HIV positive client to seek treatment of OIs?
Summary of the important points to note:
• The Counsellor has the role of giving information to the clients. Some of the relevant
information for IO includes the following.
• HIV-infected patients should receive information about ways to prevent OIs and other
common HIV-related infections. Such measures include the following:
• Maintaining good hygiene in the preparation and storage of food
• Taking drugs that prevent infections such as sulfadoxine-pyrimethamine to prevent
malaria for pregnant women and CPT to prevent PCP, toxoplasmosis and some
bacterial infections
• Cleaning the body well to avoid skin infections
• Maintaining good oral care and hygiene
• Using condoms, which can help prevent the spread of HIV and other STIs
• Getting enough rest
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MODULE 5
M5-16
Session 16 Nutrition in the Context of HIV 1 (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define nutrition and food
2. Explain importance of good nutrition to PLHIV
3. Describe the relationship between HIV and nutrition
4. Describe conditions that contribute to malnutrition
5. Exercise questions:
6. Discuss how poor nutrition contributes to faster progression towards AIDS for a
PLHIV
Self-reflection guide for the session
• Can I explain effectively the relationship between HIV progression and nutrition?
Summary of the important points to note:
• Nutrition is the science of utilization of nutrients by the body
• Nutrients: Are substances found in foods that provide energy, enhance growth, help
repair body tissues and regulate body functions
• Malnutrition: Is a condition caused by excessive or deficiency of one or more nutrient
in the body, common malnutrition are kwashiorkor and marasmus.
• Balanced meal: Food put together in a form that can be consumed and that, when
eaten together, provides an individual with adequate amount and required nutrients to
maintain good health
• A person who is malnourished and then acquires HIV is more likely to progress faster to
AIDS because the body is already weak and cannot fight co-infections
• A well-nourished person has a stronger immune system for coping with HIV and fighting
illness
Relationship between nutrition and the immune system
• Nutritional deficiencies affect immune functions that may influence viral expression and
replication, further affecting HIV disease
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M5-16
• HIV affects the production of hormones which are involved in the metabolism of
carbohydrates, proteins and fats
• Infections affect nutritional status by reducing dietary intake and nutrient absorption,
and by increasing the utilization and excretion of protein and micronutrients as the body
responds to invading pathogens.
There are causes to malnutrition in PLHIVs
• Depressed appetite, poor food intake, and limited food availability
• Chronic infection, mal-absorption, metabolic disturbances, and muscle and tissue
catabolism
• Fever, nausea, vomiting, and diarrhea
• Depression
• Side effects from drugs used to treat HIV-related infections
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M5-17
Session 17 Nutrition in the Context of HIV 2 (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Discuss balanced meals from locally available foods
2. Describe dietary management of the different conditions, which may occur for PLHIV
3. identify the main food groups
4. Define balnced meal
Exercise questions:
• Why is it important to manage the dietary requirements very closely?
• What is the role of added food nutrients?
Self-reflection guide for the session:
• What is my role in helping the identification of cheap balanced meals from locally
available foods?
Summary of the important points to note:
• Good dietary practices play an important role in maintaining a healthy lifestyle and
healthy body.
• An HIV infected person already has a weakened immune system.
• A nutritious diet can help maintain the proper functioning of the immune system and
provides needed energy, protein, and micronutrients during all stages of the HIV
infection
The following important issues should be noted:
• Balanced Meal
• Nutrient requirements for HIV positive Individuals (WHO 2003)
• Improving the quality of diet
• Multiple Micronutrient Supplements:
• Healthy Eating and life style
• Dietary Practices and Nutrition for AIDS Related Symptoms
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Encourage the dietary management of AIDS-related symptoms, which refers to the strategy
of using food and dietary practices to alleviate the effects of AIDS-related symptoms on food
intake and nutrient absorption. It is therefore important to:
• Ensure adequate food intake by; adding more flavour, encouraging PLHIV to take small
but frequent quantities of meals; and by presenting foods with a texture that can be
easily eaten by PLHIV
• Ensure comfort while eating;
• Provide more nutrient dense foods to compensate for nutrient losses.
• Prevent dehydration that occurs due to diarrhoea and fever;
• Complement medical treatment, including the provision of ARVs;
• Reduce the severity of symptoms by providing specific nutrient needs
• Increase intake of foods that may contribute to strengthening the immune system;
• Manage specific symptoms (e.g., nausea, vomiting, diarrhoea and constipation).
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MODULE 5
M5-18
Session 18 Counselling for Nutrition in the Context of HIV
Objectives:
At the end of this session trainees are expected to be able to
1. Demonstrate the steps to be followed in nutritional counselling
2. Clarify myths and misconceptions about nutrition
3. Discuss interaction between nutrition and drugs
Exercise questions:
• What is the opportune time for nutrition counselling?
• Can it be incorporated in the normal counselling session?
Self-reflection guide for the session:
• Do I have a role in empowering community about proper nutrition for PLHIV
Summary of the important points to note:
• The Counsellor should offer Nutrition counselling using the basic counselling skills, and
deal with the following:
• Addresses an individual’s needs
• Empowers an individual to make an informed choice on food and nutrition
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MODULE 5
M5-19
Session 19 Stigma and Discrimination in HIV and AIDS Context
(60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the terms stigma, discrimination and denial
2. Explain social stigma and related reactions
3. Identify stigmatised groups and their characteristics
4. Identify sources of stigma in different settings
5. Describe stigma in different settings
Exercise questions:
• How does stigma affect the response against HIV?
• Which is the greater enemy of the society, Stigma or HIV?
Self-reflection guide for the session:
• How much of the effects of stigma in my society am I aware of?
• Do I need to learn more so as to become a more effective counsellor?
Summary of the important points to note:
Stigma is the act of identifying, labelling or attributing undesirable qualities targeted towards
those who are perceived to be “shamefully different” and deviant from the social norms. Hence
in the HIV and AIDS context, it is the negative thoughts about a person or group based on a
prejudiced position due to association with promiscuity and infidelity: It is an attitude of mind
Discrimination is defined as any distinction, exclusion, restriction or preference, which is based
on exclusionary perceptions on structures: It is the act emanating from stigma
Denial is a refusal of the truth and disownment of responsibility or disassociation from the
truth.
Social stigma emerges in the following forms:
• Enacted or perceived stigma:
• Societal stigma:
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• Self Stigma:
• Symbolic or verbal stigma (acted stigma)
Stigmatised groups and their characteristics:
• People affected with chronic diseases such as HIV, TB, Cancer, Leprosy
• People with disabilities such as Deaf, blind, albino, physically hand caps
• Sex workers
• Barmaids
• Orphans and other vulnerable children
• Men who have sex with men
• The poor
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MODULE 5
M5-20
Session 20 Stigma and Discrimination (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Describe effect of stigma
2. Identify strategies for minimizing stigma and discrimination
3. Describe reasons for HIV and AIDS stigmatisation
Exercise questions:
• What is the role of a Counsellor in minimizing stigma in the society?
