**Module 16: Professional Ethics**

+----------------+-----------------------------------------------------+
| **Purpose**    | To provide participants with the necessary          |
|                | attitudes, motivation, and knowledge to apply       |
|                | ethical conduct to HIV rapid testing.               |
+----------------+-----------------------------------------------------+
| **P            | Module 5. Assuring Quality of HIV Rapid Testing     |
| re-requisite** |                                                     |
|                |                                                     |
| **Modules**    |                                                     |
+----------------+-----------------------------------------------------+
| **Module       | 45 minutes                                          |
| Time**         |                                                     |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, you will be able to:     |
| Objectives**   |                                                     |
|                | -   Describe ethical issues related to HIV rapid    |
|                |     testing                                         |
|                |                                                     |
|                | -   Explain the importance of professional ethics   |
|                |                                                     |
|                | -   Apply ethical conduct to HIV rapid testing      |
|                |                                                     |
|                | -   Take appropriate actions to maintain client     |
|                |     confidentiality                                 |
+----------------+-----------------------------------------------------+

**Module Overview**

+-----+-------+------------+---------------------------+--------------+
| **  | **T   | **         | **Content**               | **Resources\ |
| Ste | ime** | Activity/\ |                           | Needed**     |
| p** |       | Method**   |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 2 min | > Pr       | Module introduction       | > Slides     |
| 1** |       | esentation |                           | > 1-3;       |
|     |       |            |                           |              |
|     |       |            |                           | Prepared     |
|     |       |            |                           | flipchart -- |
|     |       |            |                           | content      |
|     |       |            |                           | outline      |
+-----+-------+------------+---------------------------+--------------+
| **  | 30    | > Pr       | Ethical issues in HIV     | Slides 4-12  |
| 2** | min   | esentation | rapid testing; what and   |              |
|     |       | >          | why important             | Setup for    |
|     |       | >          |                           | role-play    |
|     |       | Discussion |                           |              |
|     |       | >          |                           |              |
|     |       | >          |                           |              |
|     |       |  Role-play |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 10    | > Pr       | Applying ethics to HIV    | Slide 13-16  |
| 3** | min   | esentation | rapid testing             |              |
|     |       | >          |                           |              |
|     |       | >          |                           |              |
|     |       | Discussion |                           |              |
+-----+-------+------------+---------------------------+--------------+
| **  | 3 min | > Q&A      | Summary                   | Slide 17-18  |
| 4** |       |            |                           |              |
|     |       |            | Key messages              |              |
+-----+-------+------------+---------------------------+--------------+

**Material/Equipment Checklists:**

-   PowerPoint slides or transparencies

-   Overhead projector or computer w/LCD projector

-   Flipchart

-   Handouts:

    -   Guidelines for Ethical Behavior (ASCP)

    -   Code of Ethics (IFBLS Code of Ethics)

