Are we ready yet, for Health Care Provider Initiated HIV testing?

[Guest guest]

Are we ready yet, for Health care provider initiated HIV testing?

Dear FORUM,

According to the current epidemiological data requests for HIV tests

in general are low, and about one in 10 HIV-positive people in India

are aware of their status. Even when Anti retroviral Treatment is

available, many do not access to such treatment. In order to expand

access to ARV treatment and early treatment and support

interventions, a new policy on HIV testing has been proposed. Which

emphasizes the HIV service providers to initative an HIV testing for

people who are likely to be at the risk of HIV infection. According

to the current HIV testing policy, and HIV test could be provided

only when people request for an HIV test.

According to UNAIDS/WHO policy on HIV testing (June 2004) routine

offer of HIV testing by health care providers should be made to all

patients being:

• assessed in a sexually transmitted infection clinic or elsewhere

for a sexually transmitted infection - to facilitate tailored

counselling based on knowledge of HIV status

• seen in the context of pregnancy - to facilitate an offer of

antiretroviral prevention of mother-to-child transmission

• seen in clinical and community based health service settings where

HIV is prevalent and antiretroviral treatment is available (injecting

drug use treatment services, hospital emergencies, internal medicine

hospital wards, consultations etc.) but who are asymptomatic.

In this context Dr B B Rewari the National Programme Officer (ART)

of National AIDS Control Organistion (NACO) send the following

questions

Q 1. Is the concept of Provider initiated testing relevant for India?

Q 2 Are we ready for it now?

Q 3 Are we not already doing it in practice because in our country

whatever doctor says is followed by patient. So in a way it is

already provider initiated or provider suspected, though it has

element of pre test counselling in it?

Q 4 Is this going to decrease the stigma as the testing will be in a

way normalized to some extent?

Q 5 will it increase the number of positives detected and increase

the coverage by ART as presently patients do not even know that they

are infected and may need ART?

I think a discussion would be quite useful input for the programme to

think in terms of changing the testing policy

References:

Comments on the draft document, " Guidance on Provider-initiated HIV

Testing and Counselling in Health Facilities " Submitted by the UNAIDS

Reference Group on HIV and Human Rights to WHO and UNAIDS, January

2007

http://data.unaids.org/pub/Guidelines/2007/RGcomments-PITCguidance.pdf

UNAIDS/WHO POLICY STATEMENT ON HIV TESTING (June 2004)

http://data.unaids.org/una-docs/hivtestingpolicy_en.pdf

WHO/UNAIDS Guidance on Provider-Initiated HIV Testing and Counselling

in Health Facilities RESPONSE BY APMG

http://www.aidsprojects.com/uploads/File/APMG%20WHO%20PITC%20policy%

20response.pdf

CDC Provider-initiated and Delivered HIV Testing and Counseling in TB

Clinical Settings: Overview

http://www.cdc.gov/NCHSTP/OD/GAP/docs/tb_tools/TB%20An%

20Overview_12.1.06.pdf

WHO documents on HIV testing

http://www.who.int/hiv/topics/vct/en/

Horizons' report (2006) Expanding HIV Testing and Counseling

Operations research examines strategies to increase access and uptake

http://www.popcouncil.org/Horizons/newsletter/horizons(13)_1.html

Dr B.B.Rewari MD,FICP,FIACM,FIMSA

Sr.Physician,Dr RML Hospital & National Programme Officer (ART)

National AIDS Control Organistion

New Delhi.

Tel;23325343,23325335(O)

FAX : 011-23731746

E-mail: <drbbrewari@...>

[Guest guest]

Dear FORUM,

Re: /message/7160

I happened to read this mail. I have a few questions.

First of all I would like to clarify that all doctors do take a sexual history

from their patients along with past history, family history, social history and

personal history.

My second question is regarding confidentiality.

If you come to know that a patient with HIV positive status is getting married

to another patient of yours who is not HIV positive what do you do.

Does the rule of confidentiality apply in this case. What about the

unsuspecting partner in this case.

Seema Rao

E-MAIL: <raseema2002@...>