Integrated Counselling & Testing Centre (ICTC)

1. Integrated Counselling &
Testing Centre (ICTC)
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2. Introduction
HIV counselling and testing services were started in
India in 1997. The main functions of an ICTC are:
Conducting HIV diagnostic tests.
Link people with other HIV prevention, care and
treatment services.
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3. Overview: National AIDS Control
Program
 1992: National AIDS Control Program Initiated
 1997: VCTC services started in the country (voluntary counseling & testing centers)
 1999: NACP II Initiated (99-06)
 2000/2001: 11 centers of excellence conduct PPTCT ( Prevention of parent to child transmission)
 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 VCTC 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).
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4. HIV Stats
 Among the States/UTs, in 2015, Manipur has shown the
highest estimated adult HIV prevalence of 1.15%, followed by
Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh &
Telangana (0.66%), Karnataka (0.45%), Gujarat (0.42%) and
Goa (0.40%). Besides these States, Maharashtra,
Chandigarh, Tripura and Tamil Nadu have shown estimated
adult HIV prevalence greater than the national prevalence
(0.26%), while Odisha, Bihar, Sikkim, Delhi, Rajasthan and
West Bengal have shown an estimated adult HIV prevalence
in the range of 0.21– 0.25%.
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5. NACP III
Component 1: Intensifying and Consolidating Prevention services
with a focus on HRG and vulnerable populations
TI (Targeted interventions) for HRG & intervention among low-risk
population
ICTC (VCTC + PPTCT)
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6. 6

7. What is an Integrated Counselling and Testing Centre?
 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..
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8. Who needs to be tested in an ICTC?
Subpopulations who are more vulnerable or practice high-risk behaviour like
1. Female sex workers (FSW)
2. Injectible drug users (IDUs) high risk group (HRG)
3. Men who have sex with men (MSM)
4. Clients of FSW
5. Truckers Bridge population
6. Migrant workers
7. Spouses and children of men who are prone to risky behaviour (vulnerable population)
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9. ROLE OF AN ICTC
•Early detection of HIV.
•Promoting behavioral change and reducing vulnerability.
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10. 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
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11. Where can an ICTC be located?
An ICTC is located in
 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 Gynecology,
Paediatrics, Psychiatry, Dermatology, Preventive and Social
Medicine.
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12. Different types of ICTCs
ICTC
Stand-
Alone
ICTC
Supported
financially and
logistically by
NACP
Facility
ICTC(F-
ICTC)
Staff from
existing facilities
trained in
counseling and
testing
PPP-ICTC
Established in
private
facilities based
on F-ICTC
model
Mobile
ICTC
Takes the
package of
services to
community
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1805
4537 9196

13. Level of HIV counseling and Testing services
in India
Community level
Village level
PHC
Subdistrict level
Eg. Subdistrict Hospitals, CHC, RH
State and district level
Eg. Medical College, District Hospital
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SA-ICTC
SA- ICTC
F -ICTC
MOBILE ICTC
Reaching HRG,
Unreachable population

14. Physical Infrastructure required for an
ICTC
 The counselling room
 Blood collection and testing
room-
refrigerator,centrifuge,needl
e
destroyer,micropipette,colou
r coded waste disposal bins
 CD4 count room
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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.
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.
4. Laboratory technician-- The LT should hold a Diploma in Medical Laboratory
Technology (DMLT) from an institution which is approved by the state government
5. Outreach workers– Mobilize & Follow up Patients. Follow up the mother–baby pair
till 18 months after delivery.
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17. KITS USED FOR TESTING
1) SD BIOLINE HIV 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%
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18. 18SD BIOLINE HIV test

19. 2) HIV 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%
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20. 20HIV TRISPOT TEST KIT

