Provider Initiated HIV testing and counseling in the STI clinic setting in Fiji

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Provider Initiated HIV testing and counseling in
the STI clinic setting in Fiji

• Dr. Sophaganine Ty Ali
• Senior M/O In-charge
• Reproductive Health Clinic, Fiji

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Outline

• Demographic and health structure
• Structure of STI clinic and service delivery
• Procedure of HIV testing
• HIV testing and counseling procedure
• Future planning
• Challenges and conclusion

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1. Demographic and Health structure

• Located in the South Pacific
• 332 islands110 inhabited
• Population 905,949
• Ethnic Fijian(51), Indian(44), Other(5)
• Autonomy 4 divisional areas (Central, Eastern,
  Western and Northern)
  
• Each division has an STI clinic

Source Bureau statistic Fiji, 2006
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2. Structure of the STI clinic (RH)

• Human Resource/Staff 1 medical officer, 4
  clinical staff, 1 laboratory staff, 1 cleaner
  
• Is the referral center for STI/HIV from other
  medical areas
  
• Opening hours weekdays, 8am to 430pm

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Service provided by the clinic

• STI/HIV counseling and testing
• Treatment for STIs and HIV (OIs and HAART)
• Family planning, Pap smear
• Practical attachment for under-graduate and
  post-graduate students
  
• Provide training to other medical areas
• Community outreach

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Case attendance

• Total attendance 3018 cases per year
• 50 -Symptomatic for STIs
• 75 -Fijian ethnic
• 64 -Male

STI Clinic Suva, 2006
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HIV testing

• Screening test was done at the clinic,
• Pre test counseling done on one to one basis
• Approach for HIV test to all attendance cases

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4. HIV testing procedure
Serodia HIV ½ PA
At the clinic
_

• Repeat Serodia X 1

• Report Negative
• Counseling, give
• negative result
• Follow up/re-test

_

Reference Lab

• Follow by
• Vironistika and
• Enzygnost

_

• Counseling, give
• negative result
• Follow up/re-test

• Counseling, give
• positive result
• Follow up

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Refuses cases

• 0.003 (11/3018)
• - refused to have HIV test
• - All of them are male (5 cases were in
  the hurry, and 6 cases were not ready for the
  test)
  
• 0.00 refused screening for STIs

Source STI Suva, 2006
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STI cases (symptomatic asymptomatic)

• Providing
• Assessment
• Counseling on STI, HIV..according to the risk
• Provided according to the need

• At the time of consultation
• At the same place
• With the same health care team

• Offering
• Pap-smear (for female)
• Screening STIs
• Counselingoffer HIV test
• VCCT
• Tx. and Referral if needed
• Follow up
• Contact tracing

Turn around time for the test results
3-7 days (except for pap smear)
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Service providing
VCCT
Counseling for HIV testing
Physical examination
Counseling behavior, HIV, STIs.
?
Collection of specimen
STI screening
risk assessment
Syndromic/M for STIs
Contact tracing if needed
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Procedure for HIV testing

• Average time for waiting 15 min
• Average time spent with staff 15-20 min
• Person involved nurse, doctor and Lab-staff
• Information provided to reach consent Offer
  services

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Pre and post test counseling

• Verbally consent is obtained and patient is
  requested to sign in the file
  
• Pre and Post test counseling (negative result)
  Check list
  
• Time for pre-test counseling 15 minutes
• Positive result given with closely follow up

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Future planning

• Measures to scale-up counselling and testing to
  the peripheral level
  
• Support needed for the scaling-up

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Challenges

• Time
• Human resources
• Clinic space privacy issues
• Re-infected cases for STIs

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Conclusion

• PITC is a Gateway for
• - Provision of correct information
• - Opportunity for client to review his/her own
  risk behavior
  
• - Reducing the risk
• - Adjustment life style
• - Enter for HIV care and treatment (50 of
  positive cases in Fiji were from STI clinic)

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AcknowledgementsProf. Ahmed Latif, WHO WPRODr.
Seng Sopheap, WHO HIV and STI Focal Point, South
Pacific

• Thank you

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HIV testing strategy