Self-reflection guide for the session:
• How much can I involve myself in the minimization of stigma in my community?
Summary of the important points to note:
Effects of stigma to individuals
• The stigma associated with HIV can lead those who are infected to develop feelings of
guilt, inferiority, self-blame and despair.
• Those living or working with HIV-infected people, such as health care workers, are also
associated with them and become stigmatized.
• Loss of fundamental human rights
Strategies for minimizing stigma include:
• Advocacy against stigma
• Openness in discussion of HIV issues and sexuality
• Political will from leaders to create an environment for open communication
• Involving PLHIV fully
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M5-21
Session 21 Legal and Human Rights Issues (60min)
Objectives:
At the end of this session trainees are expected to be able to
1. Define the terms: legal issues human rights and Will
2. Describe human rights issues related to HIV and AIDS both for client and Counsellor
3. Describe features of a valid Will
Exercise questions:
• List human rights for specific groups of people as provided by the UNO
Self-reflection guide for the session:
How much do I need to learn about human rights in order to be an effective counsellor?
Summary of the important points to note:
• Legal – Something based or concerned with the law.
• Human rights – Are basic and essential requirements for people that cannot be violated
in any means.
In general PLHIV may experience the following problems related to break of human rights.
• Termination of employment
• Denied to get married
• Denied to the right to worship
• Legal support and help
• Denied access to write a “Will”
• Access medical treatment
• Access to education
• Denied to participate in community development activities
• Denied the right to have information concerning his/her life, HIV and AIDS.
The counsellor:
When a Counsellor does the following acts, he/she breaks human rights of the client
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M5-21
• Counsellors not obtaining clients’ consent to engage them in testing process.
• Confidentiality not upheld by counsellors leading to clients’ information and test results
given away without their permission
• Client’s records not identifiable to the individual client
• Counsellors not respecting clients
• Counsellor being judgemental
A Will - denotes the sum of what the Testator ( a person who makes a Will) wishes or “Wills”
to happen on his death. It also denotes the document or documents in which the intention is
expressed.
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MODULE 5
M5-22
Session 22 Legal and Human Rights for Minors (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Define minors in the context of counselling and testing
2. Describe how to deal with minors in a VCT set up
3. Identify support services for minors who receive VCT services
4. Complete the parent/guardian consent form fro testing a minor and clients with
communication disabilities
Exercise questions:
Why is it necessary to involve the guardian if dealing with a minor?
Self-reflection guide for the session:
Can I really assess correctly and decide that a young person has sufficient maturity to
understand the testing procedure and results?
Summary of the important points to note:
• In Tanzania, the legal age for adults is 18 years; that is, any one from 18 and above is
regarded as an adult and is capable of providing informed consent.
• For young people below 18, however VCT services can be provided if the Counsellor
determines the young person has sufficient maturity to understand the testing procedure
and results or is a mature minor.
• Mature minors” are permitted to access VCT services without parent or guardian
consent, they are those who are married, pregnant, those who engage in behaviours
that put them at risk or are sexually active
• At a VCT site service delivery to a minor will involve the guardian
Support services for minors who receive VCT services:
• Involvement in sports activities.
• Joining youth centres
• Joining youth activities in religious institutions, community and clubs
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MODULE
VCT Service Delivery and
Programme Management
6
Overview
Voluntary counseling and
testing (VCT) for HIV is an
essential link between HIV
Prevention and HIV care and
support. VCT promotes and
sustains behavior change,
and links with interventions
to prevent mother-to-child
transmission (PMTCT), prevent
sexually transmitted infections
(STIs), and prevent and treat
tuberculosis (TB) and other
Opportunistic infections (OIs).
VCT also facilitates early referral
to comprehensive clinical and
community-based prevention, care and support services, including access to Antiretroviral
therapy (ART). VCT improves quality of life and may play a pivotal role in reducing stigma
Session 1 Establishing VCT Site (M6-1)
Session 2 Models of VCT Service Delivery (M6-2)
Session 3 Clients flow Management (M6-3)
Session 4 Referral and Network Development (M6-4)
Session 5 Monitoring and Evaluation of VCT Services (M6-5)
Session 6 Data Colection and Reporting Tools (M6-6)
Session 7 Data Management and Data flow (M6-7)
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MODULE 6
Session 1
M6-1
Establishing VCT Site (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Discuss three phases of planning for VCT sites
2. Recognize four levels of planning VCT sites
3. Plan and establish VCT site
4. Order and procure VCT materials including testing kits and laboratory supplies
Exercise questions:
• What assessment activities are done at site, district and national levels?
• What design activities are done at site, district and national levels?
• What implementation activities are done at site, district and national levels?
Self-reflection guide for the session:
• How does a site counsellor contribute to any of the stages of planning and establishing
a VCT site?
Summary of the important points to note:
The planning of VCT services involves three phases:
• Assessment;
• Design;
• Implementation.
Also in planning VCT sites involves three levels, each level has a critical role to play in
establishment of VCT services.
• National level
• District level
• Site level
Procurement and ordering of supplies is done according to the guideline of the Ministry of
Health and Social Welfare
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M6-2
Session 2
Models of VCT Service Delivery
(60min)
Objectives:
At the end of this session participants are expected to be able to
1. Mention different models of VCT services
2. Explain the advantages and disadvantages of different models of VCT service
delivery
Exercise questions:
• What factors govern the choice of VCT model to apply?
Self-reflection guide for the session:
• What professional pressure would a Counsellor working in any of the model get?
Summary of the important points to note:
VCT services delivery can be implemented in different models, each with its own advantages
and disadvantages. In Tanzania, the most common models are;
1. Free – standing (stand –Alone) sites
2. Integrated (Facility – Based) VCT services
3. Home testing/Family VCT services
4. Mobile/Community outreach VCT services.
Advantages and disadvantages of each are discussed in the handout
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MODULE 6
Session 3
M6-3
Clients Flow Management (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Facilitate effective client service flow in a variety of Setting
2. Manage high volume client flow
Exercise questions:
• Why is it important to manage the flow of clients effectively in a VCT site?
• Self-reflection guide for the session:
• What is my personal role in the management of client flow?
Summary of the important points to note:
• The pre – test and post test counselling either individual counselling or couple counselling
and group counselling) outlines the key procedures involved in providing VCT, should
be adapted to meet the needs of the service.
• In many settings the demand for VCT is high and resources are limited, group counselling
could be utilized to reduce the amount of individual counselling time required.
