HIV TESTING

SERVICES (HTS)
ISHMAEL GUMBO
INTRODUCTION

• HIV testing services (HTS) guidelines were developed by Ministry of Health in partnership
with National AIDS Council, CDC and other partners to provide guidance on how to test
and care for persons infected with HIV.
• It is recommended that HIV testing always be voluntary and consent must be obtained
from those being tested
• Health care providers are expected to uphold child’s rights and ensure that the required
care and support services are made available.
• To achieve the intended target of diagnosing at least 90% of PLWHAs and putting 90% of
them on treatment with ARVs, HIV testing should be offered to all individuals routinely to
ensure universal coverage of the service. The approaches listed and described below are
common in the Zambian context:
FACILITY AND COMMUNITY HTS APPROACHES

• With over 1,800 HTS facilities supported by a variety of health care professionals country-
wide, Ministry of Health supports both facility-based and community-based HTS
approaches to deliver on the 90/90/90 test and treat strategy.
• Community-based HTS are designed to increase the uptake of HIV testing within the
confines of communities and target individuals who, for one reason or the other, are
unable to access facility-based HTS.
• Community-based HTS are based on the index-patient model and leads to early diagnosis
of HIV infection and prompt linkage to care and treatment
• If possible, home based HTS should be encouraged. When HTS is done within the family
context, the family is more likely to provide moral and psychosocial support to each other
UNIVERSAL HTS
• HIV Self Testing (HIVST)
.• Oral Self-test kits are finally available from Society for Family Health (SFH) and will soon
be obtained from chemists and health facilities.

• Provider Initiated Testing and Counselling (PITC)

• Provider Initiated Testing and Counselling require that health care providers should be
proactive and encourage their clients to do an HIV test. Every person who passes through
the various sections of the facility should be offered the HIV test. To do this, providers
should explain the benefits of one knowing his/her status and provide information on risk
reduction, early diagnosis and the importance of early treatment.
• Strategies used to mitigate the spread of HIV in Zambia

• In Zambia, the Ministry of Health works closely with local and international NGOs including
line ministries to coordinate the effort in mitigating the impact of HIV and AIDS in the
country. This collaboration has led to the reduction of HIV prevalence from 21% in 1996 to
11.3% by the year 2016. The interventions include the following:
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• 1. HIV testing is now routinely performed in all health facilities. All patients requiring
treatment for any kind of ailment are also required to be tested for HIV.
• 2. All HIV positive persons should be commenced on ART regardless of CD4 count.
• 3. Promotion of Counselling and Testing Services (HTS) in all the districts to ensure
prompt treatment with ART
• 4. Elimination of mother to child transmission of HIV: All HIV positive pregnant women
should be initiated on ART

