Under the regulatory framework, each person who applied for testing for HIV infection should be offered pre-test counselling. During such pre-test counselling every applicant has the opportunity to ask questions and get information about HIV, ways of transmission, estimate their risk of HIV infection with a specialist and consider ways to reduce it, get information about the organizations where you can get other assistance, etc. When issuing the test result for HIV infection, it is obligatory to explain its implications and provide post-test counselling.
The task of the National Programme on HIV Prevention, Treatment, Care and Support for HIV Positive and AIDS Patients for 2009-2013 with regard to the optimal expansion of access to Healthcare services is implemented through the organization of ART sites based on the offices of ‘Dovira’ (‘Trust). As of 01.01.2015, 707 such offices operated in the country, of which 175 provide diagnostic services, treatment of opportunistic infections, prescribing ART and support to patients, as well as laboratory monitoring of the development of HIV infection.
With the support of the GF, 122 ART sites were opened, i.e. renovation works have been carried out and/ or furniture and equipment has been purchased. In 2014, amendments to the Regulation on ‘Dovira’ office were introduced and approved by the Ministry of Healthcare of Ukraine dated 21.07.2014 № 509 and registered with the Ministry of Justice of Ukraine. Thereby its functions were expanded, specifically those in relation to:
• Diagnosing HIV, carrying out ART, registration of and medical care for HIV-positive persons.
• Medical surveillance for HIV-infected pregnant women, prescription and support for prevention of HIV transmission from mother to child.
• Prevention, diagnosis and treatment of opportunistic infections.
• Ensuring prevention, diagnosis and treatment of viral hepatitis B, viral hepatitis C, diagnosing and referral to a Healthcare institution implementing treatment of hepatitis.
• Measures as to family planning.
• Organizing and providing for post-exposure prophylaxis measures.
• Counselling family members and loved ones of people who are living with HIV.
• Formation of adherence to treatment.
• Ensuring collaboration with other institutions and organizations in the provision of hospice palliative care.
• Cooperation with social service centres for families, children and youth, services for children, centres of the Red Cross and other charitable organizations.
It should be noted that ‘Dovira’ office is also entrusted with the function of preventing HIV infection in terms of counselling and testing people for HIV, in particular representatives of risk groups. The Law of Ukraine ‘On Prevention of Acquired Immune Deficiency Syndrome (AIDS) and Social Protection’ clearly states that all testing for HIV should be carried out on a voluntary basis and be accompanied with mandatory pre-test and post-test counselling, except compulsory testing of samples of donated blood and organs. In 2014, 3,074,273 individual pre-test counselling talks were held (which is 462,495 less than in 2013) and 2,494,865 individual post-test consultations were provided (which is 416,333 fewer than in 2013), which accounts for 81% of pre-test counselling. Thus, 263,413 people (11%) did not apply for post-test counselling.
Table 7. The number of group and individual pre-test and post-test counselling sessions and the number of people who underwent
By anlysing the above, we can conclude that these data attest to the lack of quality approaches to identifying people with risky behaviour during CaT in medical institutions according to the current CaT protocol. Special attention should be given to improving the level of professional training in the institutions of all service agencies that provide CaT services.
According to the staffing schedule, ‘Dovira’ offices include an infectious diseases doctor, a nurse and a social worker; most experts had professional training at seminars, practical courses, and special programs of on the job training at regional training centres established with the involvement of medical education institutions. Regional AIDS Centres (RC AIDS) provided the clinical base for training centres.
Guiding documents for VCT
• The Procedure of Voluntary Counselling and Testing for HIV Infection (Protocol)
• MEDICAL DOCUMENTATION Form of Primary Record Documentation No. 503/o (.doc file download)
• Order of the Ministry of Healthcare of Ukraine of 11.05.2010 № 388 ‘On Improvement of HIV Diagnosing’
• Order of the Ministry of Healthcare of Ukraine of 25.02.2010 № 102 ‘On Operation of ‘Dovira’ Offices’