• In group counselling approach, the information components of pre test counselling
could be provided in a group setting while specific issues for individual person could be
discussed on an individual level
• Couples or those in polygamous marriages should be encouraged to receive counselling
together in a group or separately, with husband – wife as couples
• Couples should not be coerced into being counselled together but should be given the
opportunity to make informed decisions about being counselled together, Separation
and join together for results.
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MODULE 6
M6-4
Session 4
Referral and Network Development (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Discuss the rationale for the development of a referral system and networks
2. Develop resources to facilitate referral at VCT sites.
3. Conduct referrals as part of clinical duties at VCT sites
Exercise questions:
• How does referral relate to prevention, care and treatment?
Self-reflection guide for the session:
• Do I play my part in prevention, care and treatment just by providing the required
referrals?
Summary of the important points to note:
• Problems posed by HIV and AIDS epidemic are multidimensional and cannot be
addressed effectively by one sector or an institution. This calls for working in partnership
in meeting the need of these problems.
• Referral can be defined as an arrangement of other assistance for a client when the
initial helping situation is not or cannot be effective. It can also be referred to as the act
of transferring a client to another Counsellor or agency for services not available from
the referring sources, or for help by other Counsellors who can handle the client’s need
more appropriately.
• Partnership refers to a group of people or institutions working together for a common
goal.
• Networking Is a process of collaboration between organizations, institutions, individuals,
and Community Based Organizations (CBOs) working and aiming at a certain goal.
• The Counsellor cannot work in isolation. He/she must establish a mechanism of
cooperating with others, with a purpose of helping a client to access other professional
services.
• The Counsellor must discuss the possibility of referral with the client. The procedure
should be relaxed and easy, not hurriedly approached.
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• The referring Counsellor should also focus on the client’s need for the referral and not
on why the Counsellor is not able to effectively provide those services
The Counsellor must develop an inventory of networks where clients can be referred
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MODULE 6
M6-5
Session 5
Monitoring and Evaluation of VCT Services (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Define Monitoring and Evaluation
2. Explain reasons for collecting Counselling and Testing data
Exercise questions:
Why does a programme need to do monitoring?
Can monitoring be done in isolation without evaluation?
Self-reflection guide for the session:
Summary of the important points to note:
• Monitoring is a system designed to follow on the status of implementation of a program,
project or activity
• Evaluation is finding out whether the set goals of an activity, program or project have or
have not been met.
• In initiating and expanding the PITC interventions monitoring and evaluation are
important in order to ascertain coverage quality funding and the overall intervention
• Monitoring and Evaluation of PITC interventions in Tanzania will be based on guiding
principles laid down for voluntary counselling and testing service
• Data is needed at various levels of the health service delivery from the village level to
the national level
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MODULE 6
Session 6
M6-6
Data Collection and Reporting Tools(60min)
Objectives:
At the end of this session participants are expected to be able to
1. Complete data collection and reporting tools for VCT
Exercise questions:
•
Why should a Counsellor waste useful counselling time and fill out data collecting
forms?
Self-reflection guide for the session:
• What information can I get from the monitoring forms that can lead me to suggest
improvement at my site?
Summary of the important points to note:
• The Counsellor is part of data collection team by filling the relevant forms at the site. He/
she should at all times be vigilant in filling the forms and registers at the site.
• The information in the handout gives the guideline for filling the register and various
forms
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MODULE 6
M6-7
Session 7
Data Management and Data Flow (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Describe the system for data management
2. Explain how data/reports flow from the facility to the national level
Exercise questions:
• Why is data management important in VCT?
• Why are there strict deadline for sending data from one level to another?
Self-reflection guide for the session:
• How prepared should a Counsellor be in collecting data and filling out the register?
Summary of the important points to note:
• Data utilization and management starts with compiling the monthly summaries at every
level
• The monthly summary form should be filled out by age group and sex for each indicator,
unless otherwise indicated
• The data are collected at facility-level and moved up the national level. As previously
mentioned, the flow of data from facility to national level
• The counsellor is responsible for filling out the register and submits it to the site in
charge or counsellor supervisor at the end of the month.
• The site-in-charge or counsellor supervisor is responsible for tallying and preparing the
monthly report in duplicate (one for the site, one for the district)
• The form is sent to the DMO by the 7th of the next month
• The district report should be filled in duplicate – one for the district and one for
region. The report is sent to the RMO by the 14th of the next month.
the
• The RMO reviews district reports and compiles one region report. He/she sends the
report to the NACP by the 21st of the next month. They are filled in duplicate – one for
the region and one for NACP.
Feedback reports sent from NACP to regions, districts and sites
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MODULE
HIV Testing in VCT Service Delivery
7
Overview
This Module is intended to equip health care workers providing counselling services with the
necessary knowledge and skills for HIV testing using rapid test assays. In Tanzania, health
care providers other than the laboratory professionals are allowed to perform HIV rapid testing after successfully completing the HIV rapid testing training curriculum of the MOHSW.
HIV testing is a critical first step for controlling the epidemic because it is the entry point
for prevention, care, treatment and support services. HIV testing, in combination with appropriate counselling, is an important tool of essential health intervention in dealing with HIV
and AIDS pandemic. Voluntary Counselling and Testing (VCT) programmes are designed
to empower clients and relatives to respond more appropriately to HIV and AIDS through
promotion of awareness and behaviour change. Current rapid HIV testing technology has
allowed provision of result-specific counselling on the same-day and therefore enhancing the
efficiency and accessibility of VCT services.
HIV testing is an important step in knowing one’s HIV sero-status. This procedure is carried out after an effective Pre-test counselling. Since the outcome of the testing procedure
relates to peoples’ life, it is therefore important for someone doing the test to be competent
enough in order to produce accurate testing results. Therefore, in order to maintain and
standardize the competence and accuracy needed for all service providers who will perform
HIV rapid testing, the Ministry of Health and Social Welfare has in place a specific training
package, “Training in HIV Rapid Testing for Laboratory and Non-Laboratory Health
Workers.” All service providers who perform HIV Rapid testing in any setting must follow
and successfully complete this training curriculum. The VCT Counsellor training will utilize
the MOHSW HIV rapid test training package to cover the testing component of the training.
The package consists of the Trainer’s Guide, Participants Manual and Power Point slides.
The Trainer’s Guide provides guidance on how best to deliver the power point slides used in
the training.
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HIV Rapid Testing Training Units
The units in the said manuals are termed modules. This should not distract the Trainer.
