MODULE 3: COUNSELLING
At the end of this module the participants should be able to:
1. Define counselling
2. Describe counselling in an antenatal setting
3. Explain the fundamentals of the counselling role and relationship between the client and provider
4. Describe some of the key skills used in counselling
5. Discuss the application of counselling principles and skills to pre- and post-HIV test counselling
6. Discuss issues relating to self-care and well-being
7. Demonstrate counselling skills as applied to PMTCT services
The counselling element of antenatal care presents a unique counselling situation, as ...view middle of the document...
Group education is the mainstay of providing information, education and communication, as well as clarifying issues and answers questions. Individual pre-test counselling is maintained for those women seeking more information or who have not decided. The post test counselling should maintain high standards of care in assisting the woman make her choices and decisions.
The counselling relationship between a provider and a woman, and, where possible, her partner as well, develops throughout pregnancy and the childbirth periods, and should be seen as a dynamic process.
Specific Counselling for HIV
In Zambia, opt-out policy is used. This means that HIV testing is provided as part of the routine package of care. Women are provided with group counselling, and where necessary, individual pre-test counselling.
Wherever possible, couples should be encouraged to participate together in antenatal counselling, including pre-test counselling, because the support of the partner or spouse can be so important during pregnancy and in any decisions around the issues of HIV testing, prevention and care.
Every antenatal client should be tested for HIV as part of her antenatal package, unless she chooses not to be tested. During her antenatal counselling, the client must be counselled about HIV and PMTCT, and told that her blood will be tested for HIV and syphilis as part of her routine care. If she chooses not to be tested for HIV, the counsellor should probe to understand why she chooses not to be tested and provide additional counselling as appropriate.
The strength of this opt-out approach is that it makes HIV testing part of routine care for all antenatal women. The weakness is that women who get tested may not have made a conscious choice to be tested and may not be fully prepared for her results. For this reason, providers must be sure to provide adequate counselling, and post-test counselling is especially critical.
Group counselling/health education
Care should be taken to provide this valuable service to provide information and gain the groups understanding. In the context of PMTCT in the antenatal setting, as much ground as possible should be covered in this session, as the provision of HIV testing is routine . HIV testing will be provided as part of the package of care after this session, unless the woman declines.
Individual pre-test counselling is not meant for every woman who is going to be tested in the Antenatal clinic. However, recognising that circumstances are more complex than in many other counselling and testing services, because of the added element of the pregnancy and expected child, some women will need more information after the group counselling. In this scenario, individual pre-test counselling is extremely important in that additional information sharing and answering of any additional questions may be addressed.
Whenever possible, couples should be counselled, tested and receive results...