Post-test counselling and communication of test results

POST-TEST COUNSELLING

Post-test counselling must always be an integral component of the HIV/HCV testing process. Everyone undergoing rapid testing must be counselled when their test results are given, regardless of the result, because counselling aims not only to help the client to understand and cope with the test result, but also to provide the client with further information required and, if necessary, referral the client to other services.

Post-test counselling must offer, among much else, support concerning disclosure of HIV/HCV status and a valuable opportunity to provide accurate information about harm reduction and safer sex that is relevant to the person being tested, reflecting the test result. Behavioural change and risk reduction counselling may also have value.

COMMUNICATION OF TEST RESULTS CONSIDERING THE RISK ASSESSMENT

The communication of test results should always take into consideration the risk assessment of the person tested, above all regarding the probability of false negative result in case of recent risk behaviours and, on the other hand, the probability of false positive result if the person reported low or very low risk factors. If possible, the counsellor who provided pre-test counselling should also provide post-test counselling. In this way, the counsellor has already established a relationship with the client and can better evaluate the way to communicate the result and provide information in post-test counselling based on the risk assessment conducted during the pre-test counselling.

COMMUNICATION OF NEGATIVE (NON-REACTIVE) TEST AND WINDOW PERIOD

For those who test negative (non-reactive), post-test counselling is an important opportunity to put those at risk for HIV/HCV in contact with primary prevention programs and to encourage later retesting. A negative test does not require a confirmatory test, except if the person was tested too soon, before antibodies developed. That’s why it is fundamental to recommend a re-testing, if the client has had risk behaviour the last three months for HIV and six months for HCV, since the period between the infection and production of antibodies lasts on three or six months respectively for HIV and HCV; this is so-called “window period”. However, safer drug use and safer sexual behavior should be always stressed, no matter what the result is.

COMMUNICATION OF PRELIMINARY POSITIVE TEST RESULTS

HIV/HCV testing and counselling is the essential first step in enabling people to know their sero-status and obtain HIV/HCV treatment and care services. In the case of a HIV positive result, it’s fundamental to clearly explain that the result has to be considered a “preliminary positive” and that a more specific laboratory test (on a whole blood sample) for the confirmation of the diagnosis is needed. However, it is recommended that clients with high-risk behaviour are informed about the probability that the confirmatory test will be positive and receive the support necessary to acknowledge and cope with this information, as it is a very stressful moment. For that reason it is preferable that both pre- and post-test counselling are provided by the same counsellor, who has already established a relationship with the client and can better evaluate the likelihood of a reactive result on the basis of the risk assessment. Moreover, it must be taken into account that the provision of pre- and post-counselling in low-threshold services requires high skills and competencies, to keep up to standards of provision. In particular, when offering the counselling and testing in mobile street units, the space is limited and most of the clients are in a hurry. Therefore, it is important that the counsellor has adequate capacities and experience, in order to create a confidential atmosphere, understand quickly the specific needs of each client and provide him other with the most suitable information and support. The counsellor has to be also ready to cope with the crisis situation in the case of positive result. Moreover, the clients should have chance to step out of the mobile unit without clear marks of the result.