STI Counseling and Voluntary Counseling and Testing for HIV and AIDS in Cameroon, West Africa: Analy

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STI Counseling and Voluntary Counseling and
Testing for HIV and AIDS in Cameroon, West
Africa Analysis of decision making and client -
provider interaction Heerey, M., Amoa, M.,
Ouedraogou, D., Kim, Y.M. and Vondrasek C
PPT CCP 6/7/00 P 1
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Cameroon, West Africa

• Pop 15, 203, 000
• 11.8 HIV seroprevalence among adults (UNAIDS,
  end 2001)
• Seroprevalence 920, 000 adults children are
  infected, of this 500,000 are women (UNAIDS,
  end 2001)
• 9.0 and 10.7 among antenatal clients in urban
  and outside major urban areas (UNAIDS, end 2001)

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Key decisions patients make in the context of VCT

• Seek info/visit clinic
• Get tested
• Learn test results
• Disclosure gt partner testing, future
  prevention, living positively, future testing,
  etc.

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Provider interpersonal communication is key to
facilitate decision making

• Encourage client participation
• Discuss socio-emotional factors
• Discuss sex lifestyle
• Counsel problem solve

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Study objectives

• Phase I Assess impact of training and use of a
  counseling job aid on the quality of
  patient-provider communication in VCT
• Phase II Assess impact on patient intended and
  reported behavior related to HIV

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Phase 1 Data collection and analysis

• Single round of data collection post-intervention
• Audio-taped VCT sessions
• RIAS (Rotor Interaction Analysis System)
• process and content
• Qualitative analysis

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Interventions aimed at improving the quality of
VCT

• 10-day training technical and IPC/C process
• Counseling job aid
• risk assessment/risk reduction counseling

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Study sample

• 164 STI VCT sessions discussed in this
  presentation
• 15 providers 4 physicians and 11 nurses
• 7 sites 6 hospitals and 1 medical center
• Sites selected purposefully based on location
  (urban versus rural), accessibility, client load
  and regional representation

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Research design

• Quasi-experimental design
• 1 group received training only
• 1 group received training tool
• 1 group control

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Training and job aid increased provider and
patient communication
Control(N) 47 Training Only (N)62
TrainingTool (N)55 P lt0.001
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Providers discussed socio-emotional factors more
with training tool

• Socio-emotional codes
• personal remarks
• laughter
• expressing concern
• reassurance
• psycho-social

Control(N) 47 Training Only (N)62
TrainingTool (N) 55 P lt0.001
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Social-emotional communication

• D Have you already met someone .. a person ill
  with AIDS?
• P No, No I havent but the word it makes one.
• D Scared?
• P Yes, the word is scary.
• D It shouldnt make you afraid like that . It
  is an illness that can be avoided.

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Providers discussed sexual behavior and lifestyle
more with training tool
Control(N) 47 Training Only (N)62
TrainingTool (N) 55 P lt0.001
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Discussion of sexual behavior and lifestyle

• D So what will you then do to remain negative?
• P If we can be truthful ourselves. Faithful to
  ourselves.
• D How will you make a person to be truthful to
  you? Your partner should be a person who is
  negative and who is always prepared to remain
  negative. Somebody who goes out without
  protecting himself is a person at risk.
  Protecting a negative test is a daily fight.

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Providers encouraged client participation more w/
training tool

• Encouragement
• -show agreement
• -partnership
• -paraphrase
• -ask for understanding
• -ask opinion

Control(N) 47 Training Only (N)62
TrainingTool (N) 55 P lt0.001
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Encouraging client communication

• D What will you do once you have your results?
• P That if my test comes out negative, I will be
  protecting myself from today - if Im not yet
  married.
• D And the day you will want to get married,
  what..
• P The day I will want to marry, I will decide
  that we should go again for the test, if the
  person who is negative....
• D With the person who is negative. Do you think
  the person which is negative is a guarantee that
  he will remain negative?
• P No.

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Provision of technical information increased with
training remained steady with training tool
Control(N) 47 Training Only (N)62
TrainingTool (N55) Plt.01
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Provision of technical information

• D1 The results are negative. You are in good
  health.
• D2 We can treat the chlamydia, but not HIV. We
  can, however, slow the development of HIV.

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Counseling increased with the tool
Control(N) 47 Training Only (N)62
TrainingTool (N)55 P lt0.001
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Counseling

• D So, as an HIV positive person, you should
  avoid reinfection and eat well.
• P Wives hide such activities from their
  husbands.
• D Dialogue is important. You must talk with
  her. Maybe she doesnt know about sexually
  transmitted diseases exist - or even how one gets
  one.

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Discussion of family planning
of sessions in which FP discussed
Control(N) 45 Training Only (N)57
TrainingTool (N)51 p.013
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Client-initiated discussion of the ABCs of
prevention
of sessions in which ABC discussed
Control(N) 45 Training Only (N)57
TrainingTool (N)51 P0.007, P0.013,
P0.002
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Provider-initiated discussion of the ABCs of
prevention
of sessions in which ABC discussed
Control(N) 45 Training Only (N)57
TrainingTool (N)51 P0.007, P0.013,
P0.002
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Client Provider discussion of the ABCs of
prevention
of sessions in which ABC discussed
Control(N) 45 Training Only (N)57
TrainingTool (N)51 P0.002, P0.8,
P0.113
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Client vs provider discussion of all three
elements of ABC
of sessions with all elements of ABC
Control(N) 45 Training Only (N)57
TrainingTool (N)51 P 0.02
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Client Provider discussion of all three elements
of ABC
of sessions with all elements of ABC
Control(N) 45 Training Only (N)57
TrainingTool (N)51 P 0.4
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Conclusions

• Training alone improved provider communication
• - socio-emotional factors
• - discussion of sex and lifestyle
• - technical information
• Counseling tool increased impact of training - as
  well as had positive impact on
• - encouraging client participation
• - counseling
• - discussion of dual protection ABC

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• OPTIONAL

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Risk Assessment/Risk Reduction - GATHER Guide

• Greet Greet clients warmly. Be polite,
  respectful and attentive
• Ask Ask clients about themselves, reasons for
  coming, concerns, worries, etc.
• Tell Tell clients about their choices to prevent
  pregnancy and HIV / STIs
• Help Help clients choose the best way to prevent
  pregnancy and HIV / STIs
• Encourage Encourage clients to develop their
  Healthy Life Plan
• Remind Remind clients to come back

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Risk Assessment/Risk Reduction

• 1. Risk assessment
• unwanted pregnancy and prevention of HIV /
  STIs
• 2. Developing a healthy life plan
• taking steps to avoid risks
• 3. Strategies to overcome obstacles it is
  possible to have a healthy life style