Attachment 9. Script for Returning Test Results

Attachment 9. Script for Returning CD4 T-Lymphocyte and HIV Viral Load Test Results to Participants

Scripts for Providing CD4 and Viral Load Results

NOTE TO STAFF: This script is for providing results of CD4 and viral load tests. It is consistent with intervention messages (e.g., be active in your relationship with your provider and ask questions if there is anything about your care that you don't understand) and differentiates the Never In Care (NIC) staff from clinical care providers. The script should explain the limitations of the test results.

In an emergency situation in which a person becomes extremely distraught

when they hear their results, notify your project coordinator. They can get in touch with a

clinician on site or by phone who can talk to that person about the test results, or at least

set up a time when the participant might talk to the site’s clinical back up.

"I'm going to give you the results of the blood tests we did a few weeks ago.

Remember, we were testing your CD4 (T-cell) count and your HIV viral load.”

“Now I'm going to tell you what we found and a little bit about what these tests

are looking at. But I want to remind you that I'm not an HIV care provider, and I don't

know about the care you've been receiving from your doctor and other HIV care

providers, if you have one. So I'm not going to be able to answer detailed questions

about these results. You can still feel free to ask me questions, but if I can't answer them,

I'll probably suggest that you ask an HIV provider. Also, remember, if you signed the release form, or if you want to sign it now, we can send these results to your doctor or care provider. If you don't have an HIV care provider, we can refer you to one nearby. We think that everyone who is HIV-positive should be seen by an HIV care provider."

"OK, now your results. First your CD4 (T-cell) count is ___ . Your CD4 (T-

cell) count is the number that gives your doctor an idea of your overall health and how far

your HIV infection has gone. CD4 counts can change a lot between tests. The results can

also be different depending on which lab does the test, whether you’ve been sick recently

and many other reasons. Only a provider who sees you over time can tell you if these results really are significant for your health. HIV attacks the CD4 (t-cell) cells which are important for fighting off infections. For CD4 count, a higher number generally is better. The more that your CD4 counts drop from your normal level, the harder it is for your body to fight infections. If your CD4 count drops below 500, your HIV provider may want to monitor you more closely or discuss the use of HIV treatments with you. People with results below 200 are generally monitored more frequently as they are more likely to develop an illness related to their HIV (an opportunistic infection). Opportunistic infections are diseases that your body would fight off easily if your immune system was healthy. If your immune system is not healthy, opportunistic infections can be very serious for your health."

"Now to move on to viral load; your viral load is ______. Viral load is a newer

test. It measures the amount of HIV, or the number of copies of HIV, in your blood at a

particular time. For the results of the viral load test, a lower number of copies of HIV is

better. People’s viral load test results can be anywhere between what we call

"undetectable," which means the amount of virus in the blood was too low for the test to

measure accurately, to over a million copies of the virus in the blood. For the test we

used in this study, the lowest possible number is 50 copies. So if you have less than 50

copies of the virus, with the test we use, we can only tell you that you have less than 50

copies, we cannot give you an exact number. Generally, if the level is over 10,000

copies, your doctor or HIV care provider would generally consider monitoring you more

closely and might discuss starting you on or changing your medications. The goal of

treatment with medications for HIV is to reduce the viral load, preferably to undetectable

levels. Undetectable does not mean that there is no virus. It means that we cannot detect

the small amount of virus in the person’s blood with our current lab tests, but we know

that a small amount is there because the person is HIV positive. Even if your viral load is

undetectable, you still can transmit HIV to other people. No matter what your test results

are, remember it is important to continue practicing safer sex and safer drug use

behaviors."

WRAP UP

"Remember, we think that everyone who is HIV-positive should be seen by an

HIV care provider. If you don't have an HIV care provider, we can refer you to one

nearby. It is very important for all people with HIV to see their care providers regularly.

Only they can help you make health care decisions based on the status of your immune

system, the amount of virus in your blood, and other medical information that they have."

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