In our last outing we tried to explain the two types of HIV testing we practice in our environment. We have already mentioned the serial testing which involves the sequential testing of the individual’s blood using two different test kits. We had stated that in the event of the first test being negative, there was no need to proceed. But if the first test is positive and the second, negative; which in this case is a discordant result, a third test known as a tie breaker is now carried out. The main advantage in serial testing is that it saves cost but can be relatively time consuming. In parallel testing, two different screening tests are performed simultaneously or rather at the same time. Samples that are reactive to both tests are regarded as positive. In the event of discordance, a third test or a tie breaker will be carried out. The main advantage of this over serial testing is that it saves time.
As you would expect, HIV testing is not as easy as one would have loved it to be. There are those that no matter how persuaded would not like to go through the test. This is because of what is the biggest scourge of HIV, stigmatism. For the ignorant and ill informed, the mere mention of HIV to them is a death sentence. The truth is that knowing ones HV status is the beginning of good quality life! The simple reason is that if you don’t have the virus, you’d work hard to prevent it but if you have it you’d be proactive in dealing with it and live positively
For HIV testing, the standard 5C recommendation by the World Health Organization should be the norm. The 5C’s are consent, confidentiality, and counseling, correct test result and connection linkages. We will try to define these 5C’s and see how far we can go. In all cases an informed consent must be obtained from the client to be tested and counseled. A verbal consent is enough. Written consent is not necessarily required. The client must also be informed of his/her right to decline being tested. Secondly confidentiality must be strictly maintained. In other words, whatever the caregiver and the client discuss, will not be disclosed to a third party without the expressed consent of the person being tested. Confidentiality should be respected; but this should not play up unnecessary secrecy, stigma or the feelings of shame. Whatever is the outcome; it should not lead to the loss of self esteem. Shared confidentiality with one’s partner, family members, trusted friends and other health providers is often of high benefit to the client and other stakeholders.
Counseling before testing can be done in a group setting; but individuals should be given opportunity to ask questions privately if they so request. All HIV testing must be accompanied by appropriate and high –quality post test counseling based on the HIV test result and status reported. Experience has shown that trained counselors and nurses are better at this job than over worked doctors. Quality assurance mechanisms, supportive supervision and mentoring systems should be in place to ensure successful outcome. Correct test results should be the norm in all HIV screening. This involves the provision of high quality testing services. This would include quality management systems with quality assurance regardless of where the test is done to ensure that the client receives correct diagnosis.
Quality assurance should include both internal and external measures; and should also receive support from the National Laboratory before initiation into HIV Treatment, Support and Care program. Finally connection to prevention, treatment and care services must be done as soon as the diagnosis is confirmed. This would involve effective and appropriate follow-up, including long term prevention and treatment support. It is important to always use the national algorithm in HIV testing services and ensure quality assurance under all situations and circumstances.
In our environment the Rapid Test kits recommended for use are Determine, Unigold, Stat-Pak, Double Check Gold and Sure Check. There was a little controversy during one of the presentations in the conference. Prior to the meeting, Determine was the first choice in both serial and parallel algorithms. Now the postulation is that you could use Unigold as a first choice reagent. This they claim is even better than Determine. Clinicians and Laboratory Scientists from different hubs across the country exploded in arguments. It was really, really hot as some wondered what they would be reporting back home. It was fireworks from all stake holders. My own humble contribution was that instead of the heated argument that was going on, we should rather see it as a diagnostic plus which honestly I saw as a win-win situation.
Going by the fact that pitiably we do not manufacture these reagents and their availability largely depends on the rate of consumption and the Lead Time involved in getting these things into the lab, that there was no need to be unnecessarily rigid about this. Each hub should have its own experience and be willing to share it. That is what makes them scientists! I don’t know whether anybody listened. But by and large, it was a very heartening experience seeing the passion with which the issue was thrashed. You’d almost think that everyone there has the virus in them. It was like a family meeting where we all looked at each other’s eye balls and talked.
One of the painful things about documents like this is the poor dissemination strategy and effort to healthcare providers in both public and private sectors. Like most documents in our national life, after the initial uproar accompanying its launching and the optimism most of them are left in the book shelves to gather dust. And when you realize a great majority of health care providers that may not even come across the document it becomes very saddening. Make no mistake about it, substantial amount of money must have gone into the preparation of the document. The list of the contributors is quite awesome.
Everyone that had anything to do with the HIV family was there. From the Ivory Towers through WHO, CDC Implementing Partners, NACA, Private sector and so on were all involved in the authorship of the document .Of cause the Federal Ministry of Health, HIV treatment support and care department supervised and owns the document. Some of us had advocated that the guidelines should be abridged and pasted in the website of NACA/NASCP.I guess this has been done by now. We also hope that calendar size fliers would be made for easy comprehension in HIV centres in remote areas. On our part from time to time we will try to keep it on the front burner.

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