Challenges of HIV testing in India

The Human Immunodeficiency Virus (HIV), - the diseases it causes and its prevention and cure are widely discussed at symposiums, health conferences, and in doctors' visiting rooms.

The stigma and social ostracism associated with HIV infections and diseases  hinder the timely screening and treatment. However, if these social taboos could be overcome, it would benefit not only the patient but also the people around him or her and society ta large. This could also be beneficial to the country's economy.

The challenges in HIV testing: Personal, socio-demographic, and health system-related factors pose the gravest challenges to HIV testing in India. The fear of being tested positive and the discrimination, rejection, and stigma that follow thereafter pull many people back from conducting screening voluntarily. The fear of discord in marital relationships is yet another challenge where testing HIV positive is often seen as a case of infidelity. Lack of awareness about testing procedures, inaccessibility to testing sites, inconvenient testing hours, and cost of testing have a similar effect.

As with people's attitudes, lack of adequate resources at the testing facility can also hamper the procedure, and affect results. Many different variants of the virus are found across the globe, and some variants tend to be more prevalent in certain geographies than others.

Testing kits, when not designed to accommodate this variation, can give out incorrect results. Inadequacy of competent health personnel, unreliability of test results, and poor staff attitudes are also factors that drive patients away from HIV screening.

HIV counselling

HIV counselling and testing (HCT) facilitates the in the early diagnosis of HIV infections. Counselling enables screening individuals with high risk and making everyone aware of their individual HIV status.

Such tests comprise of different kinds of testing methods such as antibody screening tests, antigen/antibody testing through employment of techniques such as lateral flow Rapid Tests, ELISA tests, PCR-based viral load tests, and so on. Rapid test utilising principals of lateral flow chromatography is a quick way to screen a large number of individuals with a minimal requirement of technical expertise and instruments.

After a person is diagnosed with the HIV virus, more robust methods of ELISA and PCR-based Nucleic Acid testing (NAT) are performed to confirm the initial reasults. ELISA is a method that utilises very specific sets of reagents which  are able to identify infections in each sample. The process usually takes minimum three hours to complete, depending on the number of samples processed at a time.

This method of ELISA provides a more reliable outcome and is a mandatory test for all donated blood in blood banks across India, as well as many countries across the globe. ELISA platform requires only basic handling training to the lab technicians and are able to automate the processes easily at laboratories with sufficient workload.

Nucleic Acid testing is one of the most advanced methods to detect infection even at the most initial stage possible till date. This method employs extraction and identification of genetic material of the virus. It is the most powerful tool available at the moment, but it comes with its own limitations.

NAT is currently prohibitively expensive to be utilised to screen all individuals. Many that are used during the later stages of treatment are used as monitoring tools to measure the effectiveness of drugs and patient response.

The rapid HIV testing is a fairly recent development that is contributing to a transformation in the screening process.

A boon to geographical locations low on resources, this test enables HIV screening to be performed in a speedier manner, without the need for big laboratories or the use of expensive equipment.

Rapid tests are performed within mobile clinics and at community health centres, where patients receive results within 20 to 30 minutes. This eliminates delayed follow up (or lack of it) at the patient's end, and significantly brings down the worry that patients encounter during the two or three weeks till results arrive in traditional tests.

Early diagnosis and initiation of ART in children even younger than two years, can significantly bring down HIV mortality in such age groups, and also foster a healthier future. The screening is also a key to motivating people who test negative to maintain their status and take precautionary measures from being infected.

(The author is chairman, founder, Trivitron Healthcare, Neuberg Diagnostics)

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