27.3.3  Preferred ANC testing approach in Ethiopia

The ‘opt-out’ strategy is the recommended approach by the Ethiopian Federal Ministry of Health for HIV testing and counselling in the ANC setting. This helps normalise HIV testing, and makes the test a routine component of ANC. Importantly, this is also likely to increase the number of women who get tested for HIV.

Recall the ‘3 Cs’ introduced in Study Session 24. ‘consent, confidentiality and counselling’.

PMTCT programmes must adhere to the three guiding principles of testing and counselling. These are informed consent, confidentiality and the provision of post-test counselling and support services. Informed consent deals with asking mothers for their willingness to be tested. So you should obtain verbal or written consent after you counsel the mother about HIV testing. The mother has to make an informed decision. You also have to keep all information about the mother confidential. Information is only used to help the client to get the necessary health services, and the information has to be kept at the health facility. After counselling and testing for HIV, the provision of post-test counselling is essential for both HIV-negative and HIV-positive mothers. For services including PMTCT, you will be expected to refer the mother to the nearest health centre.

  • A mother comes to the health post a few days before her due date. She has never been tested for HIV. Do you think it is important to provide her with HIV testing and counselling?

  • Yes, it is essential that you offer her HIV testing and counselling, and refer her to the nearest health centre for further care.

HIV testing, and PMTCT services when appropriate, are offered at several time points during the healthcare provision and management of pregnant women. PMTCT is integrated into antenatal care, labour and delivery, postnatal care, family planning, and other settings where pregnant women and women of childbearing age receive healthcare services and education.

Therefore, you need to provide comprehensive information and counselling services for all pregnant women presenting to ANC and women of childbearing age at your health post. Mothers and potential mothers should receive information on the following issues:

  • Pre-test counselling, HIV testing, post-test counselling and follow-up services that should be offered to the mother and her partner for PMTCT of HIV.
  • Prevention of HIV in infants and young children, including interventions for PMTCT. Prevention of HIV in infants and young children includes the use of ARVs and safe breastfeeding practices.
  • Safer sex practices that would promote the prevention of transmission of HIV infection.

27.3.2  Opt-out approach to HIV testing

27.4  Steps in the HIV testing process