(Insert Agency Name) Site: (Insert Test Site) HIV Point of Care Test and HIV Prevention Counselling Observation Form Counsellor: _____________________ Observer: _________________________ Date: ____________ Step Action Did the counsellor? Comments 1 Introduce/orient client. Introduce him/herself by name Explain role State duration of session Explain test options Explain procedures Test benefits Provide Information. Test results Importance of results HIV risk and transmission Sources of additional information Obtain informed Determine if client understood the consent consent. Document in client history Assess client readiness. Readiness to receive test result the same day Support system Possible reaction to a reactive test result Emotional state Mental status Conduct the test. Explain what he/she was doing Appear organized Follow test procedures Document Use safety precautions Sex or needle-sharing partner(s) 2 Identify current risk behaviors and Circumstances of exposure circumstances Time frames STIs Mental Health and Addiction Housing Behaviors/patterns identified: Identify safer goal Goals or Prevention Strategies: behaviors that the client is willing to adopt. 3 Interpret test result. Did the counselor correctly interpret the result? If NO: Yes □ No □ Report test result. Explain the meaning of a non-reactive test and the need for further testing based on date of last risk exposure Explain the meaning of a reactive screening test result and the importance of a confirmatory test
(Insert Agency Name) Site: (Insert Test Site) HIV Point of Care Test and HIV Prevention Counselling Observation Form Counsellor: _____________________ Observer: _________________________ Date: ____________ Step Action Did the counsellor? Comments 1 Introduce/orient client. Introduce him/herself by name Explain role State duration of session Explain test options Explain procedures Provide Information. Test benefits Test results Importance of results HIV risk and transmission Sources of additional information Obtain informed consent. Determine if client understood the consent Document in client history Assess client readiness. Readiness to receive test result the same day Support system Possible reaction to a reactive test result Emotional state Mental status Conduct the test. Explain what he/she was doing Appear organized Follow test procedures Document Use safety precautions 2 Identify current risk behaviors and circumstances Sex or needle-sharing partner(s) Circumstances of exposure Time frames STIs Mental Health and Addiction Housing Behaviors/patterns identified: Identify safer goal behaviors that the client is willing to adopt. Goals or Prevention Strategies: 3 Interpret test result. Did the counselor correctly interpret the result? □ Yes □ No If NO: Report test result. Explain the meaning of a non-reactive test and the need for further testing based on date of last risk exposure Explain the meaning of a reactive screening test result and the importance of a confirmatory test
POC_Direct_Observe_Checklist.docx