Posttest discussion points when giving an equivocal HIV result

1. Inform the patient clearly of the nature of the equivocal HIV result and what this result means.

2. Give the patient the opportunity to read the result, pointing out the clinic number and date of birth.

3. Clarify the patient's understanding of the result.

4. Explain the need for a further blood specimen on the day of receiving the result for repeat testing, which may provide a more conclusive result.

5. Give clear guidance, based on your laboratory's information of when the next serum results will be available, and arrange an appointment for the patient to return.

6. Assess and address the patient's immediate reactions. Most equivocal results do turn out to be negative, but it is important to check the history and the nature of the risk, and the timing of the last risk activity.

7. Offer further support if the patient requires it.

GIVING AN HIV-POSITIVE TEST RESULT

When giving an HIV-positive result, remember that it is a medical diagnosis. It is essential that positive results are not dealt with single-handedly. They require a multidisciplinary approach, so that the patient is seen promptly and the service is responsive to their needs both physically and mentally. Depending on local clinic services, and the patient's health and mental status, you may need immediately to involve a senior doctor, HIV clinical nurse specialists, TB nurse specialists, clinical psychologists, health advisers and health practitioners.

Once you are in a private consultation room and the confirmation of ID and introductions have been made do not delay in giving the result to the patient. Often our faces and body language are our biggest give-away, and, if the patient is attuned to this then they may pick up that something is not right with their results from the expression on your face or your body language from the moment you call them in. There is no easy way of breaking bad news, and the best way to do this is to be honest. Different patient reactions require different responses from you. You should not show any 'over the top' emotions on your part. Sometimes it may be appropriate to wait for the patient to speak before you say anything else immediately after telling them the result. In some clinics it is practice that the patients see the Health Adviser immediately after the result is given (SSHA, 2004).

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