Service Provider Initiated HIV Testing

[Guest guest]

Moderators note: Dr B B Rewari the National Programme Officer (ART) of National

AIDS Control Organisation (NACO) send the following questions on the proposed

new HIV testing policy on “Provider initiated HIV testing”

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. The original posting from Dr B B Rewari,

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

on the following url.

/message/7160

______________________

Dear Forum

I congratulate Dr. B.B. Rewari to initiate the discussion on these issues. My

inputs on this issue are as under.

At present, around 10% of people living with HIV in our country know that they

are HIV-infected, but despite an increase in the availability of voluntary

counseling and testing (VCT), I believe that VCT can never meet the need for

testing on its own and that different testing approaches are needed. Testing for

HIV is the gateway to HIV treatment and an essential component of prevention

programmes. We should strive to improve, but the rights of people to be aware of

their infection should be given due consideration and importance and one such

approach is provider-initiated testing and counselling (PITC).

We can adopt the CDC guidelines with modifications tailored to our needs

(1) All Patients coming to a hospital for care should be told that this test

would be done and offered the opportunity to decline the test or get more

information; and

(2) Patients who test positive should be referred for HIV care.

Salient points and benefits of PITC:

1. Since health facilities are the most likely (and crucial) point of contact

for someone who might be HIV-infected, the main problem in care and treatment of

HIV is late presentation. Most of patients with HIV get their first positive

serologic test within 1 month of an AIDS-defining diagnosis. These " late

testers " do not respond as well to highly active antiretroviral therapy (HAART)

so that this delay results in an unnecessary increase in HIV-related mortality.

2. Currently out of 5.3 million people living with HIV in our country, only 10%

of people know that they are infected. There is evidence that knowledge of HIV

in this group could reduce the number of new infections due to self-imposed

behavioral change if they knew they were infected

3. Restricting the ‘voluntariness’ of HIV testing may adversely affect client

perceptions and uptake of treatment, care and prevention services.

The present testing model may not be the best model. It hasn’t worked or it’s

not being done properly. But the point is that we need a new model.

Regrds

Dr. Alok Vashishtha M.D.

Nirmal Medical Foundation,

Hardwar

e-mail: <dralokvashishtha@...>