1. CATHERINA JEMMOTT NOVEMBER 26TH, 2015

2. 7 health districts 7 district health teams 52 health centre/clinics 2 district hospitals Main hospital in Roseau (secondary care) 1 private hospital

3. HIV TESTING OBJECTIVES Diagnostic Blood Donor screening Antenatal screening Research & Kit Validation Drug Monitoring (treatment & Care) Resistance testing

4. HIV TESTING STRUCTURE Decentralized approach National Laboratory (reference facility & monitoring body) District Laboratory Health Centers Private Labs NGOs

5. HIV TESTING Delayed Testing Reference Laboratory Private Laboratories All Health Centers Health facilities Rapid Testing Blood Testing Sites Private Laboratories Reference Laboratory Oral Fluid Sero prevalence Studies

6. METHODOLOGIES Elisa Genscreen Ag/Ab 4 th generation Determine Unigold Aware Chembio Chem-illuminesence Cobas E 411 (fully automated system)

7. TESTING PROTOCOLS Rapid Tests (on site & Laboratory) Parallel algorithm Elisa Non Rapid tests (Laboratory) Serial algorithm

8. ON SITE TESTING National Laboratory oversees on site testing in the public sector: Conducts training of testers Procures and maintains an inventory of testing reagents and supplies Distributes testing kits & supplies Monitors testing sites – proficiency testing, on site visits, supportive supervision

9. ON SITE TESTING CONT. Counselling offered prior to testing Same day results provided for negative test reports Positive test – referred to National Laboratory for confirmation.

10. HIV TESTING IN SUPPORT OF TREATMENT CD4 test Performed at the National Laboratory Viral load test Referred to regional testing laboratory (Lady Meade Reference Unit – Barbados) Resistance testing Referred to regional testing laboratory

11. NEW INITIATIVES FOR 2016 Conduct study to assess the level of concordance in parallel testing Implement serial algorithm, based on results of study Improve reporting

12. CHALLENGES Lack of human resource dwindling donor funds Lack of dedicated budget for; - on site testing - CD4 and viral load Shipping of specimes Implementing recommendations of new WHO guidelines Meeting donor requirements for funding

15. THANK YOU!