HIV Rapid Testing

Dr. Kevin Harvey

National HIV/AIDS Programme

Ministry of Health

Jamaica

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%

Simple /Rapid HIV test

• All Positive HIV Screening Rapid test are preliminary and require confirmatory testing

• False Positive Results will occur

Rapid Test Classification

Agglutination Immuno-dot

Immuno-

chromatography

Magnetic

BeadCapillus Multispot Determine Bionor

HIV Chek Oraquik

HIVsav Uni-Gold

Complexity

LEVEL 1 LEVEL 2 LEVEL 3

No additional equipment, No lab Experience

Requires multiple reagents or pipetting

Multiple step assay Reagents and sample preparation

Determine Capillus Bionor

Uni-Gold HIVSav Multispot

Oraquick Double Chek HIVChek

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

Why Rapid Testing

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

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

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.

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.

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.

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.

Jamaica’s Algorithm

What do we use?

HIV Rapid Test Determine 1/2

Rapid TestNegative

Patient HIV Negative

Posttest Counselling Risk Reduction

Rapid Test Positive

Repeat testOn 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 TestCappilus

Pos.ELISA

Negative.

Send 1st and 2nd sample to NPHL for confirmation and Storage

Confirmed Positive

Neg.Pos.

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.

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.

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

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

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

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)

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

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

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

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)

Thank You