These are the same as the sessions in the in the VCT training manuals. Module One of the
Testing curriculum “Overview of HIV Infection” has been extensively covered in the VCT curriculum materials. The trainer is advised to go quickly through it as revision Utilization of this
HIV Rapid testing manuals should start from module 2. The units to be covered will therefore
be as follows:
• Integration of HIV Rapid Testing in HIV Prevention and Treatment Programmes
• Overview of HIV Testing Technologies
• Testing Strategies and Algorithm
• Assuring the Quality of HIV Rapid Testing – A system Approach to Quality
• Safety at the HIV Rapid Testing Site
• Preparation for Testing – Supplies and Kits
• Blood Collection
• Performing HIV Rapid Tests (Demonstrations and Practice)
• Inventory – Managing Stock at the HIV rapid Testing Site
• Use and Care of Equipment at the HIV Rapid Testing Site
• Quality Control
• Blood Collection and Handling – DBS
• Documents and Records
• Professional Ethics
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MODULE
Counselling Skills, Ethical Codes and
Supervision of Counselling Practice
8
Overview
Counselling involves skills,
which are selectively deployed
depending upon the needs
and state of the client. The
counsellors build up the skills
through field practice. The
knowledge obtained in the
class is practiced in order to
get these skills.
In order to attain positive
results in the process of helping
clients, counsellors use diverse
counselling skills. The skills can
be grouped into two categories
(i) Basic skills
(ii) Supporting skills.
The basic skills are general
because they cut across the helping process; while the supporting skills pertain to specific
Steps in the helping process.
There are four general skills. They logically follow each other in the following order:
(i) Relationship building
(ii) Exploration
(iii) Understanding
(iv) Action planning
These skills can be easily remembered by the acronym REUNDA:
Supporting counselling skills are tools that a counsellor uses in order to get information from
a client, to build a relationship, assess the presenting problem, understand the problem, and
be able to lead a client reach a solution or coping mechanism(s).
Basic counselling skills cannot be used separately without supporting counselling skills. The
supporting counselling skills must be used in the counselling process to effect the desired
change in the client.
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This module will enable the trainees to build up counselling skills and acquire knowledge and
positive attitudes for effective counselling during actual field practice. The knowledge obtained
in the classroom session will be applied on actual field so as to build counselling skills.
Session 1 – 4 Micro Counselling 1 (Practice of theories covered earlier in M8)
Session 5 Ethics in Voluntary Counselling and Testing (M8-5)
Session 6 Introduction to Ethics in VCT (M8-6)
Session 7 Counsellor Support (M8-7)
Session 8 Counsellor Supervision (M8-8)
Session 9 Field Practice (M8-9)
Session 10 Sharing Field Experiences (M8-10)
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MODULE 8
M8-5
Session 5
Ethics in Voluntary Counselling and Testing (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Discuss ethical issues that arise in the delivery of VCT.
2. Develop effective responses to ethical dilemmas
Exercise questions:
Self-reflection guide for the session:
Summary of the important points to note:
Ethical issues/dilemmas that arise in the delivery of VCT:
• Revolve around refusal of partner notification by a positive client
• Mandatory testing to clients
• Clients not showing up for their results
• Clients denying test results
• Counsellor imposing his or her and attitudes on to the clients
• Counsellor judging his/her client’s behaviour and decision making in line with the
counsellor’s own thinking
• Lack of understanding human attitudes playing part in counselling
Counsellors need to respond to these dilemmas using relevant strategies
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MODULE 8
M8-6
Session 6 Introduction to Ethics in VCT
(60min)
Objectives:
At the end of this session participants are expected to be able to
1. Define ethics
2. Explain counsellor code of ethics
3. Discuss the reasons for obtaining informed consent and maintaining confidentiality in
the continuum of care.
4. Discuss shared confidentiality in the continuum of care
5. Discuss the importance of shared confidentiality in continuum of care.
Exercise questions:
Self-reflection guide for the session:
Summary of the important points to note:
• An effective counselling session depends on Counsellor observing professional ethics.
• Counsellor’s professional ethics are systematic body of moral principles that guide or
determine the counsellor’s behaviour in his/her relation.
• The counselling profession like any other profession has a code of ethics, either
written out or ingrained in its practice. The professional ethics guide and protect the
professionals in their practice.
• The list of ethics is given in handout M VIII -6
Informed consent:
• Before any HIV testing to the client is performed, the counsellor should take the
responsibility of informing the client the meaning of the examination or testing for HIV,
and the personal, psychological, legal and social implications after the HIV test in a way,
which will help the client, reach a decision.
Confidentiality: A key concept in all ethical considerations
• It involves keeping any records on client locked in cabinet only counsellors have access
to the information.
• Environment should assure code confidentiality counselling process (code number will
be used)
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MODULE 8
M8-6
• It involves not revealing information of client unless permission if from client.
Shared confidentiality in the continuum of care
• Is process of a client releasing his or her sero- status information to other health care
providers’ legal representatives and relative
• Counsellor shall release such information only where he/she believes that the client
shall benefit or where it is mandatory by law
He or she shall also do this with the full understanding and consent of the client
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MODULE 8
Session 7
M8-7
Counsellor Support
(60min)
Objectives:
At the end of this session participants are expected to be able to
1. Identify the main features counsellor support
2. Recognise the importance of stress management and preventing burnout.
3. Develop strategies for addressing stress and preventing burnout.
Exercise questions:
Self-reflection guide for the session:
Summary of the important points to note:
• Counselling in HIV infection and the AIDS disease is stressful. Each day a Counsellor
meets people in very difficult situations.
• Each day the Counsellor is confronted with the reality of HIV, illness, death, grief and
loss.
• He/she needs assured support
• Burnout is a condition which progresses overtime until the sufferer reaches a point of
complete physical, emotional and mental exhaustion
• Stress can be defined as anything that stimulates an individual and increases their level
of alertness
• Stress management refers to efforts to control or reduce the tension felt when a situation
is perceived to be especially difficult or beyond one’s resources
• Heavy demand and high performance expected of VCT Counsellors make them
continue to work hard in the face of high-sustained stress.
• Thus, it is essential that Counsellors learn to pay attention to their own needs and
feelings. This means knowing when to relax, get more sleep, or implement stress
management strategies.
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MODULE 8
M8-8
Session 8
Counsellor Supervision (60min)
Objectives:
At the end of this session participants are expected to be able to
1. Identify the basic concepts and technical and administrative counselling supervision
2. Recognise the roles and responsibilities of supervisors and supervisees
Exercise questions:
Self-reflection guide for the session:
Summary of the important points to note:
• Supervision is virtually for education/training purposes therefore the supervisors should
announce their supervisory visits in advance.
• In this announcement, the supervisor is advised to include indication of what MODE of
supervision he/she would use and preparation of a checklist of things to be dealt with
during the forthcoming supervision visit
• Generally, supervision embraces both technical and administrative supervision
• Technical supervision in our VCT Supervision exercise for counsellors will concentrate
on supporting and providing skills to the counsellors
• Administrative supervision looks at, work schedules to ensure that counsellors have
enough time to exercise their skills; have and attend planned peer supervision sessions;
and have manageable workloads lest they succumb to burnout.
