Quality post HIV test counselling
Quality is central to the effectiveness of counselling. Many programmes have made great efforts to improve the quality of counselling, not least through the intensive training of counsellors. This indicator measures the extent to which such efforts have resulted in quality counselling. It is based on observation of posttest counselling sessions, and uses a checklist to create a score of quality that includes interpersonal skills, information gathering from the client, correct and complete information given to the client, discussion of personal circumstances and partner notification, reinforced prevention messages, referral for care and support where relevant, and other aspects of counselling.
Number of counseling sessions determined to be quality sessions by trained observers
Total number of counseling sessions observed
In a survey of facilities providing counselling and voluntary HIV testing, between three and five post-test counselling sessions are observed per site, with different counsellors if applicable. Counselling skills are scored against a standard checklist of items which constitute the minimum standards for quality post HIV test counselling.
Geographic location: N/A
Pregnancy status: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
This indicator relies on observation of counselling sessions. Observational studies are time-consuming, and counsellors may deviatefrom their standard practice in observed sessions because of the presence of the observer. Confidentiality is a major issue in observational studies of post-test counselling, and the consent of the client must be sought before observation can take place. Experience has shown that counsellors themselves often refuse to be observed. An alternative to direct observation is that counselling sessions may be audio-taped for later anonymous review. Thismay reduce reluctance to participate on the part of both the client and the counsellor, makes the review exercise more time efficient, and allows for checking of variation in scoring between reviewers. Both methods, however raise issues of ethics and confidentiality of information. Without specific procedures for informed consent and the capacity to maintain confidentiality, no taping should be attempted. The measure looks only at post-test counselling sessions. It is recognised that the quality of pre-test counselling is also important in assessing a clients needs, in helping them to make decisions about testing and in preparing them for results. In managing and improving VCT services, the evaluation of the quality of pre-test counselling will be important. However since the time and resources available for observational studies are likely to be limited, for the purposes of routine M&E, facility surveys should concentrate on post-test counselling. Since quality is determined largely by the skills, knowledge and dedication of the counsellor, it is likely that scores on pre- and posttest counselling would be highly correlated, with the inherent bias being that many people do not return for results and counselling. As with all composite indicators, improvements in some areas may mask deterioration in others. Programme managers will want to see scores reported separately by area of counselling skill and performance in order to identify areas of weakness and to improve training programmes.