Pre-test counselling

Pre-test counselling means a confidential dialogue between client and counsellor with the aim to provide accurate information about the test and the implications of a positive or negative result in order to enable the person seeking testing to make an informed choice to take responsible decisions about the test. It is a process which helps the client to define his / her feelings and to cope with stress.

The objectives of HIV/ HCV pre-test counselling are:

• To assess if the client is able to undergo the test and understand the result.
• To prepare the client for the test (included test procedures) and to give information on the diseases.
• To explain the implications of knowing that one is or is not infected with HIV or HCV.
• To facilitate discussion about ways to cope with knowing one’s HIV and HCV status.
• To discuss sexuality, relationships, possible sex- and drug- related risk behaviors, in order to help the client understand his/her own risk behaviors and prevent infection.

This makes clear that HIV/HCV counselling encompasses two components: provision of information and prevention 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.

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 (for example: 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.

It is important to stress that HIV and HCV are chronic diseases, and treatment is available.