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MODULE 8
Session 9
M8-9
Field Practice (60min)
GUIDE FOR COUNSELLOR SUPERVISOR TO ASSESS A TRAINEE AT PRACTICUM
SITE DURING COUNSELLING
Objective:
Familiarise with procedure at practicum site.
Training Coverage:
The coverage has been focusing on HIV and AIDS /STIs, and HIV testing hence the trainees
will be assessed on the application of basic and specific Counselling Skills. These will be
specifically assessed in the areas of Pre-Test, Post-Test and Supportive Counselling.
Assessment Criteria:
The supervisor will assess the trainee using the attached checklist.
A part from the Pre-test, Post-test and Supportive counselling the trainees can also be
exposed to counselling of the special groups e.g. couple, family, youth counselling.
The Supervisor will write short individual report indicating:
“General performance of each trainee including strong and weak points”
“Code of conduct (discipline)”
Supervisors will also give a general comment on the performance of the students
indicating in the report gasps/areas, which need more inputs.
Trainees:
At the end of each assessment:
1. A trainee should make self-assessment starting with strong point and ending with
weak points.
2. A trainee will indicate areas, which need more input or emphasis.
3. A trainee should select and write one interesting case study to be presented in the
class.
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
122
MODULE 8
M8-9
VCT PRACTICAL ASSESSMENT TOOL (CHECK LIST)
1.
NAME OF THE TRAINEE: ……………………………………………………………..…
2.
EVALUATORS/SUPERVISOR’S NAME: ……………………………………................
3.
PRACTICUM SITE/AREA: …………………………………………......................……
4.
DATE:………………………………………………...........................................………
5.
TYPE OF COUNSELLING INDIVIDUAL / GROUP
6.
DATE:………………………………………….............................................…………
7.
RATING SCALE
Descriptive Term
Numerical Value
Letter Grade
 POOR
0 – 49%
E
 SATISFACTORY
50 – 64%
D
 GOOD
65 – 75%
C
 VERY GOOD
76 – 85%
B
 EXCELLENT
86 – 100%
A
1. INSTRUCTION
Tick 
in the appropriate column according to your (supervisor observation/or
activities done)
1. Distribution of marks.
 Item (1) = 5%
 Item (2) relationship building15%
 Item (3) explorations skills 30%
 Item (4) understanding skills 30%
 Item (5) action planning skills15%
 Item (6) recording keeping 5%
Total
100%
N.B Marks for each item is indicated in brackets (
123
)
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE 8
S/N
DIRECT OBSERVATION – ACTIVITIES
1.
Counsellor’s Trainee’s General appearance (5)
2.
RELATIONSHIP BUILDING
M8-9
POOR
= Welcome the client promptly and appropriately
(1/2)
= Greets the client (1/2)
= Shakes hands with client (1/2)
= Building rapport (1)
= Gives introduction (1)
= Orientation and explains her/his role (1)
= Assures privacy (1/2)
= Assures confidentiality (1)
= Indicates observation/ communication and
appropriate Eye contact (1/2)
= Listens actively (1/2)
= Counsellor Voice (1/2)
= Sets mutual time contact (1/2)
= Attending behaviour *sitting arrangement – Chair in
a V shape arrangement) (1/2)
= No Physical barrier (s) between counsellor and
client (1/2)
= Counsellor closer to the door and near to client
(Psychological distance) (1/2)
= Relaxed (1/2)
= Open body Posture (1/2)
= Leans forward (1/2)
= Eye contact (1/2)
= Respect (1)
= Empathy (1)
= Trust (1 ½ )
3.
EXPLORATION SKILLS
= Open ended questions (3)
= Closed ended questions (3)
= Minimal encourages (3)
= Eye contact (3)
= Active listening (3)
= Genuineness (3)
= Concreteness (3)
= Nodding (2)
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
124
SATISFACTORY
GOOD
VERY
GOOD
EXCELLENT
REMARKS
MODULE 8
M8-9
S/N
DIRECT OBSERVATION – ACTIVITIES
POOR
SATISFACTORY
GOOD
VERY
GOOD
EXCELLENT
REMARKS
= Grunting (2)
= Empathy (2)
= Answering (3)
4.
UNDERSTANDING SKILLS
= Summarization (1)
= paraphrasing (1)
= Reflection of feelings (1)
= Empathy (1)
= Respect (1)
= Identification of client’s problem (1)
= Ability to discuss sensitive issues (1)
= Ability to help client realize perceived information
(1)
= Ability to give factual information on HIV/AIDS/STI or
as presented problem (1)
= Ability to help client make a personalized risk
assessment:(2.5)
= Client sexual and other behaviours explored (1)
= Clients sexual and other behaviours
summarized (1)
=Clients readiness to change Risk behaviours
assessed (1)
= Ability to help client make a personalized Risk
Reduction Plan (2.5)
= Counsellor assess potential barriers to the
suggested risk reduction strategies (2)
= Ability to discuss on HIV testing and
implications (2)
= Client given chance to propose strategies for
positively living with HIV and AIDS. (2)
= Counsellor gives a list of alternative risk reduction
strategies for consideration (1)
= Counsellor’s ability to discuss on significant
others (1)
= Counsellor supports client’s sustainable plan for
change of behaviour (2)
= Counsellor supports the client to elicit a
commitment for change of behaviour (2)
= Client’s personalized risk reduction plan written by
Counsellor and given to client to reinforce Behaviour
change. (1)
125
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE 8
S/N
DIRECT OBSERVATION – ACTIVITIES
5.
ACTION PLANNING (SKILLS)
M8-9
POOR
= Concreteness (1)
= Genuineness (1)
= Trust (1)
= Respect (1)
= Setting appointment for next visit (3 ½ )
= Termination of Counselling session (3 ½ )
= Jotting down important points (4)
= Ability to provide IEC materials(1)
6.
RECORD KEEPING
= Counselling registration form (2)
= Consent form used to pass on information to third
party (1)
= Summary of counselling session (2)
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
126
SATISFACTORY
GOOD
VERY
GOOD
EXCELLENT
REMARKS
MODULE 8
M8-9
7.
COMMENTS:
8.
MARKS/SCORES
8.1 Sub-Total Marks:
8.2 Grand Total Marks:
8.3 Overall Grade:
9.
GENERAL COMMENTS:
10.