**Teaching Guide**

+-----------------+-----------------------------------------------------+
| **Slide         | **Teaching Points**                                 |
| Number**        |                                                     |
+=================+=====================================================+
| **1**           | **[Module 16: Professional Ethics]{.underline}**    |
|                 |                                                     |
|                 | DISPLAY this slide before you begin the module.     |
|                 | Make sure participants are aware of the transition  |
|                 | into a new module.                                  |
+-----------------+-----------------------------------------------------+
| **2**           | **[Learning Objectives]{.underline}**               |
|                 |                                                     |
|                 | STATE the objectives on the slide                   |
+-----------------+-----------------------------------------------------+
| **3**           | **[Content Overview]{.underline}**                  |
|                 |                                                     |
|                 | EXPLAIN the topics that will be covered in this     |
|                 | module.                                             |
+-----------------+-----------------------------------------------------+
| **F             | WRITE the content outline on a flipchart prior to   |
| lipchart**![](m | training.                                           |
| edia/image1.wmf |                                                     |
| ){width="0.8423 | REFER to it frequently to orient participants to    |
| 611111111111in" | where they are in the module.                       |
| height="0.84236 |                                                     |
| 11111111111in"} |                                                     |
+-----------------+-----------------------------------------------------+
| ![](m           | These three slides are introduced before ethics is  |
| edia/image2.gif | defined (in slide #8). The intent is to provide the |
| ){width="0.4479 | context and examples of the ethical dilemma that    |
| 166666666667in" | participants will likely face on their job. These   |
| height="0.54166 | examples will help them better grasp the abstract   |
| 66666666666in"} | concept of ethics. Facilitate a discussion around   |
| ***TIPS***      | each scenario.                                      |
|                 |                                                     |
| **4-6**         |                                                     |
+-----------------+-----------------------------------------------------+
| **4**           | **[Scenario I]{.underline}**                        |
|                 |                                                     |
| **Flipchart**   | ASK a participant (or volunteer) to read the        |
|                 | scenario on the slide.                              |
| ![](m           |                                                     |
| edia/image1.wmf | FACILITATE a discussion.                            |
| ){width="0.8423 |                                                     |
| 611111111111in" | > ASK participants:                                 |
| height="0.84236 |                                                     |
| 11111111111in"} | -   What are the issues here?                       |
|                 |                                                     |
|                 | -   What is the right thing to do?                  |
|                 |                                                     |
|                 | -   What are the consequences if you don't do the   |
|                 |     right thing?                                    |
|                 |                                                     |
|                 | -   How hard is it for you to do the right thing?   |
|                 |                                                     |
|                 | > WRITE participant responses on the flipchart.     |
+-----------------+-----------------------------------------------------+
| **5**           | **[Scenario II]{.underline}**                       |
|                 |                                                     |
| **Flipchart**   | ASK a participant (or volunteer) to read the        |
|                 | scenario on the slide.                              |
| ![](m           |                                                     |
| edia/image1.wmf | FACILITATE a discussion.                            |
| ){width="0.8423 |                                                     |
| 611111111111in" | > ASK participants:                                 |
| height="0.84236 |                                                     |
| 11111111111in"} | -   What are the issues here?                       |
|                 |                                                     |
|                 | -   What is the right thing to do?                  |
|                 |                                                     |
|                 | -   What are the consequences if you don't do the   |
|                 |     right thing?                                    |
|                 |                                                     |
|                 | -   How hard is it for you to do the right thing?   |
|                 |                                                     |
|                 | > WRITE participant responses on the flipchart.     |
+-----------------+-----------------------------------------------------+
| **6**           | **[Scenario III]{.underline}**                      |
|                 |                                                     |
| **Flipchart**   | ASK a participant (or volunteer) to read the        |
|                 | scenario on the slide.                              |
| ![](m           |                                                     |
| edia/image1.wmf | FACILITATE a discussion.                            |
| ){width="0.8423 |                                                     |
| 611111111111in" | > ASK participants:                                 |
| height="0.84236 |                                                     |
| 11111111111in"} | -   What are the issues here?                       |
|                 |                                                     |
|                 | -   What is the right thing to do?                  |
|                 |                                                     |
|                 | -   What are the consequences if you don't do the   |
