Horizons | Research Summary| HIV Voluntary Counseling and Testing: An Essential Component in Preventing Mother-to-Child Transmission of HIV

RESEARCH SUMMARY

December 2003

HIV Voluntary Counseling and Testing:
An Essential Component in Preventing Mother-to-Child Transmission

Program Recommendations

Increasing utilization of VCT as part of antenatal care requires addressing both obstacles to service delivery and attention to the demand for services. This means expanding tested strategies, such as group pre-test counseling and using lay counselors to supplement MCH staff, and community and client education, as well as trying out new approaches.

Clinics with sufficient staff can offer individual pre-test counseling, but most sites lack counselors and face severe time constraints. A good alternative may be counseling in small groups, which facilitates the dissemination of standardized messages. It also allows women who are too shy to raise questions to learn from the questions of other women and to understand that their peers have similar concerns. Groups can also introduce opportunities for peer counseling, for example, by mothers to mothers-to-be. However, clinics must also give clients the chance to ask questions privately after a group session.

In PMTCT settings, MCH staff should carry out rapid testing in the antenatal clinic and give women their results the same day, unless they opt to wait until another visit to receive their results.

Programs should devote most of their VCT resources and time to post-test counseling. PMTCT programs need to bolster their efforts to provide supportive post-test counseling after a woman receives her results, utilizing not only PMTCT counselors in the clinic but also peer counselors in the community. Ongoing post-test counseling should help women disclose safely to partners and others. This means that training for counselors needs to acknowledge the role violence may play in the lives of some women and therefore equip counselors to facilitate but not force disclosure. Post-test counseling also needs to reinforce infant feeding counseling, help address prevention of unwanted pregnancy among HIV-infected women through family planning, and provide an entry point for care and support.

Care and support organizations have used a number of strategies for follow-up counseling and support, including facilitating support groups and using peer and lay counselors to provide ongoing counseling at the PMTCT site, at community settings, or in the home. PMTCT programs should establish links with existing care and support organizations and test promising strategies to tap into these resources for the benefit of their clients.

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