Counseling Script - Female

MOH/CDC/WHO Viral Persistence Study Counseling Scripts
Talking points-WOMEN
We do not yet know if there is any possibility of passing Ebola to another person through vaginal fluids,
rectal fluids, sweat, tears, urine, or saliva. We believe the risk is very low, but we do not know for
certain.
Pre-Test
Vaginal, Menstrual, Breast Milk, Rectal, Saliva, Sweat, Tears, Urine
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Greet the participant:
o Remember to express empathy and happiness that they survived Ebola.
o Ask how they are doing since they have recovered and if they have any questions.
Discuss the purpose of the visit:
o Give information to [the client] about the testing we will do to detect if pieces of the Ebola
virus are in her fluids.
Tell participants that at pre-test they do not need to do anything differently. If the test does
detect pieces of Ebola in any bodily fluid, you will give her more information when you go over
the test result with her.
Talk about confidentiality and possible discomfort:
o Let the participant know that anything they tell you will be confidential.
o Let the client know that if they feel uncomfortable at any time, they can tell you and you
will move on.
o Inform the client that receiving test results is optional and the choice is entirely up to
them.
o Ask if they would like you to help them strategize how to tell their partner or family
members about their test results.
Tell the survivor it is important that she monitors her health:
o Inform participants that even though the RT-PCR tests are reliable, it may be possible
that virus could still be present in the body but not able to be found in body fluids.
o There have been a small number of survivors who became seriously ill after they
recovered, and so we may ask to follow up with the participant after the study ends to
ensure they are well even after finishing the study.
o Ask participants who feel unwell to call Dr. Sesay or Dr. Massaquoi for further help.
Inform participant that condoms can help prevent against HIV, STIs and unwanted pregnancy.
Give client condom demonstration and condoms and discuss condom negotiation.
Offer HIV test
Refer participants who report psychological, sexual, or physical harm by their partners
(intimate partner violence) to proper services.
Refer participants with medical or psychological problems to Dr. Sesay or Dr. Massaquoi.

For Pregnant Participants ONLY (at Pre-Test Visit)
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Confirm that participant is currently pregnant.
Give participant information about Ebola and pregnancy:
o There is no evidence to show that women who survive Ebola and then become pregnant
can pose a risk for Ebola virus transmission
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It is very important for all pregnant women to receive antenatal care (ANC) to keep the
participant and her baby safe.
Ask participant if she is attending/receiving antenatal care:
o If Yes
 Document which ANC she already attends by writing a note-to-file
 Inform receptionist
o If No
 We can help you find antenatal care in your area. You can speak to the nurses
and doctors in the M34 survivor clinic next door today to be connected to
antenatal care. Would you like to do that?
 Refer to survivor clinic for subsequent referral to appropriate ANC.
Inform the participant that maintaining good health is important in pregnancy.
o Your body works extra hard when you are pregnant so it is important to take good care
of yourself. Part of this is a healthy diet. I would like to provide you with some nutritious
biscuits which will help keep you healthy.
 Distribute BP100 bars and refer to BP100 guidance sheet to give instructions.
Inform participant that our study is interested in understanding her pregnancy:
o Our research project is offering pregnant participants the opportunity to be followed up
through their pregnancy to childbirth. Participation in this research is entirely optional
and you can change your mind at any time. Would you like to hear more about this
research study?
 If YES:
 Administer nested pregnancy informed consent form
 Inform study operations manager and research assistant

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Delivery of Results
Vaginal, Menstrual, Breast Milk, Rectal, Sweat, Tears, Saliva, Urine
Positive:
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Explain the results:
o Explain that the RT-PCR test detected pieces of the Ebola virus in the sample that they
provided.
o Explain that because of these results, it is possible that they may be able to pass Ebola
to a person who has contact with their [SEXUAL FLUID] through activity like vaginal,
anal, oral, or manual sex.
Tell the survivor it is important that they monitor their health:.
o There have been a small number of survivors who became seriously ill after they
recovered, and so we may ask to follow up with the participant after the study ends to
ensure they are well even after finishing the study.
o Ask participants who feel unwell to call Dr. Sesay or Dr. Massaquoi for further help.
Encourage participant to continue with the study until they get two negative test results in a
row.