|                 |     right thing?                                    |
|                 |                                                     |
|                 | -   How hard is it for you to do the right thing?   |
|                 |                                                     |
|                 | > WRITE participant responses on the flipchart.     |
+-----------------+-----------------------------------------------------+
| **7**           | **[What Could Be the Consequences                   |
|                 | of...]{.underline}**                                |
|                 |                                                     |
|                 | SUMMARIZE the discussion using this slide.          |
|                 |                                                     |
|                 | > REFER participants back to the points captured on |
|                 | > the flipchart.                                    |
|                 | >                                                   |
|                 | > STATE the following key points, if                |
|                 | > [not]{.underline} already captured:               |
|                 |                                                     |
|                 | -   A false positive HIV result can lead to:        |
|                 |                                                     |
|                 |     -   Considerable personal stress                |
|                 |                                                     |
|                 |     -   Family and marital problems                 |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   A false negative result can lead to:            |
|                 |                                                     |
|                 |     -   Increased transmission                      |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Each result you report is connected to a        |
|                 |     patient/client.                                 |
|                 |                                                     |
|                 |     -   A lot is at stake -- people's health,       |
|                 |         lives, mental health. The emotional costs   |
|                 |         of a wrong result can be huge. Also the     |
|                 |         health consequences can be enormous         |
|                 |                                                     |
|                 |     -   Considerable personal stress also includes  |
|                 |         depression, fear and even suicidal          |
|                 |         tendencies.                                 |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   You must strive to do the right things right.   |
+-----------------+-----------------------------------------------------+
| **8**           | **[What Is Ethics?]{.underline}**                   |
|                 |                                                     |
|                 | STATE the definition on the slide.                  |
+-----------------+-----------------------------------------------------+
| **9**           | **[Why is Ethics Important?]{.underline}**          |
|                 |                                                     |
|                 | STATE the text on the slide.                        |
|                 |                                                     |
|                 | CONCLUDE In other words if we do not apply a code   |
|                 | of ethics the patient or someone else will suffer.  |
+-----------------+-----------------------------------------------------+
| **10**          | **[Scenario IV]{.underline}**                       |
|                 |                                                     |
| **Flipchart**   | STATE the scenario on the slide.                    |
|                 |                                                     |
| ![](m           | FACILITATE a discussion.                            |
| edia/image1.wmf |                                                     |
| ){width="0.8423 | > ASK participants:                                 |
| 611111111111in" |                                                     |
| height="0.84236 | -   What are the issues here?                       |
| 11111111111in"} |                                                     |
|                 | -   What is the right thing to do?                  |
|                 |                                                     |
|                 | -   What are the consequences if you don't do the   |
|                 |     right thing?                                    |
|                 |                                                     |
|                 | -   How hard is it for you to do the right thing?   |
|                 |                                                     |
|                 | > WRITE participant responses on the flipchart.     |
+-----------------+-----------------------------------------------------+
| **11**          | **[Maintaining Confidentiality]{.underline}**       |
|                 |                                                     |
|                 | STATE the points on the slide.                      |
|                 |                                                     |
|                 | ADD the following points:                           |
|                 |                                                     |
|                 | -   Prior to testing, clients should be informed    |
|                 |     about the purpose, advantages, and              |
|                 |     disadvantages of testing. This process ensures  |
|                 |     understanding of the Counseling-Testing         |
|                 |     process.                                        |
|                 |                                                     |
|                 | -   Keeping information confidential means that it  |
|                 |     is kept a secret from everyone.                 |
|                 |                                                     |
|                 | EMPHASIZE People often violate ethics not because   |
|                 | they mean to, but because they are careless.        |
|                 | Therefore, we must be extra vigilant about ethical  |
|                 | conduct.                                            |
+-----------------+-----------------------------------------------------+
| ![](m           | Prior to the module (preferably a day or two        |
| edia/image2.gif | before):                                            |
