HIV/AIDS

Training


Training requirements

Basic training is essential for all HIV testing and counselling staff members, including reception and administrative staff, and for lay volunteers working in conjunction with formal health service sites and community-based health services. Some areas are common to all staff members but particular subgroups need additional technical training.

Specific issues to be covered through training for all staff

  • basic HIV awareness (HIV transmission and prevention);
  • purpose and benefits of HIV testing and counselling;
  • process of HIV testing and counselling;
  • confidentiality issues;
  • how the HIV testing and counselling team works together, including roles and responsibilities and line management;
  • health and safety issues.

Basic training for all counsellors

Basic training in counselling (pre-service and in-service). All counsellors need basic training for routine/uncomplicated cases.

This includes:

  • pre-test counselling/ pre-test education or information;
  • post-test counselling;
  • ongoing counselling.

Tools

WHO Global Programme on AIDS - Source Book for HIV/AIDS Counselling Training (1995)

This source contains information on the importance of counselling, the various psychosocial and cultural aspects that must be considered as well as various counselling processes. Each section has a summary at the end and points of discussion. Its content is based on findings from field-tested versions of the WHO/GPA draft HIV counselling manual.

Voluntary HIV Counselling and Testing : Manual for Training of Trainers (WHO SEARO 2004)

This is the second of 5 modules of a training manual; it is designed to assist trained and experienced VCT counsellors in the development and delivery of training, and is not for use as a self-directed training tool.

Module 6: HIV Testing and Counselling for PMTCT (from WHO/CDC PMTCT generic training package)
Project Respect: Counselling Intervention Manual (CDC 1993)

Project RESPECT was a multi-centre randomized trial evaluating the efficacy of HIV prevention counselling in changing behaviour and reducing new STDs. The Brief Counselling Intervention was one of two counselling models tested in the study. This two-session prevention counselling intervention is based on the Client-Centred HIV Counselling that has been recommended by CDC for use in public clinic settings where HIV testing is done.

This four-session prevention counselling intervention was developed for the trial during an 18-month preparation phase, and was pilot tested. The intervention is based on theories of behavior change, particularly social cognitive theory and the theory of reasoned action.

Voluntary Counselling and Testing; Skills Training Curricuum (FHI 2005)

This manual comprises a curriculum for participants who are being trained as VCT counsellors. There is an overview unit as well as 7 independent units, each of which includes goals and objectives as well as materials required. The units contain information that range from risk assessment to conducting HIV tests and counselling. Also included are: exercises and skill building (questioning, listening); overheads as well as handouts for teaching each unit; protocols (13 components, including disclosure) and checklists.

This manual comprises a curriculum for trainers of trainers as well as trainers of counsellors. There is an overview unit as well as 7 independent units, each of which includes goals and objectives as well as materials required. The units contain information that range from risk assessment to conducting HIV tests and counselling. Also included are: pre- and post-course knowledge assessment forms; overheads as well as handouts for teaching each unit; protocols (including disclosure) and checklists.

Integrated Management of Adolescent and Adult Illness - Interim Guidelines for First-Level Facility Health Workers

IMAI supports the introduction of an effective approach to chronic care (including a team approach, patient partnership, inclusion of expert patients'/peer support staff on the clinical team, and effective adherence support). This approach could permit rapid expansion of human resources for HIV care while providing the skills and clinic capacity for effective management of other chronic illnesses. A short module describes the General Principles of Good Chronic Care. These principles are used in the Chronic HIV Care guidelines.

Acute care presents a syndromic approach to the most common adult illnesses including most opportunistic infections. Clear instructions are provided so the health worker knows which patients can be managed at the first-level facility and which require referral to the district hospital or further assessment by a more senior clinician. Preparing first-level facility health workers to treat the common, less severe opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without referral to the district.

This module includes patient education, psychosocial support, prevention for positives, clinical staging, prophylaxis (INH, cotrimoxazole, fluconazole), preparation for ARV treatment then clinical monitoring, response to side effects, adherence preparation and support, management of chronic problems, and data collection based on a simple treatment card. The Chronic HIV Care with ARV Therapy effectively integrates HIV care and prevention, increasing the potential for preventive interventions. The broader uptake of preventive interventions is essential for HIV control.

The module covers management of symptoms during acute or chronic illness, education of the patient, family and community caregiver to provide care at home, using the Caregiver Booklet; and end-of-life care. Symptom management is very important in patients on ARV treatment. In order to expand access to palliative care, this approach assumes that most of the care will be given by the patient's family with back-up by multi-purpose health workers at first- level facilities. This module covers palliative care in both children and adults.


