Zambia Prevention, Care and Treatment staffJANUARY 2008 – Until recently, prevention efforts in healthcare settings in low-resource countries have targeted persons at risk of HIV infection. However, prevention is also crucial for HIV-positive people. People living with HIV and AIDS require knowledge and support so they can protect others from infection, protect themselves from HIV reinfection, and avoid other sexually transmitted infections. Because antiretroviral treatments require HIV–positive people to make frequent visits to health clinics, providers have many opportunities to support and reinforce prevention for positives.
These considerations led to two new FHI publications–a guide for health managers on incorporating prevention in the healthcare setting, and a facilitator's manual and PowerPoint presentation on prevention for positives that quickly updates healthcare staff on this very important topic.
Both publications were developed and field-tested in Kabwe, Zambia, with the assistance of FHI’s Zambia Prevention, Care and Treatment Partnership and under the auspices of Zambia's Ministry of Health.
Primary responsibility for authorship rests with Gretchen Bachman and Leine Stuart, senior technical officers at FHI's Washington, D.C., office. As Stuart noted, "The development of the training module on providing prevention services for HIV-infected clients in the clinical setting evolved as a direct result of the need identified while working with the clinicians in Kabwe."
Bachman added, "We couldn't have done these manuals without the input of the clinicians who worked with us. Their input helped to focus on the everyday situations that they face promoting HIV prevention in a community that is still grappling with how to talk about taboo subjects like sexuality and HIV."
The guide for health managers systematically leads a team of providers through the process of incorporating prevention within all services of a clinical facility. It details six steps that lead to this goal, including establishing a multidiscipinary prevention task force and developing and implementing an action plan. To support clinic managers in this process, the guide includes easy-to-use tools for rapid assessments and training materials to encourage prevention counseling within routine clinical encounters.
Users of the guide will benefit from its advice on how to talk to clients about very difficult subjects, as well as details about the steps of a process called Assess, Plan, Support for providers to follow. The method does not take up much time, yet results in the incorporation of prevention into routine encounters with HIV-positive clients.
The facilitator's manual and a set of PowerPoint slides are to be used for presentations on prevention for positives for non-clinical as well as clinical staff at health facilities. Both the manual and the slides incorporate notes and discussion questions. They are accompanied by a self-test for participants, one that will let them know how much they know (and don't know) about prevention in care.
The 45 slides provide the facts on prevention for positives, including those on pregnancy, contraception, and sexual dysfunction. The presentation includes practice sessions and recommendations on talking to clients about difficult subjects, as well as many specifics on the Assess, Plan, Support method.
The slides conclude with a role play for participants: one person assumes the role of a female client who is HIV-positive and exhibits bruises, while another takes the role of a health provider who needs to find out if she knows how to avoid HIV transmission to a partner, counsel her on pregnancy and contraceptive use, and discover whether she is experiencing domestic violence.
The facilitator's manual, the PowerPoint presentation, and the accompanying self-test can be downloaded from this site in several formats. The guide for health managers can also be downloaded, and its self-tests for clinical and non-clinical staff can be downloaded separately (view all Prevention for Positives materials).