WHAT IS THE PROBLEM?

PEPFAR recognizes the importance of providing all HIV Testing Services (HTS) in accordance with internationally recognized standards to ensure the provision of safe and ethical HTS to all clients. PEPFAR minimum standards for safe and ethical Index/Partner Notification HTS include adherence to the 5Cs (Consent, Confidentiality, Counseling, Correct, and Connection/linkage), inclusion of Intimate Partner Violence risk assessment, monitoring adverse events, and training and supervising providers on the rights of clients, informed consent, and ethics. PEPFAR is committed to ensuring that (1) all PEPFAR-supported sites meet the minimum standards for safe and ethical index testing services AND (2) routine monitoring and remediation practices are in place for accountability and action.  PEPFAR believes that working collaboratively with diverse stakeholders is essential to improve the quality and effectiveness of services we support. As such, PEPFAR will work collaboratively with civil society partners, government leaders, and PEPFAR Implementing partners to ensure all voices are heard, remediation actions are taken in a timely manner, and the safety and ethical treatment of clients remains of utmost importance.

WHAT IS THE TOOL?

Here we provide PEPFAR’s Guidance on Implementing Safe and Ethical Index Testing services. These materials include a summary slide deck (PDF), several tools and implementation forms that address each of the following components listed below. Collectively, these materials will help ensure minimum standards for safe and ethical index testing are continuously met, and relevant remediation and accountability measures are in place.

Please note that the materials posted below are for informational purposes only. Index testing site assessments may be done by an individual or team that includes the United States Government (USG) staff, PEPFAR Implementing Partner, Ministries of Health (MOH), and/or civil society partners. USG staff are responsible for oversight and working with Implementing Partners to implement remediation, if necessary.

All PEPFAR-supported programs should take steps to implement safe and ethical index testing services by:

  1. Monitoring site and provider-level compliance with minimum standards for index testing.
  2. Obtaining informed consent prior to the elicitation interview and before contacting partners.
  3. Conducting an Intimate Partner Violence risk assessment for each named partner and providing appropriate services for clients experiencing violence.
  4. Implementing a robust mechanism for detecting, monitoring, reporting, and following up on any adverse events associated with index testing services.
  5. Utilizing quality assurance and accountability to remediate any gaps in the provision of index testing services.

RESOURCES FOR IMPLEMENTING SAFE AND ETHICAL INDEX TESTING

These resources include a Guidance document (slide deck in PDF form) with background information and details on each of the five components listed above. All implementation forms and tools referenced in the slide deck are also provided below, along with a short description.

  1. Compliance with Minimum Standards: These site assessments tools will allow USG teams to work with implementing partners, local stakeholders, and governments to assess whether PEPFAR-supported sites providing index testing services meet the minimum standards for safe and ethical index testing. These minimum standards (described in the Guidance mentioned above) align with the core 5Cs of HIV Testing Services: Consent, Confidentiality, Counseling, Correct Test Results, and Connection to Treatment or Prevention Services. The REDCap tool is designed to be completed through an online platform, but we’ve also included PDF and excel versions with the same content as the online version.
    • CDC (REDCap) [92 KB]
      • This tool can be used to assess whether sites meet minimum standards for safe and ethical Index Testing (online or paper-based version) and should be filled out for every facility and community-based IP providing index testing.
    • USAID (REDCap) [85 KB]
      • This tool can be used to assess whether sites meet minimum standards for safe and ethical Index Testing (online or paper-based version) and should be filled out for every facility and community-based IP providing index testing.
    • Excel version of the REDCap [124 KB]
      • This version can be used, if needed, instead of the online REDCap tool. It includes all the same content as the online REDCap.
  2. Obtain Informed Consent
  3. Intimate Partner Violence (IPV) Risk Assessment and Service Provision
  4. Adverse Events Monitoring and Reporting
  5. Quality Assurance and Accountability
  6. Sample Data Sharing Agreement Template
    • This template provides an example for a memorandum of understanding between two organizations (or health facilities) who would like to engage in a shared confidentiality relationship in order to facilitate index testing, linkage to treatment, tracing of individuals with a missed appointment, and other HIV services. Organizations should feel free to adapt and customize this agreement as appropriate.

U.S. Department of State

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