HIV counselling with rapid tests (Centers for Disease Control)
HIV counseling and testing for youth: a manual for providers (USAID 2005)

This manual is a guide to best practices for offering HIV counseling and testing services for youth. To strengthen youth counseling and testing services, this manual functions as a reference tool on youth and HIV/AIDS, a guide to counseling young clients about HIV testing, prevention, care, and treatment, a reference tool on related services, and a place to record local referral networks.

Routine HIV Testing and Counselling for PMTCT. Ministry of Health, Botswana (2006)

This module is designed to provide healthcare workers with the basic knowledge and introductory skills to conduct routine HIV testing and counselling in Sexual and Reproductive Health (SRH) care settings.

Advanced/Specialized Training in Counselling

Some counsellors in the services can be trained in more advanced counselling skills so that they can support less experienced counsellors with complex cases or have clients/patients referred to them. Specialized training is also needed for counsellors seeing young people, families/couples and vulnerable groups such as sex workers and IDUs.

This training may cover counselling in respect of:

  • domestic violence and rape;
  • premarital matters / couples;
  • discordant couples;
  • sexual behavioural risk negotiation;
  • managing HIV disclosure and its consequences in environments with high stigma or denial.

Tools

Voluntary Counselling and Testing (VCT) Communication about Sexual Health (CASH)

The module is meant for the training of counsellors in the concepts of communication about sexual behaviour and related issues. Also included are: exercises and skill building (questioning, listening) and performance standards for condom demonstrations.

Counselling Guidelines on Disclosure of HIV Status

These guidelines are based on the experiences and advice of people from across Southern Africa who are either living with HIV or who have extensive experience of counselling people living with HIV. It contains information for counsellors concerning disclosure, the consequences of a client's decision, coping mechanisms, and the effects of the media on disclosure. There is a non-disclosure form that can be photocopied and used as a safeguard against exploitation from the media and media personnel.

HIV Status and Disclosure: Choices and Consequences

This pamphlet is designed to help HIV positive people think through the issues involved in disclosure, and to help them make informed choices about disclosing their HIV status. It includes guidelines concerning how to deal with the media. There is a non-disclosure form that can be photocopied to be used as a safeguard against exploitation from the media and media personnel.

document is no longer online

Training of Trainers

The training of trainers is essential in many settings where a rapid scaling up of HIV testing and counselling services is planned.

Continuing Education

HIV testing and counselling is a rapidly changing field. For example, the new ARV treatments and PMTCT opportunities mean that it is highly advantageous for people to know their status. Counsellors need continuing education so that they are familiar with current treatment options and, for example, with areas such as counselling on infant feeding if they are involved in PMTCT. Staff involved in HIV testing also need to have access to continuing education so that they can be aware of new test kits, technologies and procedures.

Ongoing Supervision, Support and Mentoring

Burnout and staff attrition have been noted in many HIV testing and counselling services. A senior counsellor should be trained to develop a programme of support, supervision and mentoring for counsellors. Regular staff appraisals can help to keep staff motivated and maintain a high quality of service.

A Reference Guide for Counselors and Trainers - Chapter 9 (FHI VCT toolkit, 2004)
WHO and HHS/CDC Prevention of Mother-to-Child Transmission of HIV (PMTCT) Generic Training Package

The World Health Organization (WHO) and the United States Department of Health and Human Services-Centers for Disease Control and Prevention (HHS-CDC) have collaborated to develop the Prevention of Mother-to-Child Transmission of HIV (PMTCT) Generic Training Package. Recognizing that building human capacity requires collaboration at multiple levels and across organizations, the curriculum is designed to support the scale up of PMTCT services and assist in unifying and strengthening existing PMTCT training efforts.

Guidelines for counselling children who are infected or affected by HIV and AIDS (Southern Africa AIDS Trust 2004)
Youth centered counseling for HIV/STI prevention and promotion of sexual and reproductive health: a guide for front-line providers (WHO/PAHO 2005)

Front-line providers have a unique opportunity to reach youth and promote HIV prevention and healthy sexuality. Their position as professionals and health experts lends them credibility in communities and provides the opportunity for them to openly address taboo subjects surrounding sexual health. Nurses, doctors, community health workers, social workers, counselors, and teachers all come into contact with young people on a regular basis and have many opportunities to make a positive impact. HIV prevention cannot be left to one agency, organization, or AIDS clinic. Ample evidence shows that collaboration between stakeholders leads to improved results.