TRAINEE SIGNATURE:
--------------------------------------------------------------------------SUPERVISOR’S SIGNATURE:
---------------------------------------------------------------------------
127
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
MODULE 8
Session 10
M8-10
Sharing Field Experiences (60min)
CASE STUDY FORMAT FOR SHARING
Guidelines for case study should include the following
1. Personal particulars of the client
2. Briefly write history of the client
3. Identify reasons for VCT services
4. Identify type of counselling
5. Outline the situation of counselling done
6. Briefly write the procedure of counselling
7. Write constrains /obstacles encountered during the counselling session
8. Write learning experiences from your case.
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
128
ANNEXES
A
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
B
4:00-5:00
3:45-4:00
2:45-3:45
Getting to know
each other
(M1-2)
The Trends of HIV
& AIDS situation
(M2-3)
The body immune
system and HIV
(M2-2)
TEA BREAK
Basic
communication skills:
Overview (M3-6)
Roles of an effective
Counsellor (M3-14)
Weekly Test
Recap
DAY 6
Processes & practice of
counselling: National VCT
Guideline (M3-12)
Processes & practice of
counselling: Counselling
barriers (M3-11)
Processes & practice of
Counselling;
counselling Supportive
counselling skills (M3-10) Silence microskills (M3-16)
Processes & practice of
Counselling; listening
counselling: Basic Stages and questions microskills
(M3-9)
(M3-15)
Processes & practice of
counselling: Overview
(M3-8)
Recap
DAY 5
Basic
The role of VCT
Charcteristic of an effective
communication skills:
in HIV prevention,
Counsellor
Effective communication
care and coping (M2-9)
(M3-13)
(M3-7)
Introduction to
HIV testing (M2-8)
Counselling
theories: Humanistic
(M3-5)
Terms used in
HIV testing (M2-7)
Counselling
theories: Cognitive 4
(M3-4)
Counselling theories:
Behavioural 3 (M3-3)
TEA BREAK
Counselling
psychonalitic (M3-2)
Counselling
overview 1 (M3-1)
Recap
DAY 4
1:45-2:45
Introduction (M1-1)
HIV prevention strategies
(M2-5)
Modes of HIV
transmission, prevention
strategies (M2-5)
Modes of HIV transmission
and related risk factors
(M2-4)
Recap
DAY 3
Basic information Myth and misconceptions
on HIV and AIDS
about HIV
(M2-1)
and AIDS (M2-6)
Language of HIV
(M1-5)
Self- concept
(M1-4)
Values
(M1-3)
Recap
DAY 2
LUNCH
Pretest
Official opening
Registration and administrative issues
DAY 1
VCT TRAINING TIMETABLE (WEEK 1)
12:45-1:45
11:45-12:45
10:45-11:45
10:15-10:45
9:15-10:15
8:15-9:15
8:00-8:15
Time / Day
(ANNEX 1-1) C
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
Recap
DAY 9
Children Counselling
Skills (M4-8)
Recap
DAY 10
Pre test counselling:
Identification of risk
behaviours (M3-19))
5:00-5:20
4:00-5:00
Micro-Counsellingw
Overview of Children
Pre Test Counselling: Role Counselling Post-test
Counselling and their
plays (M3-20 &21)
Role plays (M3-22 -26)
legal issues (M4-7)
TEA BREAK
Crisis Counselling
(M4-14)
Counselling for treatment and
drug adherence 2 (M5-5)
Factors Promoting
Post-testing Councelling Counselling for treatment and
Youth Counselling
for “ PMTCT” (M4-13)
drug adherence 1 (M5-4)
(M4-6)
2:45-3:45
3:45-4:00
Pre test counselling: HIV
Supportive counselling: Youth Counselling Pre-test Counciling for “ Continuum of care in HIV and
Test results and likely
(M3-26)
Skills (M4-5)
PMTCT” (M4-12)
AIDS (M5-3)
reactions (M3-21)
LUNCH
Pre Test Counselling: Role Counselling Post-test
plays (M3-20 &21)
Role plays (M3-22 -26)
Counselling for ARV/ART
(M5-6)
Weekly Test
Recap
DAY 12
Overview of TB/HIV
co-infection (M5-8)
Factors Promoting Moth- Overview of HIV and AIDS
Family Counselling
The role of a Counsellor
er to Child Transmission care and Treatment services
(M4-3)
in ART (M5-7)
of HIV (M4-10)
(M5-1)
Psychosocial support Strategies for Prevention Counselling issues across
Post test counselling:
in Family Counselling of Mother to Child Trans- the HIV disease continuum
Coping (M3-25)
(M4-4)
mission of HIV (M4-11)
(M5-2)
Post test
counselling:Provision
of Positive HIV test
Results(M3-24)
TEA BREAK
1:45-2:45
12:45-1:45
Pre test counselling:
Development
of risk
11:45-12:45
reduction plan (M3-20)
10:45-11:45
10:15-10:45
Supporting client and
significant others to cope
with loss (M4-16)
Councelling for Loss, Grief
and Bereavement (M4-15)
Recap
DAY 11
VCT TRAINING TIMETABLE (WEEK 2)
Post test
Changes during
The role of VCT in
Pre test counselling over- counselling:Adherence
Pregnancy and
Couple Counselling
9:15-10:15
view (M3-18)
to risk reduction
introduction to “ PMTCT”
(M4-2)
strategies (M3-23)
Programme (M4-9)
Counselling: Non-verbal Post test counselling:
Couple Counselling
Behaviour micro skills
Provision of Negaive
(M4-1)
(M3-17)
HIV Test results (M3-22)
Recap
Recap
8:00-8:15
8:15-9:15
DAY 8
DAY 7
Time / Day
(ANNEX 1-2) HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
D
Data Colection and
HIV Testing in VCT
Reporting Tools
Module 7
(M6-6)Filling forms
Recap
5:00-5:20
4:00-5:00
3:45-4:00
Management of
opportunistic
infections (M5-15)
Legal and human rights
issues (M5-21)
Micro-Counselling
TEA BREAK
HIV Testing in VCT
Module 7
HIV Testing in VCT
Module 7
HIV Testing in VCT
Module 7
HIV Testing in VCT
Module 7
Monitoring and
Evaluation of VCT
Services (M6-5)
Overview of
Stigma and discrimination
opportunistic
(M5-20)
infections (M5-14)
2:45-3:45
HIV Testing in VCT
Module 7
HIV Testing in VCT
Module 7
HIV Testing in VCT
Module 7
Module 7
HIV Testing in VCT
Module 7
HIV Testing in VCT
Recap
DAY 18
Micro counselling:
Exploration (Mhip 8-2)
HIV Testing in VCT Micro counselling: Relations
Module 7
building 1 (M8-1)
STIs related
Stigma and discrimination Referral and Network HIV Testing in VCT
counselling (M5-13)
1 (M5-19)
Development (M6-4)
Module 7
The role of a
Stigma and discrimination
Counsellor in STI/
Cients flow
in HIV and AIDS context
RTI management
Management (M6-3)
(M5-19)
(M5-12)
LUNCH
Overview of STI/RTI Counselling for nutrition in Models of VCT service HIV Testing in VCT
Module 7
(M5-11)
the context of HIV (M5-18)
delivery (M6-2)
1:45-2:45
12:45-1:45
11:45-12:45
10:45-11:45
TEA BREAK
8:15-9:15
Legal and human
rights issues for
minors (M5-22)
Recap
DAY 17
10:15-10:45
