1. HIV Rapid Testing Dr. Kevin Harvey National HIV/AIDS Programme Ministry of Health Jamaica

2. Simple /Rapid HIV test kits  Use an HIV enzyme immuno assay(EIA) Are equivalent to HIV ELISA screening Assays used in approved HIV testing Laboratories Specificity of these kits generally are >=99.5% Sensitivity of these kits generally are >=99.0%

3. Simple /Rapid HIV test All Positive HIV Screening Rapid test are preliminary and require confirmatory testing False Positive Results will occur

4. Rapid Test Classification AgglutinationImmuno- dot Immuno- chromatography Magnetic Bead CapillusMultispotDetermineBionor HIV ChekOraquik HIVsavUni-Gold

5. Complexity LEVEL 1LEVEL 2LEVEL 3 No additional equipment, No lab Experience Requires multiple reagents or pipetting Multiple step assay Reagents and sample preparation DetermineCapillusBionor Uni-GoldHIVSavMultispot OraquickDouble ChekHIVChek

6. Point of Care HIV Rapid Testing Providing comprehensive HIV Counselling and HIV screening at the point of care Confirmatory HIV testing at an approved laboratory Or Confirmatory HIV testing using rapid test algorithm

7. Why Rapid Testing

8. According to the CDC, using the rapid HIV screening test would have meant that, in 1995: Almost 700,000 more people would have learned their HIV status (individuals who did not return for results) Approximately two million people whose rapid-test results were negative would have learned their HIV status without a second clinic visit

9. Why Rapid Testing 8170 more people (22 percent of all positive tests performed in 1995) would have received confirmed positive test results 8301 HIV-negative people would have received preliminary false-positive results after a reactive rapid test, representing 0.4 percent of the 2.1 million people tested for HIV

10. Why Rapid Test Most (97 percent) of those who received a false positive result would have returned to learn their confirmatory test result was negative.

11. Why Rapid Test 1115 (0.05%) of HIV-infected people who did not return for confirmed results would have been given a reactive rapid-test result But also received counseling about the likelihood of being infected and the need for behavioural changes.

12. The CDC concluded from these figures that the use of a rapid test with same-day results can: substantially improve the delivery of VCT [counseling and testing] services. Because most persons who are tested are not infected, they can receive counseling and learn their HIV status in a single visit.

13. In addition, providing preliminary positive results also increases the number of infected persons who ultimately learn their infection status Increased Numbers referred for medical treatment and additional prevention services.

14. Proposed Modifications of WHO/UNAIDS HIV Testing Strategies

18. Jamaica’s Algorithm What do we use?

19. HIV Rapid Test Determine 1/2 Rapid Test Negative Patient HIV Negative Posttest Counselling Risk Reduction Rapid Test Positive Repeat test On same sample Unigold Rapid Test Negative Recheck sample ID /Quality assurance Pos. Indicate preliminary positive result to Patient with appropriate counselling Repeat test using Diff Rapid Test Cappilus Pos. ELISA Negative. Send 1 st and 2 nd sample to NPHL for confirmation and Storage Confirmed Positive Neg. Pos.

20. Protocol for HIV Rapid Testing In Jamaica The individual carrying out the test must exercise optimum confidentiality. In cases where individuals other than the doctor performs test, the results must be provided to the doctor first, who will then in turn inform the patient and provide the appropriate counselling.

21. Protocol for HIV Rapid Testing In Jamaica A rapid test positive or negative result should be indicated to the patient only with appropriate counselling interventions.

22. Protocol for HIV Rapid Testing In Jamaica All women testing positive for the first time during pregnancy should have a repeat HIV test at the six weeks post- Partum clinic visit A notification form must be completed and submitted to the medical officer of health for the parish (in sealed envelope marked confidential) or to the epidemiology unit at the ministry of health

23. Protocol for HIV Rapid Testing In Jamaica Though very accurate must be confirmed by routine testing, as there still exist a possibility of false positives and false negatives- this must be conferred to all patients undergoing this test

24. Protocol for HIV Rapid Testing In Jamaica The National public Health laboratory must evaluate all HIV Rapid test prior to use - not all HIV rapid test perform with the requisite level of sensitivity and specificity to recommend use For Quality control purposes one in ten of all samples positive or negative should be sent to the NPHL along with the patient, details and result of test The Kit lot # and expiry date should also be submitted

25. Voluntary Counselling and Testing-goals Make choices to reduce their risks of HIV infection and transmission- To sexual Partners and Infants Make informed choices about contraception and condom use Discuss HIV status and testing with their partner(s)

26. Voluntary Counselling and Testing Individual Who Test HIV Positive Counselling allows the Client to react to an HIV-positive result and receive empathy and support from a counsellor

27. Voluntary Counselling and Testing Choose Nevirapine or AZT prophylaxis therapy if pregnant Understand infant feeding options and choose the most appropriate one Understand treatment options and availability

28. Revisiting HIV Counseling and Testing Practices Pre Test Counselling Inform Patients of the possibility of false positive results The specifics of the individual test must be considered and discussed Stress the importance of confirmation of all preliminary positive results

29. Conclusion HIV rapid testing is a screening tool not a diagnostic tool All positives must be confirmed at a standard laboratory & Must only be offered with appropriate voluntary counselling (Pre and Post test)

30. Thank You