Integrated counseling & testing centre

1. By:-Jageshwar Dayal kori
-Ishan Sanodia
-Gabriel Daske
Integrated Counseling & Testing
Centre (ICTC) Visit.
Mahatma Gandhi Memorial
Medical College Hospital, Indore.
Guided By:- Dr. Sanjay Dixit
Dr. Veena Yesikar

2. Introduction
An individual who is infected with the human immunodeficiency virus (HIV)
will not develop the acquired immunodeficiency syndrome (AIDS)
immediately.
It is important that an individual who is HIV-infected is aware of his/her status
as otherwise he/she could unknowingly transmit the virus to others.
The only way to the presence of HIV and get timely treatment is through a
simple blood test. HIV counselling and testing services were started in India in
the year 1997.
Under NACP-III, Voluntary Counselling and Testing Centres (VCTC) and
facilities providing Prevention of Parent to Child Transmission of HIV/AIDS
(PPTCT) services are remodelled as a hub or ‘Integrated Counselling and
Testing Centre’ (ICTC) to provide services to all clients under one roof..

3. Overview: National AIDS Control Program
• 1992: National AIDS Control Program Initiated
• 1997: VCT services started in the country
• 1999: NACP II Initiated (99-06)
• 2000/2001: 11 centers of excellence conduct PPTCT
• 2001: Operational guidelines for PPTCT and VCT (revised in ’04 & ’07)
• 2002: PPTCT services started throughout the country
• 2003: GFATM : support to PPTCT
• 2004: GFATM : support to HIV-TB coordination
• 2006: NACP-III framework designed, Integration of VCT and PPTCT as ICTC
• 2007: Provider Initiated testing for ANC mothers, TB patients, STI patients,
HRG population.
• 2014 : NACP-IV launched for 5 years(2012-2017).

4. Problem status of HIV in INDIA
Source:- NACP-IV Strategy Document
India has demonstrated an overall reduction of 57% in estimated annual new HIV infections
(among adult population) from 2.74 lakhs in 2000 to 1.16 lakhs in 2011
The challenge before us is to make all HIV-infected people in the country aware of their status so
that they adopt healthy lifestyles and prevent the transmission of HIV to others, and access life-
saving care and treatment.
S. No. year HIV Prevalence Annual New
HIV infections
Population
infected with
HIV
1 2000 - 2.74 lakhs
2 2001 0.41 %
3 2006 0.35 %
4 2011 0.27 % 1.16 lakhs 20.9 lakhs

5. Packages of services under NACP-IV :
• Prevention services
• Care, Support, and treatment services
Goals & Objectives
Objective 1: Reduce new infections by 50% (2007
Baseline of NACP III)
Objective 2: Comprehensive care, support and
treatment to all persons living with HIV/AIDS

6. Components
• Component 1: Intensifying and Consolidating Prevention
services with a focus on HRG and vulnerable populations
• Component 2: Expanding IEC services for (a) general
population and (b) high risk groups with a focus on behavior
change and demand generation
• Component 3: Comprehensive Care, Support and Treatment
• Component 4: Strengthening institutional capacities
• Component 5: Strategic Information Management Systems
(SIMS)

8. What is an Integrated Counselling and Testing Centre?
An integrated counselling and testing centre is a place where a person is
counselled and tested for HIV, on his own free will or as advised by a
medical provider.

9. Who needs to be tested in an ICTC?
Subpopulations who are more vulnerable or practice high-risk
behaviour like
1. sex workers and their clients,
2. men who have sex with men (MSM),
3. transgenders,
4. injecting drug users (IDUs),
5. truckers,
6. migrant workers,
7. spouses and children of men who are prone to risky behaviour.

10. ROLE OF AN ICTC
•Early detection of HIV.
•Provision of basic information on modes of transmission and
prevention of HIV/AIDS
•Promoting behavioural change and reducing vulnerability.
•Link people with other HIV prevention, care and treatment
services.

11. GATHER Approach
G = Greet the client
A = Ask about the problem
Active listener
Assess degree of risk behavior
Show respect and tolerance
Enable patient or client to express freely
Determine access to support and help in family and community
T = Tell the client about specific information that he or she desires
H = Help them to make decisions
E = Explain any myths or misconceptions(also known as INFORMED
DECISION MAKING)
R = Return for follow up or Referral

12. -An ICTC is located in
health facilities owned by the government,
in the private/notfor- profit sector,
in public sector organizations/other government departments such as
the Railways, Employees' State Insurance Department (ESID)
in sectors where nongovernmental organizations (NGOs) have a presence.
-In the health facility, the ICTC should be well coordinated with the Department of
Medicine, Microbiology, Obstetrics and Gynaecology, Paediatrics, Psychiatry,
Dermatology, Preventive and Social Medicine.
-In MGMMC, ICTC is located in Microbiology Department.
Where can an ICTC be located?

13. Different types of ICTCs
ICTCs can be classified into two types:
1. Fixed-facility ICTCs
• Stand-alone
• Facility-integrated
2. Mobile ICTCs
A mobile ICTC will consist of a
 van with a room to conduct a general examination and counselling
 a space for the collection and processing of blood samples, etc. There are 4,537
stand-alone Integrated Counseling and Testing Centres (ICTCs), 9,196 Facility Integrated
ICTCs and 1,805 under Public and Private Partnership model.

