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HIV testing and counselling toolkit

HIV testing and counselling services are a gateway to HIV prevention, care and treatment.


A note about terminology

The acronym VCT (voluntary counselling and testing) is widely used in reference to HIV testing and counselling services. However, HIV testing and counselling is a term that covers a variety of interventions in different service settings:

1. In traditional client-initiated voluntary counselling and testing (VCT), individuals actively seek HIV testing and counselling services because they wish to learn their status.

2. In provider-initiated testing and counselling (PITC), HIV testing and counselling is recommended by health-care providers to persons attending health care facilities as a standard component of medical care. The major purpose is to enable specific clinical decisions to be made and/or specific medical services to be offered. This would not be possible without the knowledge of the HIV status of the people concerned.

In the case of persons presenting to health facilities with symptoms or signs of illness that could be attributed to HIV, it is a basic responsibility of heath care providers to recommend HIV testing and counselling as part of routine clinical management. This includes recommending HIV testing and counselling to tuberculosis (TB) patients and to persons suspected of having TB.

PITC also aims to identify unrecognized or unsuspected HIV infection in persons coming for care at the health facility. Health-care providers may therefore recommend HIV testing and counselling to patients even if they do not have obvious HIV-related symptoms or signs, in some settings. Such patients may nevertheless be HIV-infected and may benefit from knowing their HIV status by receiving specific preventive and/or therapeutic services. In such circumstances, HIV testing and counselling is recommended by health-care providers as part of a package of services provided to all patients during all clinical interactions in health facilities. As with client-initiated HIV testing and counselling, PITC is voluntary and informed consent, counselling and confidentiality (the three Cs) must be observed. Patients retain the right to decline the recommendation of HIV testing and counselling if they do not wish testing to be performed.

VCT in the traditional sense is one approach to ethical HIV testing and counselling procedures that should be expanded and radically scaled up to meet the urgent requirement for greater access to ARV treatment and prevention. In addition, health facilities represent a key point of contact with people with HIV who are unaware of their status and who would benefit from HIV-specific services. PITC is a valuable and important addition to the available range of approaches.