• 5. Promoting Voluntary Medical Male Circumcision (VMMC), cervical cancer screening and
condom use
• 6. Health education and advocating for the rights of PLWAs
• 7. Early treatment of TB & STIs
HIV COUNSELLING
• HIV counselling for HTS is a confidential dialogue in which a trained health care provider
motivates and supports a person seeking an HIV test in an enabling and private environment
that encourages a person to make an informed personal decisions about his HIV status and to
help access treatment, care and support.
• This process encompasses pre-test and post-test counselling
• Pretest counselling/information
• This is the psychological preparation of a client for the possible outcome of test results. Pre-test
counselling is meant to motivate and encourage the clients to know their HIV status. The health
care provider should ALWAYS explain the benefits of people knowing their HIV status.
• Prepare the counselling room in a well-ventilated room that assures privacy, away from noise
and other disturbances. Avoid conducting counselling sessions next to a busy OPD or antenatal
clinic.
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Welcome the client warmly and initiate introductions
Establish their reasons for coming to the Centre
• Reassure the clients of confidentiality
• Discuss the importance of the HIV test and what happens after the results come out
• Explain the benefits of starting treatment early – emphasize that Undetectable viral load =
Untransmittable HIV
• Explain how ART works: side effects and how to deal manage them
• Discuss importance of partner notification/disclosure and elicitation of sexual partners
• Discuss the importance of retesting after three months for clients who test negative
• Encourage the clients to ask questions
• Be reassuring and show respect to the client
• Give your client appointment time for their results
• Post Test counselling
.• This is the counselling that is done after the results are already given to the clients to help them
plan the way forward. It is recommended that results always be given out by the same
counsellor who conducted the pre-test counselling.
• How to conduct post-test counselling
• o Welcome the client and make him/her to feel comfortable
• o Show the client his/her results immediately s/he settles down
• o Give client enough time to comprehend the results
• o Ensure that the client understands his/her results
• o If Negative, teach the client how to stay negative
• o If positive, emphasize the importance of ART and when client can start
• o Discuss shared confidentiality and then refer to ART staff
• o Encourage the clients to ask questions
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• NB: As a counsellor, ensure that you schedule at least two more follow-up counselling sessions
with your clients. This helps you to check on them in order to find out how they are copying in
life. Follow-up sessions help your clients to feel encouraged and supported.
• USE OF ANTIRETROVIRAL DRUGS (ARVS)
• Antiretroviral drugs are medicines which are prescribed to help eliminate HIV particles from
the blood. If taken correctly, with good adherence, antiretroviral drugs often result into
significant viral suppression to a stage where the HIV becomes undetectable in the blood
• According to 2018 HIV Treatment Guidelines by the Ministry of Health, persons who test HIV
positive must be commenced on treatment immediately
• When taken correctly, ARVs are known to improve the quality of life thereby enabling the
person to continue living a healthy and productive life
• Antiretroviral drugs should be taken every day for life, following the health care provider’s
instructions. Like all medicines, antiretroviral drugs have side effects, however, these do not last
for a long time and can easily be dealt with if one follows instructions on how to deal with them.
HOW DO ARVS WORK?

• How do ARVs work?

• 1. ARVs reduce the viral load: (Stop HIV from invading immune cells, Slow down the viral
replication in the infected immune cell)

• 2. ARVs improve the immune functioning

• 3. ARVs reduce the occurrences of opportunistic infections
• 4. ARVs increase vitality

• 5. ARVs improve the general health status of an individual

GOALS OF ART

• Maximal and durable suppression of HIV replication

• Restoration and preservation of immune function

• Restoration of normal growth and development in children
• Reduction of HIV related illnesses and death

• Improved quality of life

• Back to school, work, business.
ADVANTAGES OF STARTING ART EARLIER:

• 1. You prevent CD4 decline,

• 2. You prevent escalation of opportunistic infections,
• 3. You protect the brain & other vital organs,
• 4. You preserve immune response to HIV (HIV immune response does
not improve on therapy)
• 5. Children generally respond very well to ART
IMPORTANT CONSIDERATIONS WHEN TAKING ART
• 1) ART is life long
• 2) Requires adherence and discipline (compliance & commitment to treatment)
• 3) Regular medical check-up for infections, allergies, drug interactions. e.t.c
• 4) Regular biochemical check-ups:
• ▪ Full Blood Count
• ▪ Viral load count
• ▪ CD4 count
• ▪ Liver Function Test
• ▪ Kidney Function Test.
• 5) Requires good diet, plenty of fluids and rest
• 6) Should use condoms to reduce chances of re-infection and cross resistance of ARVs.
CAUSES OF ARVS DRUGS RESISTANCE

• 1. Incomplete treatment
• 2. Inadequate dosage
• 3. Mutation (changing characteristics of the HIV virus).
• 4. Mono therapy (using a single drug)
• 5. Being infected with a drug resistant type of HIV
COMMON SIDE EFFECTS OF ARVS

• ∙ Stomach upset leading to nausea, vomiting, diarrhoea or constipation

• Anemia (associated with AZT)
• Skin rashes, Dizziness and or drowsiness
• Headaches, Increased appetite
• Anxiety, dysphoria and bad dreams (associated with Efivarence)
• Rheumatism (associated with Lamivudine)
• What is the Immune reconstitution inflammatory syndrome (IRIS)? This condition happens when a
previously suppressed immunity becomes reactivated by the use of ARVs. When the reactivated immune
system starts fighting dormant opportunistic infections, the individual will experience symptoms of ill health
such as headaches, diarrhoea, sweating, high fever and vomiting. To avoid IRIS, all clients who are eligible
to ART must be thoroughly screened treated for OIs prior to initiating ART.
WHAT ARE IMMUNE BOOSTERS?

