The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. The importance of HIV Testing Somboon Nookhai HIV Technical Support Laboratory Services Section Thailand MOPH U.S. CDC Collaboration 2 nd National HIVQUAL-T Forum November 2008

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. HIV Testing Anti-HIV test (blood, saliva, urine)Anti-HIV test (blood, saliva, urine) P24 antigen testingP24 antigen testing Combined p24 antigen & anti-HIV testingCombined p24 antigen & anti-HIV testing HIV DNA-PCR (newborns)HIV DNA-PCR (newborns) HIV RNA-PCR (blood bank, individual vs. pooled)HIV RNA-PCR (blood bank, individual vs. pooled)

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Natural Course of HIV Infection and Host Responses Relative Levels Months Years After HIV Infection CD4+ T-cells Plasma HIV Viremia Anti-HIV Ab HIV-CTL+CD8 activity Acute HIV infection Symptom AIDS-related illness

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. HIV Marker During Early Infection Months Years After HIV Infection Plasma HIV RNA Anti-HIV Ab p24 antigen Day DNA PCR RNA PCR p24 Ag Anti-HIV Transfusion Volume 40:

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. WHO Guideline for HIV testing

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Remark 1. A1, A2 and A3 mean Anti-HIV test kit number 1, number 2 and number 3 respectively. All test kits use different types of antigen or different principles. Test kit number 1 should be the most sensitive. 2. It is suggested that 2 different test kits may be 'enough for diagnosing patients who have AIDS related illnesses. 3. For newly diagnosed individuals with HIV, a second specimen is required for testing with at least 1 assay of antibody testing before reporting. 4. For an indeterminate result, patients should be followed and re-tested at 2 weeks, 3 and 6 months after the initial test. If the results remain indeterminate after 6 months then 'negative by antibody' can be reported

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry.

Why should be tested To know individual HIV statusTo know individual HIV status To prevent further infectionTo prevent further infection To prevent further spreading (+PMTCT)To prevent further spreading (+PMTCT) To have early access to care including ARVTo have early access to care including ARV To prevent HIV-related morbidity & mortalityTo prevent HIV-related morbidity & mortality

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Who should be tested? Routine test: blood donor, ANC, pre-operative, life insurance, etc.Routine test: blood donor, ANC, pre-operative, life insurance, etc. Diagnostic test: in ones with suspected symptoms including TBDiagnostic test: in ones with suspected symptoms including TB Voluntary test: in ones with perceived risk (VCT)Voluntary test: in ones with perceived risk (VCT) Client-initiated HIV testing & Counseling "opt-in"Client-initiated HIV testing & Counseling "opt-in" Provider-initiated HIV testing & Counseling “opt-out” or “PITC”Provider-initiated HIV testing & Counseling “opt-out” or “PITC”

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. WHO PITC Recommendation in epidemic types Recommendation in all epidemic types –All adults, adolescents or children who present to health facilities with signs, symptoms or medical conditions that could indicate HIV infection. –Infants born to HIV-positive women as a routine component of the follow-up care for these children. –Children presenting with suboptimal growth or malnutrition in generalized epidemics, and under certain circumstances in other settings such as when malnourished children do not respond to appropriate nutritional therapy. concentrateRecommendation in concentrate epidemic types –STI services –Health services for most-at-risk populations –Antenatal, childbirth and postpartum services –Tuberculosis services.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Concerns about provider-initiated HIV testing and counseling (PITC) Clients may not have the power to opt-out, i.e., mandatory testingClients may not have the power to opt-out, i.e., mandatory testing True informed consent may not be obtainedTrue informed consent may not be obtained Counseling service is limitedCounseling service is limited Confidentiality brokenConfidentiality broken No concurrent national effort to increase treatment, care, and preventionNo concurrent national effort to increase treatment, care, and prevention No concurrent national effort to ensure human rights through policy and legal frameworksNo concurrent national effort to ensure human rights through policy and legal frameworks More infected persons detected may be interpreted as bad work on preventionMore infected persons detected may be interpreted as bad work on prevention

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry. Who support HIV testing Universal Coverage Healthcare SchemeUniversal Coverage Healthcare Scheme –ANC, General Operation National AIDS Program for ART, NHSONational AIDS Program for ART, NHSO –HIV screening in risk group with VCT (2 times a year) –PCR for babies twice a year Social Security SchemeSocial Security Scheme –N/A Civil Servant Medical Benefit SchemeCivil Servant Medical Benefit Scheme –N/A