| ){width="0.4479 |                                                     |
| 166666666667in" | -   IDENTIFY appropriate people (volunteers from    |
| height="0.54166 |     participants or other facilitators) to play the |
| 66666666666in"} |     roles.                                          |
| ***TIPS***      |                                                     |
|                 | -   PREPARE them for the task by explaining the     |
| **12**          |     intent, plot, and background of the role-play.  |
|                 |                                                     |
|                 | -   HELP them develop their script or lines for a   |
|                 |     3-5 minute play.                                |
|                 |                                                     |
|                 | -   PROVIDE ample time for them to rehearse. The    |
|                 |     better prepared they are, the more successful   |
|                 |     the role-play will be, and the more impact it   |
|                 |     has on the participants.                        |
|                 |                                                     |
|                 | -   SECURE props for role-play, e.g., dining table, |
|                 |     chairs, glasses, beer bottles, notepad for      |
|                 |     taking orders.                                  |
|                 |                                                     |
|                 | [Plot for the Role-Play]{.underline}                |
|                 |                                                     |
|                 | > *Two friends (Kathy and Judy) from different test |
|                 | > sites met for dinner one evening at a local       |
|                 | > restaurant. Their conversation evolved from the   |
|                 | > usual discussion about family into a discussion   |
|                 | > about work. Kathy commented that she felt sorry   |
|                 | > for Sue, a very pretty lady, who is now 5 months  |
|                 | > pregnant and was just diagnosed with HIV.*        |
+-----------------+-----------------------------------------------------+
| **12**          | **[Role-Play]{.underline}**                         |
|                 |                                                     |
|                 | INTRODUCE the role-play and the characters in the   |
|                 | role-play.                                          |
|                 |                                                     |
|                 | -   You are going to watch a role-play.             |
|                 |                                                     |
|                 | -   There are two roles -- Kathy and Judy. They are |
|                 |     both community counselors and each works at a   |
|                 |     different HIV rapid testing site. They are      |
|                 |     meeting for dinner at a restaurant.             |
|                 |                                                     |
|                 | -   The role-play will take about 3-5 minutes.      |
|                 |                                                     |
|                 | DISCUSS the questions on the slide.                 |
|                 |                                                     |
|                 | DEBREIF by summarizing key discussion points.       |
+-----------------+-----------------------------------------------------+
| **13**          | **[Who is Responsible for Ethics?]{.underline}**    |
|                 |                                                     |
|                 | ELABORATE the points on the slide.                  |
|                 |                                                     |
|                 | -   Everyone at a testing site plays a part.        |
|                 |                                                     |
|                 | -   Your testing site may not have all the          |
|                 |     categories of staff mentioned, nevertheless     |
|                 |     anyone who plays a part in testing or has       |
|                 |     access to the test results must adhere to       |
|                 |     ethical conduct.                                |
|                 |                                                     |
|                 | -   They may cheat in some way, damage specimens,   |
|                 |     falsify results, or inform other people about   |
|                 |     results. Equally they can decide to ensure that |
|                 |     specimens are delivered, recorded, stored and   |
|                 |     reported with high quality.                     |
+-----------------+-----------------------------------------------------+
| **14**          | **[How Do We Apply Ethics To HIV Rapid              |
|                 | Testing?]{.underline}**                             |
|                 |                                                     |
|                 | PROVIDE the following examples.                     |
|                 |                                                     |
|                 | -   Work done                                       |
|                 |                                                     |
|                 |     -   Use only kits approved for use in country   |
|                 |                                                     |
|                 |     -   Ensure quality outputs -- Following SOPs as |
|                 |         written. If a test procedure calls for 20   |
|                 |         minutes incubation or wait time, DON'T take |
|                 |         shortcuts. Wait the full time before        |
|                 |         recording and reporting test results        |
|                 |                                                     |
|                 |     ```{=html}                                      |
|                 |     <!-- -->                                        |
|                 |     ```                                             |
|                 |     -   Keep supplies and kits in safekeeping.      |
|                 |         Unauthorized use of test kits outside of    |
|                 |         the testing site is prohibited.             |
|                 |                                                     |
|                 |     ```{=html}                                      |
|                 |     <!-- -->                                        |
|                 |     ```                                             |