• Immune boosters are mainly food supplements, vitamins and minerals which support the
body’s production of immune cells and also assist the body to fight infections better.
• Although the best immune booster is well prepared food, persons receiving ART can also
benefit from the following selenium rich supplements and fortified vitamins such as
Zincovite, Immunace, neurobion, centrum, vitacip and several others.
SPECIAL CONSIDERATIONS FOR ART IN CHILDREN
• 1. When starting ART, ensure that all potential adherence barriers to adherence are addressed
• 2. Select treatment that is potent, durable, convenient, non-toxic, well-tolerated, and sustainable
• 3. Teach children to take the medicine even if it doesn’t taste sweet. Give a sweet or juice
afterwards.
• 4. There are also syrup versions of antiretroviral drugs meant for children. However, in the
absence of syrup formulations, older children may be prescribed pediatric tablets.
• 5. Adherence in children is key to their recovery. Train family and child on dosing and schedule.
Ask the ART provider to explain the dosing frequency, food and fluid requirements
• 6. Presence of other infections such as TB, Hepatitis B or C or chronic renal or liver disease that
could affect drug choice -
• 7. Educate family and child about HIV & importance of ART adherence
• 8. Monitor response and adherence
• 9. Respond promptly to problems
METHODS OF RISK REDUCTION
• In Zambia, the most common mode of HIV transmission is heterosexual sexual intercourse
followed by mother to child transmission. Steps that people can take to reduce the risks of HIV
transmission are:

• o Abstaining from sex unless one can effectively use condoms.

• o Use of condoms consistently whenever they have sexual intercourse even with a trusted
partner
• o Reducing the number of sexual partners to just one, but still using condoms unless their HIV
status (negative) is verified.
• o Women should start their antenatal clinic as soon as they discover that they are pregnant
• o Being faithful to one sexual partner and ensure that s/he is safe and protected
• o Teaching adolescents about reproductive health issues; waiting until they much older may be
too late.
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• Pre Exposure Prophylaxis (PrEP): WHO (2013) recommends that sexually active HIV negative individuals or those who
are in a discordant relationship may take ART combination of Tenofovir Disoproxil Fumarate (TDF) 300mg and
Emtricitabine (FTC) 200mg once daily OR TDF 300mg and Lamivudine (3TC)300mg once daily to protect themselves
from acquiring HIV from their HIV positive partners. This is known as Pre Exposure Prophylaxis (PrEP). Those taking
PrEP may only stop taking it when their sexual partner is virally suppressed or when they themselves sero-convert.
• Post Exposure Prophylaxis (PEP): This is short term antiretroviral therapy that is given to an individual who has been
exposed to HIV through accidents such as needle pricks including unprotected sex due to rape, child sexual abuse or
sexual assault. PEP works by preventing HIV replication in an exposed person, thus preventing the HIV infection from
becoming established. Short term ART is administered for a period of 30 days to HIV negative victims after the following
eligibility procedure has been undertaken:
• ▪ Immediately after the accident, victim should wash thoroughly with soap and running water
• ▪ Do HIV test immediately to verify current status
• ▪ A positive result means that the victim was already positive and should instead be commenced on full ART
• ▪ A negative result is eligibility to receive PEP

• NB: ART regimes are under constant modifications, as such the regimes outlined above may be replaced by new ones in
the next few years.
 Index Testing Services

• Index testing, also referred to as partner testing/partner notification services, is

an
approach whereby the exposed contacts (i.e., sexual partners, biological
children and
anyone with whom a needle was shared) of an HIV-positive person (i.e., index
client), are elicited and offered HIV testing services.
• The goal of index testing is to break the chain of HIV transmission by offering
HIV testing services (HTS) to persons who have been exposed to HIV and
linking them to: HIV treatment, if positive or prevention services if negative.
 Intimate Partner Violence (IPV)

• Intimate partner violence is domestic violence by a current or former spouse or

partner in an intimate relationship against the other spouse or partner. IPV can
take a number of forms, including physical, verbal, emotional, economic and
sexual abuse.
• Four types of intimate partner violence—physical violence, sexual violence,
stalking, and psychological aggression.
 END OF LECTURE