NPS/CA-205
STANDARD OPERATING PROCEDURE for
Nigeria PreP Study
Study Site: SOPs Number :SA-102
Title
COUPLE COUNSELLING
Version Number: Version Date: Effective date:
Approval name Signature Date
Annual Review
Review date Revision Date Signature
Document History
Version number Reason for change Date
1.0 Initial release 28th March 2015
Distribution List
Name/Location No of copies Name/Location No of copies
1. Introduction
Most new HIV infections in sub Saharan Africa are acquired from cohabiting heterosexual
partners. Couple counselling is recognized as an important and effective intervention in
which the two clients are counselled and provided with HIV test results as a couple. This
encourages the couple to start planning for their future and discuss a realistic risk reduction
plan that they can implement together. In situations where the couple refuses to receive
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services together, they can be counselled and receive results separately and then encouraged
to disclose results to each other. Preventing HIV transmission from the infected couple
requires first knowing the HIV status of the partners before initiating any prevention strategy.
2. Objectives
To establish a standardized operating procedure for HIV couple counselling in the
Nigerian Prep Study.
3. Responsibility
Study counsellors are responsible for providing HIV couple counseling in accordance with
this SOP. The PI/Site coordinator is responsible for training counseling staff to provide
HIV couple counseling in accordance with this SOP and for providing day-to-day
oversight and support to counseling staff to ensure that this SOP is followed. The PI is
ultimately responsible for ensuring that all applicable study staff follows this SOP.
4. Definitions
Couple: Two persons in an ongoing sexual relationship; each of these persons is
referred to as a “partner” in the relationship.
Opt-out approach. The study will offers HIV testing on an opt-out basis to all clients
within the study. The client is informed of his/her right to refuse an HIV test that is
routinely recommended and provided to each client.
Couples HIV testing and counselling: When two or more partners are counselled,
tested and receive their results together. When couples receive their results together,
there can be mutual disclosure of HIV status, and the couple can receive appropriate
support and be linked to follow-up services by a counsellor, health care provider or
community-based worker.
Partner testing: Another strategy for increasing knowledge of HIV status and
disclosure among partners is partner testing. This is when one partner has already
been tested, and the other partner is then tested separately. This would be a common
scenario in antenatal settings, where women are routinely offered HTC and then
encouraged to bring in their partner for partner testing. Partner testing may occur with
or without disclosure. Whenever appropriate and feasible, however, mutual disclosure
of HIV test results under the guidance of a counsellor should be encouraged and
facilitated. In this document partner testing with mutual disclosure is considered a
form of CHTC.
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Standard protocol of counselling. Counselling in the study centres will follows the
Nigerian national HIV counselling and testing Guidelines and records are maintained
according to the SOP. All counselors must abide to the ethical standards of
counselling. Depending on the need, nature and wish of the clients, individual, group
or couple counselling is offered, and sessions usually last about 40 minutes to one and
half hours.
Confidentiality. All the information collected is kept confidential and is not shared
with anyone without the consent of the client. All staff of the study handling records
and those who may deal with the clients' personal files must sign an oath of
Confidentiality. Breaching the oath may result in official as well as other action
against the staff member.
4. Procedures
The study will enroll HIV-infected individuals and their partner. Positive persons are
generally expected to be referred to the study after having undergone HIV counseling and
testing outside of the study. However, it may be necessary for study staff to perform HIV
testing confirm infection (see Nigerian National HIV testing and counselling guidelines).
When study staff are required to perform HIV testing, all such testing will be performed in
the context of pre-test and post-test counseling. All counseling will be provided in
accordance with the Nigerian National policies and guidelines.
For this study, the term “risk reduction counseling” refers to counseling provided to HIV
positive partner in the study to reduce their risk of re-infection and their risk of transmitting
HIV to others. The risk reduction counseling will be provided as part of the pre- and post-
testing counseling as in the national HIV testing and counselling Guidelines, and will
additionally be provided to any participant upon her/his request. .
Condoms will be provided to all participants free of charge throughout their participation in
the study, and risk reduction counseling will include information/education as well as skills
building on condom use and condom negotiation strategies as needed for each participant.
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Counseling will also include HIV/AIDS education, discussion of disclosure issues and
emotional support, discussion of healthy living strategies, discussion of stressors and
potential strategies to address these, and provision of referrals, as applicable to each
participant. When applicable, counselling will also address the benefits of HIV counselling
and testing for other members of the family.
The Counselor will;
A. Assure that each person has given his/her consent for counselling and testing and is
aware that he/she is expected to disclose the test results to the partner.
B. Meet with each to determine if there are any issues between the partners such as a
history of violence that may make disclosure difficult or the use of coercion with
regards to testing.
C. Conduct pre–test counselling either with the couple together or individually. Risk
assessment must be done individually, in order to accurately assess risk.
D. First provide test results individually, and then assist a member of the couple to share
the test results with his/her partner.
E. Counsel, encourage, and assist individuals who are reluctant to disclose their test
results to their partners.
F. Disclose an individual test result only with the client's permission.
G. After the disclosure of the test results, proceed with post-test counselling with both
partners present according to national guidelines.
HIV serocordant couple
For couples who were found both positives should be referred to the HIV treatment clinic.
The Site coordinator must ensure that they are linked to the services. The receipt of the
service must be expressly document in their records.
HIV serodiscordant couple
Couple found to have HIV discordant results should be referred to the PI/Site coordinator
for recruitment into the study. Before referral to the PI, counsellors must provide HIV
prevention counselling for the couple and this should be documented.
This SOP has been read and understood by:
Name Date Name Date
1. 8.
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2. 9.
3. 10.
4. 11.
5. 12.
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