Patients’ psychosocial needs, medical interventions and legal policy may all change in the months and years following an HIV positive diagnosis. The WeSSI has been developed to set standards in Health Advising by addressing these needs and changes in an ongoing and structured manner.
The WeSSI is a structured interview to be completed with all patients diagnosed HIV positive. Issues covered include wellbeing, disclosure and confidentiality, occupation, safe sex and criminalisation of transmission of HIV and post exposure prophylaxis for a sexual exposure (PEPSE), partner notification, testing children, and prevention of mother to child transmission.
Use of the WeSSI can help ensure that patients are well informed; services meet broader responsibilities by raising conventional risk management issues (such as discussing PEPSE, criminalisation and testing children); and information is documented and readily accessible to staff.
Audit and Patient Satisfaction
The WeSSI is designed to be easily audited. Outcomes are whether patients have received any ‘new information’ or an ‘intervention’ (or ‘action’) as a result of its use.
Patient satisfaction is rated by a questionnaire
Both the audit tool and the patient satisfaction questionnaire can be found on the Society of Sexual Health Advisers’ (SSHA) website.
Using the WeSSI
The WeSSI is designed as a health advising consultation and validated for use in Genito-urinary Medicine (GUM). This is because interventions (for example provider notification, testing children) are best managed from GUM; interventions and incomplete WeSSIs can be followed up at the patient’s next attendance in 3-4 months; regular attendance means the WeSSI can be repeated annually; and patients found the issues raised ‘relevant and acceptable’ in a GUM setting.
A central aspect of the role of the health adviser in GUM is to raise psychosocial and medicolegal aspects of care with patients (for example in pre and post HIV test discussion). Independent of patients’ medical treatment and care, the specific and boundaried role of the health adviser is well suited to a consultation using the WeSSI. The WeSSI has also been used by a Clinical Nurse Specialist (CNS) in HIV/AIDS.
Knowledge and skills
As the WeSSI raises potential risk management issues health advisers need to have a high degree of knowledge and expertise in a range of areas ranging from criminalisation, transmission, PEP, and occupational guidance.
A consultation using the WeSSI means that patients are asked about highly emotive issues including their mental health, disclosure and its effects, concerns about confidentiality, informing partners, and testing children.
As the WeSSI suggests rather than prescribes formatted questions it is recommended that staff have both well developed counselling and communication skills, and are trained in motivational interviewing techniques around prevention.
All of the above require staff to receive appropriate supervision.
Staff should identify and address the patient’s own concerns before commencing the consultation with the WeSSI. This both enables staff to focus on the patient’s needs first and facilitates the discussion of other issues not raised by the WeSSI.
Patients’ circumstances may change following their initial interview with the WeSSI; for example they may meet new partners or their untested children may come to the UK. Therefore it is also recommended that patients are re-interviewed annually.
Each session takes approximately 45 minutes – 1 hour. It is anticipated that repeat consultations are shorter.