Two components of HIV/HCV counselling

PROVISION OF INFORMATION ON TESTING (informative counselling)

To establish initial rapport with the client, the counsellor should convey positive regard, genuine concern, and empathy toward the client. This connection will help build trust. It is important to be professional and respectful toward the client and to recognize that some risk behaviors, such as drug use and sex work, may be sensitive topics and difficult for the client to discuss. The client should be helped to feel comfortable with the test procedures, understand the role of the counselor, and be clear about the content and purpose of the session (CDC - Guide to Comprehensive Hepatitis C Counseling and Testing).

In any setting where the testing is provided, all clients should receive information about the “basic rules” of testing: confidentiality and anonymity of the information; informed consent; the right to decline the test even after the pre-test counseling; and the need for risk assessment. Providers must also recommend the person tested to contact those who might be at risk, if the test result is positive.

Even if the majority of people are aware of the basic information about HIV and HCV, a quick assessment of the knowledge about the diseases can be helpful, depending on the time available. Some written information can also be provided (informative leaflet).

About the test itself, the following elements of testing and counselling should be clearly explained: the duration and testing procedures; a description of the main characteristics of the rapid test; the validity

of the test and clear emphasis on the “window period”; the meaning of test results (included services available in the case of either a negative or a positive test result); and confidentiality and respect of privacy in the treatment of test results; the follow-up process in case of positive result. Moreover, during this phase, the counsellor should also: discuss what result the client is expecting; how the client would react to the result; and advantages and disadvantages of taking the test.

The counsellor should explain that the rapid test has the same specificity and sensitivity of other II/III generation tests on whole blood (except in the early phase of infection) and, as in other type of tests, there is the possibility of having false positive result, therefore, they should emphasize that a positive result must be confirmed by other

more specific tests. The counsellor should also explain the procedures for confirmatory testing, when foreseen. It is important to have clear procedures in place, following national HIV/HCV testing strategies and algorithms, to confirm positive test results and to link clients to treatment and care.

PREVENTION COUNSELLING

Prevention counselling is an interactive process that consists of:

• assessing an individual’s risk for acquiring or transmitting HIV and or HCV, based on a discussion of risk behaviours;
• developing an individualized plan to reduce these risk behaviours.

When offering HIV/HCV counselling to people who use drugs, it’s important to focus on drug-related risk behaviours, encouraging clients to identify the drug use behaviours that put them at increased risk for acquiring HIV/HCV and understand the reasons why they continue to engage in them, in order to set and reach a specific, realistic, risk-reduction goal. The counselor should also explore previous attempts to reduce these risks and support clients in their successes and efforts. Strategies for reducing the risk of sexual transmission should also be addressed among clients who use drugs.