Indeterminate:
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Explain the results:
o Explain that the RT-PCR test could not tell if pieces of the Ebola virus are in the sample
that she provided because it was on the border of detected and not detected.
o Explain that because of these results, it is possible that they may be able to pass Ebola
to a person who has contact with their [SEXUAL FLUID] through activity like vaginal,
anal, oral, or manual sex.
Tell the survivor it is important that they monitor their health:
o Inform participants that even though the RT-PCR tests are reliable, it may be possible
that virus could still be present in the body but not able to be found in body fluids.
o There have been a small number of survivors who became seriously ill after they
recovered, and so we may ask to follow up with the participant after the study ends to
ensure they are well even after finishing the study.
o Ask participants who feel unwell to call Dr. Sesay or Dr. Massaquoi for further help.
Encourage participant to continue with the study until they get two negative test results in a
row.

1st Negative RT-PCR Test- Sexual Fluids (Vaginal, Rectal, Menstrual):
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Explain the results:
o Explain that the RT-PCR test did not detect pieces of the Ebola virus in the sample that
they provided.
o Explain that we would like to test them again to make sure pieces of Ebola is not
detected in their fluids.
Tell the survivor it is important that they monitor their health:
o Inform participants that even though the RT-PCR tests are reliable, it may be possible
that virus could still be present in the body but not able to be found in body fluids.

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There have been a small number of survivors who became seriously ill after they
recovered, and so we may ask to follow up with the participant after the study ends to
ensure they are well even after finishing the study.
o Ask participants who feel unwell to call Dr. Sesay or Dr. Massaquoi for further help.
Encourage participant to continue with the study until they get two negative test results in a
row.

Second Negative RT-PCR Test:
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Inform participation is stopped for now, and the participant is welcome to the 3 and 6 months
follow up visits.
Discharge participant from the study.

2nd Negative RT-PCR Test- Close Contact Fluids:
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Inform participation is stopped for now, and the participant is welcome to the 3 and 6 months
follow up visits.
Discharge participant from the study

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Post-Test Counseling
Vaginal, Menstrual, Breast Milk, Rectal, Sweat, Tears, Saliva, Urine
Positive/Indeterminate/1st Negative RT-PCR Test
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Explain RT-PCR results again, ask if participant has any questions.
Explain to participants that there are basic good health habit he will need to follow to make sure
the risk of transmitting Ebola through any positive fluid is as low as possible until they get two
negative RT-PCR results in a row.
Also Explain to participants that she may be able to pass Ebola to a person who has contact
with [sexual fluid] through activity like vaginal, anal, oral, or manual sex until she gets two
negative test results in a row.
o Saliva:
 Avoid spitting in places that others could come into contact with saliva (on the
street)
 Do not share eating utensils with others without washing them with soap and
water, and do not share food that you have been eating with others
 Wipe your mouth with a clean tissue and throw that tissue in a lined dust bin and
then wash your hands immediately with soap and water.
 Wash your hands often with soap and water. Try not to touch your eyes, nose,
and mouth with unwashed hands.
 Do not share your toothbrush or other personal care items with others.
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Tears:
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Use a condom if you engage in manual, oral, vaginal, or anal sex or choose
abstinence.

Wash your hands often with soap and water.
Wipe your eyes with a clean tissue and throw that tissue in a lined dust bin and
then wash your hands immediately with soap and water.
Try not to touch your eyes, nose, and mouth with unwashed hands.
Do not share your personal care items with others.
Use a condom if you engage in manual, oral, vaginal, or anal sex or choose
abstinence.

Urine:
 Do not urinate in places where others can come into contact with your urine (on
the street, into sewers). Urinating in pit latrines or toilets is ok.
 Wash your hands with soap and water each and every time you use the toilet.
 Try not to touch your eyes, nose, and mouth with unwashed hands.
 If urine comes in contact with eyes, nose, mouth, wash the areas very well with
water.
 If urine comes in contact with open skin (skin with cuts, wounds), rinse with water
very well and clean with soap.
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In the home, regularly clean toilet areas with water that has bleach in it.

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Use a condom if you engage in manual, oral, vaginal, or anal sex or choose
abstinence.

Sweat:
 Wash your hands often with soap and water.
 Try not to touch your eyes, nose, and mouth with unwashed hands.
 Do not share your razor, or other personal care items with others.
 Do not share your unwashed clothing with others
 Wash personal clothing separately from items that belong to others
 Avoid close skin to skin contact with other people
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Use a condom if you engage in manual, oral, vaginal, or anal sex or choose
abstinence.