14. Physical Infrastructure required for an ICTC
In a facility, the ICTC should be located
in a place that is easily accessible and
visible to the public.
• The counselling room
• Blood collection and testing room—
Refrigerator, Centrifuge, Needle
destroyer, Micropipette, Colour-coded
waste disposal bins.
• CD4 count room

16. Human resources for an ICTC
The ICTC requires a team of skilled persons consisting of the manager (medical
officer), counsellor and LT.
1. ICTC manager (medical officer)-- The administrative head of the facility where
the ICTC is located must identify and nominate a medical officer as manager in-
charge of the ICTC.
duties:-
• Administrative
• Demand generation
• Quality assurance
• Supply and logistics
• Monitoring and supervision

17. 2. Counsellors--The counsellor should be a graduate in Psychology/Social
Work/Sociology/Anthropology/ Human Development or hold a diploma in
Nursing with a minimum of 3–5 years of experience in the field of HIV/AIDS.
duties:-
• Preventive and health education--provided pre-test information/counselling,
post-test counselling and follow-up counselling.
• Psychosocial support
• Referrals and linkages—Maintain effective coordination with the RCH and TB
programmes as well as with the antiretroviral therapy (ART) programme,

18. 3.Laboratory technician-- The LT should hold a Diploma in Medical
Laboratory Technology (DMLT) from an institution which is approved by
the state government.
duties:-
• HIV testing according to standard laboratory procedure.
• Keep the facility neat and clean at all times.
• Keep a record of HIV test results and stock of rapid HIV diagnostic kits.
Follow universal safety precautions and strictly adhere to hospital waste
management guidelines.
4. Outreach workers– Mobilize & Follow up Patients. Follow up the
mother–baby pair till 18 months after delivery.

20. HIV COUNSELLING
HIV/AIDS counselling/education is a confidential dialogue between a client and a
counsellor aimed at providing information on HIV/AIDS and bringing about
behaviour change in the client. It is also aimed at enabling the client to take a
decision regarding HIV testing and to understand the implications of the test
results.
Steps:- 1. HIV pre-test counselling/information
2. HIV post-test counselling
3. Follow-up counselling -- In follow-up counselling there is a re-emphasis
on adoption of safe behaviours to prevent transmission of HIV infection to others.
Follow-up counselling also includes establishing linkages and referrals to services
for care and support including ART, nutrition, home-based care and legal support.

22. TRAINING OF STAFF

23. SUPERVISION AND MONITORING

25. KITS USED FOR TESTING
1) SD BIOLINE HIV-1/2 3.0 test
-is an immunochromatographic(rapid) test for qualitative detection of
antibodies specific to HIV-1 and HIV-2 in plasma/serum/whole blood.
-Manufactured by SD BIO STANDARD DIAGNOSTICS PVT. LTD.
- sensitivity=100%
-specificity=99.8%

26. SD BIOLINE HIV-1/2 3.0 test

27. SD BIOLINE HIV-1/2 3.0 test

28. 2) HIV-1/2 TRISPOT TEST KIT:
-it is a rapid Trispot test to detect antibodies to HIV-1 & HIV-2 in
human serum/plasma.
-Manufactured by BHAT BIO-TECH INDIA(P) LTD.
-sensitivity=100%
-specificity=99.7%

29. HIV-1/2 TRISPOT TEST KIT

30. HIV-1/2 TRISPOT TEST KIT

31. 3) COMBAIDS –RS Advantage-ST:HIV 1+2 immunodot test kit:
-It is for the detection of antibody to HIV 1 and/or HIV 2 in whole
blood /serum /plasma.
-Manufactured by Span Diagnostics Ltd.
-sensitivity=100%
-specificity=100%

32. COMBAIDS HIV-1/2 IMMUNODOT TEST KIT

33. COMBAIDS HIV-1/2 IMMUNODOT TEST KIT

34. STRATEGY 3
For individual Dx of patients ,ICTC uses STRATEGY 3 which is as follows:
-All samples are tested with one rapid test.(SD BIOLINE HIV-1/2 3.0 test).
-If test result is NON-REACTIVE:final report NEGATIVE.
-If test result is REACTIVE then sample is tested again by different systems(TRI-
DOT &BI-DOT tests).
-Results can be REACTIVE or NON-REACTIVE.
-If result is REACTIVE with 2nd & 3rd antigen test then report is POSITIVE.
-If result is NON-REACTIVE with either 2nd or 3rd antigen test ,then report is
INTERMEDIATE.
-If result is NON-REACTIVE with 2nd & 3rd antigen test then report is NEGATIVE.

35. Three Tests Done:

36. Testing Algorithm

37. Summary of the month(JUNE 2016) :Status

38. Fig a:Positivity
322
165
487
23
0
23
0
100
200
300
400
500
600
ICTC Client(Excluding
Pregnant women)
ICTC Client:
Pregnant/BF mothers
Total ICTC Clients
4)No. of clients provided post test
counseling & given result
5)No. of clients diagnosed positive for
HIV(after 3 specific tests)

39. Fig b:Co-infection(HIV+TB)
27
0
7
0
0
5
10
15
20
25
30
ICTC Client(Excluding Pregnant women) ICTC Client:Pregnant/BF mothers
7)No. of ICTC client referred to RNTCP
(microscopic centre)
8)No. of HIV infected TB patients(CO-
INFECTION.

40. Fig c:Direct & Referred Patients
1
328 329
0
23 23
0
50
100
150
200
250
300
350
Client Initiated(DIRECT) Provider Initiated(Referred) TOTAL
2)Tested for HIV
4)Were diagnosed HIV+(after 3 specified
tests)

41. Fig f:Category wise Positivity
21
1
0 0
1
0
23
0
5
10
15
20
25
1)Heterosexual 2)Homosexual 3)Blood/Blood
product
4)Infected
syringe/Needles
5)Parent to child 6)Not
specified/unknown
7)Total
Total
Total

42. THANK YOU