Nutrition in the context of
HIV 1 (M5-16)
TB/HIV related
counselling 1
(M5-9)
Recap
DAY 16
TB/HIV related
Nutrition in the context of Establishing VCT site Data management HIV Testing in VCT
counselling 2 (M5HIV 2 (M5-17)
(M6-1)
and Data flow (M6-7)
Module 7
10)
Recap
Recap
8:00-8:15
DAY 15
VCT TRAINING TIMETABLE (WEEK 3)
9:15-10:15
DAY 14
DAY 13
Time / Day
(ANNEX 1-3) E
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
Recap
Field practice 1
(M8-9)
Field practice 2
(M8-9)
Recap
Micro counselling:
Understanding (M8-3)
Micro counselling:
Action planning (M8-4)
8:00-8:15
8:15-9:15
9:15-10:15
Field practice 4
(M8-9)
Introduction to ethics
in VCT (M8-6)
10:45-11:45
11:45-12:45
4:00-5:00
Post-test
Field practice 7
(M8-9)
Field practice 6
(M8-9)
Counsellor supervision
(M8-8)
2:45-3:45
3:45-4:00
Field practice 5
(M8-9)
Counsellor support
(M8-7)
1:45-2:45
12:45-1:45
Field practice 3
(M8-9)
Ehics in Voluntary
Counselling and Testing
(M8-5)
10:15-10:45
DAY 20
DAY 19
Time / Day
(ANNEX 1-4) Field practice 14
(M8-9)
TEA BREAK
Field practice 13
(M8-9)
Field practice 12
(M8-9)
LUNCH
Field practice 11
(M8-9)
Field practice 10
(M8-9)
TEA BREAK
Field practice 9
(M8-9)
Field practice 8
(M8-9)
Recap
DAY 21
Field practice 21
(M8-9)
Field practice 20
(M8-9)
Field practice 19
(M8-9)
Field practice 18
(M8-9)
Field practice 17
(M8-9)
Field practice 16
(M8-9)
Field practice 15
(M8-9)
Recap
DAY 22
Closure session
Closure session
Evaluation of the course
Sharing field experiences
with other 4 (M8-10)
Sharing field experiences
with other 3 (M8-10)
Sharing field experiences
with other 2 (M8-10)
Sharing field experiences
with other 1 (M8-10)
Recap
DAY 23
VCT TRAINING TIMETABLE (WEEK 4)
(ANNEX 2-1)
Date (dd/mm/yy)
National Counselling Test Register
Counsellor’s name
Client’s
code
number
Partner’s
code
number
Type of
Sex Client’s
attendance (M/F) age
(use
(years)
code A)
District and ward of Education
level (use
usual residence
code B)
Marital
status
(use
code C)
Pregnan
status (u
code D)
CODE:
(A) Type of attendance
(B) Education level
(C) Marital status
(D) Pregnancy status
(E) Referred from
(F) Typ
N=New client
RT=Return visit for re-test outside the window period
RW=Return visit for re-test within the window period
RS=Supportive follow-up visit
NE=None
PI=Primary incomplete
PC=Primary completed
SO=Secondary and above
S=Single
C=Cohabiting
MM=Married monogamous
MP=Married polygamous
S/D=Separated/Divorced
W=Widow/widowed
YP=Pregnant
NP=Not pregnant
DN=Don't know
NA=Not applicable
TB = TB clinic (out-patients)
STI = STI clinic (out-patients)
OP= Out-patient health services
(not STI or TB)
IP = In-patient health services
BTS = Blood transfusion services
HBC = Home based care
SR = Self referral
I=Individu
C=Couple
G=Group
P=Client w
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
F
Marital
status
(use
code C)
)
s)
vices
es
rvices
Pregnancy Referred
status (use from
(use
code D)
code E)
Type of
Pre-test
counselling counselled
(use
(Y/N)
code F)
Agreed
and tested
for HIV
(Y/N)
Post-test
counselled
and results
given (Y/N)
HIV final
test
results
(use
code G)
Disclosure
planned to who
(fill all that
apply) use
code H
Referred
to:(fill all
that apply)
use code I
(F) Type of Counselling
(G) HIV test results
(H) Disclosure planned
(I) Referred to:
I=Individual
C=Couple
G=Group
P=Client with parent / Guardian
P=Positive
N=Negative
INC=inconclusive
NT=not tested
S=Spouse
SX=Sexual partner who is
not spouse
F=Family member
FR=Friend
RL=Religious leader
O=Other
CTC=Care and treatment centre
PMTCT=PMTCT centre
TB=TB clinic
OTH=Other services
N=None
G
Remarks
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
H
F in STI clinic
Fin OPD
Number of new clients HIV positive
Number of return/follow-up visit clients pre-test counselled (Return=RT+RW+RS)
Number of return/follow-up visit clients agreed and tested for HIV
Number of return/follow-up visit clients post-test counselled and given HIV test results
Number of return/follow-up visit clients HIV positive
Number of clients saying they will disclose test results to sexual partner (s) (Sexual parterner=S+SX)
Number of inconclusive test results
Referred from:
-TB=TB clinic (out-patients)
-STI=STI clinic (out-patients)
-OP=Out-patient health services (not STI or TB)
-IP=In-patient health services
-BTS=Blood transfusion services
-HBC=Home based care
-SR=Self referral
Referrals to
-CTC=Care and treatment centre
-PMTCT=PMTCT centre
-TB=TB clinic
-OTH=Other services
6
7
8
9
10
11
12
13
FOther (specify) ______________
Total
M
Total
F
M
14
F
M
Number of counsellors attended traininig according
to national guidelines during the month***:_______________
Fin Blood donation centre
15 - 24
F
M
** Number of active counsellors is number of people who regularly provide HIV pre / post test counselling. Part time counsellors include people who work full time at the facility but counselling is only one of their main duties
*** Attended Training – this can be new training or refresher training
Notes: * Site-in-charge means the focal person who supervises reporting for the site
Number of new clients post-test counselled and given HIV test results
Number of new clients agreed and tested for HIV
3
Part time
5
Number of new clients pre-test counselled (New=N)
2
Fin Family planning clinic
4
Total number of clients pre-test counselled (=2+6)
1
Fin IPD
FOther (specify) ____________
Full time
FOutreach (Mobile/Home based)
Number of active counsellors during the reporting month**
– who are trained according to national guidelines
– who are not trained according to national guidelines
FStand alone VCT
Facility Based: FVCT
Fin TB clinic
Site-in-charge contact:________________________________
District:____________________________________
Type of Site (tick):
Name of site-in-charge*:______________________________
Name of site:_______________________________
MINISTRY OF HEALTH AND SOCIAL WELFARE
COUNSELLING AND TESTING SERVICES
SITE MONTHLY SUMMARY FORM
(ANNEX 3-1) SITE MONTHLY SUMMARY FORM
Year: ______________
25 - 34
F
35 - 49
F
M
50+
F
The Printing cost of this form was supported by:
M
Number of Counselling Rooms:________________________
Date of reporting:__________________________________
REPORTING MONTH:
I