Breast Milk
 During the post-test counseling session with a lactating woman with a RT-PCR
positive or indeterminate test ask:
 Are you currently breastfeeding any baby or child?
 If yes, ask for each baby or child: What is the age of the baby or child?
Is the baby or child an Ebola survivor? Is the child healthy or
feeling unwell.
 It may be possible to pass Ebola virus through your breast milk to your baby. To
protect your baby, please follow the guidance below until you receive at least
two RT-PCR test results in a row where pieces of Ebola are not detected in your
breast milk:
 If you are breastfeeding any baby:
o Do not breastfeed until you receive two RT-PCR test results in a row
where pieces of Ebola are not detected in your breast milk
o The study staff will contact the nutrition officer for further assistance
with alternative infant feeding support for the study participant and her
baby.
o You may experience some pain in your breasts due to suddenly stopping
breastfeeding. We will teach you safe ways to express and dispose of
this milk to alleviate this pain and reduce inflammation.
 Our recommended method is that she express into a plastic
cup, pour the liquid in a latrine or toilet, and burn the cup.
o Use a condom if you engage in manual, oral, vaginal, or anal sex or
choose abstinence.
o Lactating women will receive their results within 3 days after the
collection of the specimen. Women with positive breast milk results will
be offered testing every 3 days until 2 consecutive RT-PCR tests are
negative. Women with a first negative test will come back after 3 days
to do a confirmatory test.
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You will arrange a visit the participant and an MOH nutrition officer who
will give her some safe nutrition resources for her baby. Her name is
Mariamma and her number is 078 566 889. Resources include:
o BP100
o Ready to Use Infant Formula
o Ultra-high temperature processing (UHT) milk for children
between 6 and 12 months old
 This nutrition specialist will help the participant understand this new way
of feeding her baby until she gets a negative test result for her breast
milk.
Explain to participants that she may be able to pass Ebola to a person who has contact with
[sexual fluid] through activity like vaginal, anal, oral, or manual sex until she gets two negative
test results in a row.
Tell the survivor it is important that she monitor her health:
o Inform participants that even though the RT-PCR tests are reliable, it may be possible
that virus could still be present in the body but not able to be found in body fluids.
o There have been a small number of survivors who became seriously ill after they
recovered, and so we may follow up with the participant after the study ends to ensure
they are well even after finishing the study.
o Ask participants who feel unwell to call Dr. Sesay or Dr. Massaquoi for further help.
Talk with client about their relationships and their sexual behavior, condom use, condom
negotiation, abstinence. Give client condom demonstration and condoms.
ADDITIONAL INFORMATION FOR POSITIVE/INDETERMINATE MENSTRUAL BLOOD:
o We recommend that you use disposable menstrual pads to catch the blood during your
period and to throw them out in a way that others cannot come into contact with them.
Refer participants who report psychological, sexual, or physical harm by their partners
(intimate partner violence) to proper services.
Refer participants with medical or psychological problems to Dr. Sesay or Dr. Massaquoi.
Encourage client to continue until they get two negative RT-PCR test results in a row.

Post-Test Counseling for Pregnant Women ONLY
 The participant will have already received her pregnancy results from the nurse after she took
the test.
 Confirm her results with her:
o “I have the results from the pregnancy test you did with the nurse earlier. It shows you
are pregnant. How do you feel about this?” Probe: ask how she is feeling and whether
she wants to discuss anything about the pregnancy with you.
 Give participant information about Ebola and pregnancy:
o There is no evidence to show that women who survive Ebola and then become pregnant
can pose a risk for Ebola virus transmission
o It is very important for all pregnant women to receive antenatal care (ANC) to keep the
participant and her baby safe.
 Ask participant if she is attending/receiving antenatal care:
o If Yes:
 Document which ANC she already attends by writing a note-to-file
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



 Inform receptionist
o If No:
 We can help you find antenatal care in your area. You can speak to the nurses
and doctors in the M34 survivor clinic next door today to be connected to
antenatal care. Would you like to do that?
 Refer to survivor clinic for subsequent referral to appropriate ANC.
Inform the participant that maintaining good health is important in pregnancy.
o Your body works extra hard when you are pregnant so it is important to take good care
of yourself. Part of this is a healthy diet. I would like to provide you with some nutritious
biscuits which will help keep you healthy.
 Distribute BP100 bars and refer to BP100 guidance sheet to give instructions.
Inform participant that our study is interested in understanding her pregnancy:
o Our research project is offering pregnant participants the opportunity to be followed up
through their pregnancy to childbirth. Participation in this research is entirely optional
and you can change your mind at any time. Would you like to hear more about this
research study?
 If YES:
 Administer nested pregnancy informed consent form
 Inform study operations manager and research assistant

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