Confidential HIV screening result at a PHC without a counsellor
A 24-year-old woman, 20 weeks pregnant, attends the PHC for her second antenatal check-up. As part of the ANC profile, a rapid HIV screening test is done and is reactive. The medical officer has left for the day, and there is no ICTC counsellor at the PHC. The positive result is written in the laboratory register, which lies on the counter. The woman's husband's aunt works as a cleaner at the PHC; she sees the register and asks the lab technician whether her nephew's wife has 'that disease'. The woman herself has not yet been told. She has come with her mother-in-law, who asks why the 'blood test is delayed'. The PHC has no confirmatory test facility; the district ICTC is 30 km away.
1. Who should be told the result, and how should disclosure be handled?
Read the worked answer
Disclosure: The result belongs to the woman. A reactive rapid test is a screening result, not a diagnosis; it must be confirmed at the ICTC. She should be told by a trained person - the medical officer or ICTC counsellor - in a private room, with post-test counselling. If the medical officer is unavailable, the lab technician should not disclose the result; arrange a confidential referral and keep the report sealed. The woman should be helped to understand that she can decide when and how to tell her husband, and that partner testing is offered with consent.
Do not disclose to the mother-in-law, the cleaner, or any relative without the woman's consent. Confidentiality is a legal and ethical duty. If the woman is not told before she leaves, the PHC must arrange follow-up so that she is informed privately, not through a relative.
2. What should the lab technician say to the cleaner and the mother-in-law, and what records or incident reporting should follow?
Read the worked answer
To the cleaner/aunt: 'I cannot discuss any patient's reports. Please ask the patient to meet the doctor.' Do not confirm or deny, and do not show the register. The register should not be left open on the counter; it should be kept closed and accessible only to authorised staff. Use a patient code or ID rather than the full name where local policy allows.
To the mother-in-law: explain that the doctor will speak to the patient first and that results are confidential. Offer to arrange a meeting with the medical officer; do not disclose.
Records: document the incident in a confidentiality incident register, inform the medical officer, and counsel the cleaner about confidentiality. The HIV test result should be entered in the confidential ICTC or ANC record, not in an open register.
3. Outline the follow-up plan for confirmation, partner testing and prevention of mother-to-child transmission.
Read the worked answer
Follow-up plan: refer the woman to the district ICTC, 30 km away, for confirmatory testing and counselling; give her a referral slip and, if possible, transport support. If confirmed, link her to prevention of mother-to-child transmission services and ART. Offer partner testing and disclosure support. Advise her on safer sex and infant feeding only after proper counselling. Maintain a confidentially coded register and a follow-up date.
The PHC should also review why a rapid test was done without a counsellor present and ensure that ANC HIV testing follows the national algorithm: pre-test information, consent, rapid test, confirmatory test, post-test counselling. The medical officer should be informed of the reactive result the same day.