1. The policy development for introducing of the oral fluid based rapid HIV test kit in Thailand Writers in the 2009 Write Workshop (WHO Bulletin)

2. Topic New option for HIV screening system - The introducing of the oral fluid based rapid HIV test kit in Thailand, an analysis for policy development Why Thailand is an interesting place to study this topic? Thailand is a developing country which face a big problem of HIV/AIDS. The study which propose policy suggestion in Thailand should be useful for other developing countries.

3. Puzzle Many studies in the international literature encourage people not only in developed countries but also developing countries to use the test as HIV self-testing. The important issues should be concerned by policy maker, if introducing the technology of oral fluid based, rapid HIV test kit in Thailand based on the current situation. Policy recommendation for making an introduction of HIV self-testing is feasible in Thailand in the future.

4. Research Questions How do we properly make a policy development for introduction of the oral fluid based, rapid HIV test kit in Thailand ?

5. Oral fluid based rapid HIV test kit Figure 2 : Method of collecting oral fluid sample Figure 1 : The component of oral fluid HIV test kit Figure 3 : Interpreting the result form oral fluid HIV test kit

6. Pros and Cons of the test Advantages Non-invasive technique, conveniently collecting sample Easy to interpret the result accurately even in an untrained people Shortly interpreting result in 20 minute No adverse effect from blood collection for clients No risk to be exposed to blood for health provider. Disadvantages and negative consequences Person would not receive face to face pre & post counseling. Misuse by testing someone without their consent. Illegal distribution of the test to unsuitable setting. Public misunderstanding about HIV virus can communicate via saliva Over utilization and burden of health expenditure

7. Objective Objectives of this study is to provide policy suggestion on properly adopting the oral fluid based rapid HIV test to health care service. The policy analysis based on societal perspective

8. Methodology Qualitative study : Focus group discussion among stakeholders related to the issue, including Health providers responsible for HIV screening, Decision maker in the area of HIV/AIDS policy, Third party payer, Manufacturer in private company Leaders of non-governmental organizations and Clients who sought HIV test.

9. Result: The requirement system for adopting the test in each level of health setting Healt h setti ng Additional requirement systems Hospital Meet the standard requirement** Private clinic 1. Anonymous system. Meet minimum requirement* Commu nity Center 1. Pre and Post counseling system with trained personal. 2. Anonymous system. 3. Referral system for client with reactive result to hospital. Surveill ance 1. Pre & Post counseling system with trained personal. 2. Referral system for client with reactive result to hospital. 3. Preparation of screening area to be confidential for client All level 1. Support the appropriate information for client. 2. Providing training program to health provider. 3. Penalty system of illegal distribution. Standard requirement of HIV screening premises 1. Pre and Post counseling* 2. anonymous system 3. referral system to hospital* 4. confirmatory system 5. follow up system * Minimum requirement

10. Discussion The study proposed an argument against previous literature encouraging public to use the test as self-testing. Thailand is not well prepared for self-testing regarding the barriers below. - Need more trained counselors. - Need more strongly understanding about HIV/AIDS among people. - Need more access to innovative counseling - Need more effectively supportive system Product launch to the market Product distribution Product be used in health setting Pre-counseling in group at health setting HIV/AIDS background, Important of HIV test, HIV risk reduction How to do the test, Recommendation after getting the test result Clients was offered of self test after counseling Come to hospital for - post counseling and - confirmatory testing Self test reactiveSelf test negative Follow-up for repeat test in next 3 months Hotline telephone counseling 4. Supportive system along side the path of self testing ? 2. Trained counselors ? 1. Patient ? 3. Health care facilities  ?

11. Control for the product Control for distribution Control for pre-services Self-testing for HIV infection Preventive system for undesirable effect Required system after their HIV self-testing Positive result Negative result Government sector responsible for regulating the quality standard of health product Government sector responsible for controlling health product distribution to legally setting Government sector responsible for controlling HIV/AIDS services and regulating health personal ethics Concerning sector Government sectors NGO, Community worker, Community hospital setting and government sector responsible for developing HIV/AIDS policy Regulating quality standard of product in pre and post marketing process Controlling a comprehensive content on the label of HIV testing product Defining the type of health care setting can be provide HIV self test Controlling and monitoring product distribution to legally permitted setting Establishing penalty system and complaint service for illegal distribution Rendering Hotline services for post counseling to clients who use the test and referral system to standard requirement system. Monitor undesirable outcome resulting from HIV self testing Establishing protection systems for misuse in vulnerable group Support consumer protection activities, Strengthen in patient right Providing essential information for consumer through various communication: brochures telephone, computer program, etc Government sectors Manufacturer/ product supplier Community hospital setting Providing communication media with standardized high quality counseling media for pre-group counseling such as video tape recorder or other media Training health personal for providing pre-counseling for self-testing properly Regulating health professional practice and rendering complaint service Regulating health professional to provide health care practice based on standard requirements of HIV screening premises. (+) System for confirmatory test, anonymous system, comprehensive post counseling and referral system to hospitalization for patient with HIV infection. ( - ) Follow up system in 3-6 months after the test High potential health care sectors such as community hospital, province hospital, private hospital, etc Recommendation on the requirement system for properly use the oral fluid based rapid HIV antibody test kits in each process of adoption Policy for public relation Disseminating essential information to enhance the knowledge and create good understanding in society on the related issue of HIV/AIDS Government sector responsible for controlling HIV/AIDS services Government sectors mass media and local journalists Government sectors Manufacturer/ product supplier

12. Conclusion For Thailand, the introduction of oral fluid based rapid HIV test kit should be adopted in order to increase accessibility to the HIV screening system. The progression of using the technology should make step by step, the more hasty the more mistake –First step: using the test in the defined setting, hospital & clinic (current situation) –Second step: using in the program of provider initiative for HIV testing –Third step: self-testing with supportive system from hospital –Last step: self-testing with over the counter purchases A further study is needed to answer the critical questions about cost-effectiveness analysis of the using the test in provider initiative program. (2 nd step)