21. 3) COMBAIDS –HIV 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%
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22. COMBAIDS HIV-1/2 IMMUNODOT TEST KIT
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23. STRATEGY 3
For individual diagnosis 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(TRIDOT &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.
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24. When is ART (Anti-retroviral therapy) initiated?
Criteria for ART
If CD4 is between 200-250, this should be repeated in four weeks and treatment to
be considered in asymptomatic patients
•Adherence to ART regimen is vital in treatment. Any irregularity in following the
prescribed regimen can lead to resistance to HIV drugs, and therefore can weaken
or negate its effect.
• ART centres are located in medical colleges, district hospitals and non-profit
charitable institutions providing care, support and treatment services to PLHIV.
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25. PREVENTION OF PARENT TO CHILD TRANSMISSION (
PPTCT)
The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT)
programme was launched in the country in the year 2002 following a feasibility
study in 11 major hospitals in the five high HIV prevalence states.
The PPTCT programme aims to prevent the perinatal transmission of HIV
from an HIV infected pregnant mother to her newborn baby. The programme
entails counselling and testing of pregnant women in the ICTCs.
Currently, there are more than 15000 Integrated Counselling and Testing
Centres (ICTCs) in the country, most of these in government hospitals, which
offer PPTCT services. Of these ICTCs, nearly 550 are located in Obstetrics
and Gynaecology Departments and in Maternity Homes where the client load
is predominantly comprised of pregnant women.
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26. Services to Pregnant Women
 Offer HIV counselling and testing.
 Moving from ANC centric to Family Centric
 ART to all HIV pregnant women regardless of CD4 count and who
staging. Preferred regimen is TDF(TENOFOVIR)+
3TC(LAMIVUDINE)+EFV(EFAVIRENZ)
 Promoting institutional delivery
 Provision of care for associated conditions.
 Counselling for exclusive breastfeeding up to 6 months
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27. Services to HIV exposed infants(HEI)
 Exclusive breastfeeding up to 6 months
 ARV prophylaxis up to 6 weeks with Nevirapine syrup which can extend
to 12 weeks if duration of ART of mother is less than 24 weeks
 CPT (clotrimoxazole prophylactic therapy) initiated after 6 weeks .
 Confirmatory test done at 6 months, 9 months, and 12 months after
cessation of breast feeding.
 Lifelong ART at the earliest if confirmed HIV positive .
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28. Comprehensive management given to minimize the risk of infection following
potential exposure to blood-borne pathogens e.g. HIV.
This includes:
1. First aid
2. Counseling
3. Risk assessment
4. Relevant laboratory investigations based on informed
consent of the exposed person.
5. Depending on the risk assessment, the provision of short
term (4 weeks) of ART.
6. Follow up and support
28POSTEXPOSURE PROPHYLAXIS

29. 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
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30. Objectives
1. Facilitating decision to undergo HIV test
2. Providing psychological, social and emotional support for
• People who have contracted the virus and
• Others affected by the virus.
3. Preventing transmission of HIV by
• Providing information about risk behaviours (such as unsafe sex or needle-
sharing)
• Motivating people to take good care of their health,
• Assisting them to develop personal skills necessary for behaviour change,
• Adopting and negotiating safe sexual practices.
4. Ensuring effective use of treatment programmes by
• Establishing treatment goals and
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31. PRE- TEST COUNSELLING
 Information should be simple and up to date.
 Pre test counseling helps a person to understand the
possible results of an HIV test. It may be positive, negative
or equivocal. The counselor must explain the meaning of
each such test result. This should be utilized as an
opportunity to assess the likely reaction of the client to a
positive or negative test result.
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32. POST-TEST Counselling
Test Result?
Positive
Equivocal
Negat
ive
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33. WHAT IF NEGATIVE RESULT
Window period
Prevention of further exposure
Behavior modification
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34. WHAT IF POSITIVE RESULT
Immediate reporting
Time to get over shock
Explain Implications
Encouragement
Possible treatment and efficacy
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35. WHAT IF EQUIVOCAL RESULT
• Window period
• Related HIV virus
• Cross reaction with Non viral protein
Cause of Equivocal result
• Retesting
Alternative methods
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36. FOLLOW-UP counselling 36
In follow-up counselling there is a re-emphasis on adoption of safe
behaviors 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.

37. Issues to be addressed by HIV/AIDS counselling
HIV/AIDS counselling is intended to address the physical, social,
psychological and
spiritual needs of the client. Besides, the following issues should also be
addressed:
• Problems related to infection and illness
• Death, bereavement
• Social discrimination
• Sexuality
• Lifestyle
• Prevention of transmission
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39. In order to adopt an appropriate strategy
for prevention and control,
we need to detect the spread of the
disease in the country
 That is we need an area specific targeted intervention and best practice
approach.
So we have various surveillances;
 HIV sentinel surveillance
 HIV sero surveillance
 AIDs case surveillance
 STD surveillance
 Behavioral surveillance
 Integration with surveillance of other diseases like TB
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40. HIV Sentinel surveillance
 Determine the level of HIV infection among general
population and high risk groups.
 To understand the trends of HIV epidemic again in
general population and high risk groups
 To understand geographical spread of HIV infection
and to identify emerging pockets
 To estimate HIV prevalence and HIV burden in the
country
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41.  Annual cross sectional survey of the risk groups
 In the same place for over a few years by unlinked anonymous serological
testing procedures.
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42. THANK YOU
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