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The importance of HIV Testing

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Thailand MOPH U.S. CDC Collaboration. 2nd National HIVQUAL-T Forum. 17- 18 November 2008 ... Anti-HIV test (blood, saliva, urine) P24 antigen testing ... – PowerPoint PPT presentation

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Title: The importance of HIV Testing


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-CTLCD8 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
Months
Years After HIV Infection
Day
DNA PCR
RNA PCR
p24 Ag
Anti-HIV
Transfusion Volume 40143-158
5
WHO Guideline for HIV testing
6
Remark 1. A1, A2 and A3 mean Anti-HIV test kit
number 1, number 2 and number 3 respectively. All
test kits use different types of antigen or
different principles. Test kit number 1 should 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 2 weeks, 3 and 6 months
after the initial test. If the results remain
indeterminate after 6 months then 'negative by
antibody' can be reported
7
(No Transcript)
8
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

9
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

10
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 concentrate epidemic types
  • STI services
  • Health services for most-at-risk populations
  • Antenatal, childbirth and postpartum services
  • Tuberculosis services.

11
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

12
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
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