|                 |     -   If you have questions, ASK.                 |
|                 |                                                     |
|                 |     -   DO NOT falsify results.                     |
|                 |                                                     |
|                 | ```{=html}                                          |
|                 | <!-- -->                                            |
|                 | ```                                                 |
|                 | -   Behavior of staff - Testing staff should        |
|                 |     conduct themselves in a professional manner.    |
|                 |     Examples of professionalism include:            |
|                 |                                                     |
|                 |     -   Dressing appropriately. If lab coat of      |
|                 |         apron is soiled, change to a clean one      |
|                 |                                                     |
|                 |     -   Turning cell phones off. It is disruptive   |
|                 |         and not considerate of clients to talk on   |
|                 |         the phone during the course of testing.     |
|                 |                                                     |
|                 |     -   Not discussing results of interaction with  |
|                 |         clients with others. Maintaining patient    |
|                 |         confidentiality is a MUST.                  |
|                 |                                                     |
|                 | -   Behavior of management -- Management sets the   |
|                 |     example or expectations of how staff should     |
|                 |     conduct themselves.                             |
+-----------------+-----------------------------------------------------+
| ![](me          | If the country already has in place national policy |
| dia/image3.wmf) | on ethics or code of conduct, cite the specific     |
| {width="0.49166 | legislation and replace slides 15-16. If not, use   |
| 666666666664in" | these two slides to guide discussion.               |
| heigh           |                                                     |
| t="0.4416666666 |                                                     |
| 6666665in"}***C |                                                     |
| ustomization*** |                                                     |
|                 |                                                     |
| ***Notes***     |                                                     |
|                 |                                                     |
| **15-16**       |                                                     |
+-----------------+-----------------------------------------------------+
| **Transition**  | EXPLAIN A Code of Ethics is an expression of basic  |
|                 | values - the principles and standards by which you  |
|                 | should conduct yourself                             |
|                 |                                                     |
|                 | STATE A number of laboratory professional           |
|                 | organizations have code of ethics, with common      |
|                 | principles of conduct. The next 2 slides highlight  |
|                 | principles from IFBLS and ASCP                      |
+-----------------+-----------------------------------------------------+
| **15**          | **[Code of Ethics (IFBLS)]{.underline}**            |
|                 |                                                     |
| **Flipchart**   | DISCUSS each point on the slide. ASK:               |
|                 |                                                     |
| ![](m           | -   What does this mean to you?                     |
| edia/image1.wmf |                                                     |
| ){width="0.8423 | -   What personal action will you take to           |
| 611111111111in" |     demonstrate this conduct?                       |
| height="0.84236 |                                                     |
| 11111111111in"} | WRITE participant responses on the flipchart.       |
|                 |                                                     |
|                 | STRESS the last point:                              |
|                 |                                                     |
|                 | -   Be accountable... you must take personal        |
|                 |     responsibility for everything you do.... be     |
|                 |     able to answer for your conduct and moral       |
|                 |     obligations to choose to do right over wrong.   |
+-----------------+-----------------------------------------------------+
| **16**          | **[Code of Ethics (ASCP)]{.underline}**             |
|                 |                                                     |
| **Flipchart**   | DISCUSS each point on the slide. ASK:               |
|                 |                                                     |
| ![](m           | -   What does this mean to you?                     |
| edia/image1.wmf |                                                     |
| ){width="0.8423 | -   What personal action will you take to           |
| 611111111111in" |     demonstrate this conduct?                       |
| height="0.84236 |                                                     |
| 11111111111in"} | WRITE participant responses on the flipchart.       |
|                 |                                                     |
|                 | CONCLUDE the discussion by summarizing key points   |
|                 | from the flipchart.                                 |
+-----------------+-----------------------------------------------------+
| **17**          | **[Summary]{.underline}**                           |
|                 |                                                     |
|                 | ASK participants to answer the questions on the     |
|                 | slide.                                              |
+-----------------+-----------------------------------------------------+
| **18**          | **[Key Messages]{.underline}**                      |
|                 |                                                     |
|                 | STATE the key messages on the slide.                |
|                 |                                                     |
|                 | ANSWER any questions participants may have.         |
+-----------------+-----------------------------------------------------+