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The importance of HIV Testing

The importance of HIV Testing

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The importance of HIV Testing

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  1. The importance of HIV Testing Somboon Nookhai HIV Technical Support Laboratory Services Section Thailand MOPH U.S. CDC Collaboration 2nd National HIVQUAL-T Forum 17- 18 November 2008

  2. HIV Testing • Anti-HIV test (blood, saliva, urine) • P24 antigen testing • Combined p24 antigen & anti-HIV testing • HIV DNA-PCR (newborns) • HIV RNA-PCR (blood bank, individual vs. pooled)

  3. Natural Course of HIV Infection and Host Responses CD4+ T-cells Anti-HIV Ab HIV-CTL+CD8 activity Relative Levels Plasma HIV Viremia Months Years After HIV Infection Acute HIV infection Symptom AIDS-related illness

  4. HIV Marker During Early Infection Plasma HIV RNA Anti-HIV Ab p24 antigen 11 16 22 Day Months Years After HIV Infection DNA PCR RNA PCR p24 Ag Anti-HIV Transfusion Volume 40:143-158

  5. WHO Guideline for HIV testing

  6. Remark 1. A1, A2 and A3 mean Anti-HIV test kit number 1, number 2and number 3respectively. All test kits use different types of antigen or different principles. Test kit number 1should be the most sensitive. 2. It is suggested that 2 different test kits may be 'enough for diagnosing patients who have AIDS related illnesses. 3. For newly diagnosed individuals with HIV, a second specimen is required for testing with at least 1 assay of antibody testing before reporting. 4. For an indeterminate result, patients should be followed and re-tested at 2weeks, 3 and 6months after the initial test. If the results remain indeterminate after 6 months then 'negative by antibody' can be reported

  7. Why should be tested • To know individual HIV status • To prevent further infection • To prevent further spreading (+PMTCT) • To have early access to care including ARV • To prevent HIV-related morbidity & mortality

  8. Who should be tested? • Routine test: blood donor, ANC, pre-operative, life insurance, etc. • Diagnostic test: in ones with suspected symptoms including TB • Voluntary test: in ones with perceived risk (VCT) • Client-initiated HIV testing & Counseling "opt-in" • Provider-initiated HIV testing & Counseling “opt-out” or “PITC”

  9. WHO PITC Recommendation in epidemic types • Recommendation in all epidemic types • All adults, adolescents or children who present to health facilities with signs, symptoms or medical conditions that could indicate HIV infection. • Infants born to HIV-positive women as a routine component of the follow-up care for these children. • Children presenting with suboptimal growth or malnutrition in generalized epidemics, and under certain circumstances in other settings such as when malnourished children do not respond to appropriate nutritional therapy. • Recommendation in concentrateepidemic types • STI services • Health services for most-at-risk populations • Antenatal, childbirth and postpartum services • Tuberculosis services.

  10. Concerns about provider-initiated HIV testing and counseling (PITC) • Clients may not have the power to opt-out, i.e., mandatory testing • True informed consent may not be obtained • Counseling service is limited • Confidentiality broken • No concurrent national effort to increase treatment, care, and prevention • No concurrent national effort to ensure human rights through policy and legal frameworks • More infected persons detected may be interpreted as bad work on prevention

  11. Who support HIV testing • Universal Coverage Healthcare Scheme • ANC, General Operation • National AIDS Program for ART, NHSO • HIV screening in risk group with VCT (2 times a year) • PCR for babies twice a year • Social Security Scheme • N/A • Civil Servant Medical Benefit Scheme • N/A