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
VCT coordinator contact:________________________________
Region:____________________________________
Referrals to
-CTC=Care and treatment centre
-PMTCT=PMTCT centre
-TB=TB clinic
-OTH=Other services
13
Total
M
Total
F
M
14
F
M
F
M
25 - 34
F
M
35 - 49
F
M
50+
* CT= Counselling and Testing
The Printing cost of this form was supported by:
4Number of CT Sites reported:_______________________________
F
Number of Counselling Rooms:______________________
c Other (specify)_________________ (________)
4Number of CT Sites in the District:___________________________
15 - 24
Number of counsellors attended traininig according
to national guidelines during the month***:__________________
Year: ______________
Date of reporting:__________________________________
REPORTING MONTH:
c in Blood donation centre (________)
** Number of active counsellors is number of people who regularly provide HIV pre / post test counselling. Part time counsellors include people who work full time at the facility but counselling is only one of their main duties
*** Attended Training – this can be new training or refresher training
Notes: * VCT Coordinator means the focal person in charge of reporting for the district
Referred from:
-TB=TB clinic (out-patients)
-STI=STI clinic (out-patients)
-OP=Out-patient health services (not STI or TB)
-IP=In-patient health services
-BTS=Blood transfusion services
-HBC=Home based care
-SR=Self referral
Number of clients saying they will disclose test results to sexual partner (s)
Number of inconclusive test results
Number of return/follow-up visit clients HIV positive
10
11
Number of return/follow-up visit clients post-test counselled and given HIV test results
9
12
Number of return/follow-up visit clients agreed and tested for HIV
Number of new clients HIV positive
5
8
Number of new clients post-test counselled and given HIV test results
4
Number of return/follow-up visit clients pre-test counselled
Number of new clients agreed and tested for HIV
3
7
Number of new clients pre-test counselled
2
Part time
6
Total number of clients pre-test counselled (=2+6)
Full time
1
Number of active counsellors during the reporting month**
– who are trained according to national guidelines
– who are not trained according to national guidelines
Facility Based: c VCT (________) c in TB clinic (________) c in STI clinic (________) c in OPD (________) c in IPD (________) c in Family planning clinic(________)
c Stand alone VCT (________) c Outreach (Mobile/Home based) (________)
c Other (specify) ____________ (________)
Number of Sites by types:
Name of VCT coordinator*:______________________________
District:____________________________________
MINISTRY OF HEALTH AND SOCIAL WELFARE
COUNSELLING AND TESTING SERVICES
DISTRICT MONTHLY SUMMARY FORM
(ANNEX 3-2) DISTRICT MONTHLY SUMMARY FORM
HIV and AIDS Voluntary Counselling and Testing - Participants Manuals
J
Name of VCT coordinator*:______________________________
Number of return/follow-up visit clients agreed and tested for HIV
Number of return/follow-up visit clients post-test counselled and given HIV test results
Number of return/follow-up visit clients HIV positive
Number of clients saying they will disclose test results to sexual partner (s)
Number of inconclusive test results
Referred from:
-TB=TB clinic (out-patients)
-STI=STI clinic (out-patients)
-OP=Out-patient health services (not STI or TB)
-IP=In-patient health services
-BTS=Blood transfusion services
-HBC=Home based care
-SR=Self referral
Referrals to
-CTC=Care and treatment centre
-PMTCT=PMTCT centre
-TB=TB clinic
-OTH=Other services
8
9
10
11
12
13
Total
M
Total
F
M
14
F
M
F
M
25 - 34
F
M
35 - 49
F
M
50+
F
Number of Counselling Rooms:______________________
F Other (specify)_________________ (________)
* CT= Counselling and Testing
The Printing cost of this form was supported by:
Number of Districts reported:________________________________
Number of Districts in the Region:____________________________
Number of CT Sites reported:_______________________________
Number of CT Sites in the Region:___________________________
15 - 24
Number of counsellors attended traininig according
to national guidelines during the month***:__________________
Year: ______________
Date of reporting:__________________________________
REPORTING MONTH:
Fin Blood donation centre (________)
** Number of active counsellors is number of people who regularly provide HIV pre / post test counselling. Part time counsellors include people who work full time at the facility but counselling is only one of their main duties
*** Attended Training – this can be new training or refresher training
Notes: * VCT Coordinator means the focal person in charge of reporting for the region
Number of return/follow-up visit clients pre-test counselled
7
Number of new clients post-test counselled and given HIV test results
4
6
Number of new clients agreed and tested for HIV
3
Number of new clients HIV positive
Number of new clients pre-test counselled
2
Part time
5
Total number of clients pre-test counselled (=2+6)
Full time
1
Number of active counsellors during the reporting month**
– who are trained according to national guidelines
– who are not trained according to national guidelines
Facility Based: FVCT (________) Fin TB clinic (________) F in STI clinic (________) Fin OPD (________) Fin IPD (________) Fin Family planning clinic(________)
FStand alone VCT (________) FOutreach (Mobile/Home based) (________)
FOther (specify) ____________ (________)
Number of Sites by types:
Region:____________________________________
MINISTRY OF HEALTH AND SOCIAL WELFARE
COUNSELLING AND TESTING SERVICES
REGION MONTHLY SUMMARY FORM
(ANNEX 3-3) REGIONAL MONTHLY SUMMARY FORM
CONTACTS
Ministry of Health and Social Welfare
National AIDS Control Programme
P.O. BOX 11857
Dar es Salaam, Tanzania
Tel: +255 22 2131213, Fax +255 22 2127175
Website: http://www.nacp.go.tz
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2008
HIV and AIDS Voluntary Counselling and Testing Participant’s Manual UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE
HIV and AIDS Voluntary
Counselling and Testing
Participant’s Manual
National AIDS Control Programme
February 2008