It is vital to facilitate the integration of VCT within the setting of primary care services. The constraints of time and space in a busy clinic must be balanced against the need to ensure appropriate patient privacy and participation in the decision-making process. ^15,16 The reality for busy clinics in the developing world is that pre-test counseling must be brief so as to minimize disruption of the flow of patient services.¹⁷ The same practitioner—whether nurse, social worker, or physician—who sees the patient for the presenting complaint provides counseling during the same session and refers the patient directly to the lab for rapid HIV testing; the patient returns to the referring provider to receive and discuss the test result. This streamlined approach to VCT minimizes the inconvenience and effort imposed on the patient, since returning to the clinic at a later date presents considerable difficulty for many people in impoverished settings.¹⁸

If the initial rapid HIV test is positive, a second (different) rapid test is performed as confirmation. If both tests are positive, the patient is definitively identified as HIV-positive. If the two tests are discordant—that is, if the first test is positive and the second test is negative—a third (different) rapid test or Western Blot analysis is performed and considered the definitive result. This process is illustrated in Protocol 2.1.^*

*All protocols for Chapter 2 are grouped at the end of the chapter, immediately before the References.