Unique Challenges, Unique Solutions: Tackling HIV Testing on World AIDS Day

Nov. 30, 2019

Laboratory staff prepare reagents for HIV testing.
Source: Photo courtesy of GPHP staff

World AIDS Day is a remembrance day -- it reminds us that there are still challenges involved in decreasing HIV/AIDS across the globe. And it helps us to understand that those challenges are as unique as the locations where they exist and the people who experience them.

Consider HIV testing. HIV testing is a simple trip to the clinic in many parts of the developed world, but in other parts of the world, learning one’s HIV status can be time- and resource-consuming.

HIV Testing: When It’s Easy

Many readers may be fortunate to have access to HIV testing sites. For those with access to reliable private or public health services, getting tested is pretty simple:
  • Find a location: doctor’s office, a clinic, confidential testing location, or even a health fair.
  • Have a conversation with a health care professional.
  • Have the test done.
  • Wait.
If a person is not part of a high-risk population, the first test is an antibody/antigen test and can be as easy as a fingerprick or saliva sample. This test looks for the presence of an HIV protein and/or antibodies the body has started producing to fight the viral infection. Depending on the type of test (rapid or not), the results can be ready within 30 minutes to 48 hours.

If the test is negative, there are actions that should be taken to stay that way. First, practice responsible behaviors. Also, follow health professionals’ recommendations to get tested periodically.

If the test is positive, the patient will need to reconnect with a doctor or public health service for follow-up testing to confirm the diagnosis. This time, it will be the viral load test. This test measures the amount of the HIV virus in the blood – this is called the viral load. A technician will draw blood, which is then sent out to a lab for testing and analysis.

A diagnosis of HIV infection absolutely cannot be taken lightly, but thankfully, HIV is no longer a death sentence. This is particularly true for those with reliable access to quality private or public health care, medications, support and sexual health tools like condoms. With access to these, one has a good chance of reaching the goal of an undetectable viral load, which means the virus is at a low enough leve that it's unlikely to be transmitted (the U = U concept).

HIV Testing: When It’s Not So Easy

In remote parts of a country, or in countries that don’t have health services infrastructure, the simple recommendation to “get tested” is not so simple. Even getting to a clinic for a diagnostic test can be a day-long task.

Once one does get to a clinic, whether it has the facilities and equipment for the test is another issue. Staff cannot perform a test if they don’t have the supplies. Staff can’t accurately perform a test unless they’re properly trained. Staff must also have to know how to handle the blood sample safely. All of these are hurdles that can add complications to the HIV testing procedure.

Fortunately, most clinics can perform the antigen/antibody test used as a first-line diagnostic for HIV infection. Diagnosis becomes more complicated though when clinics need to confirm a positive diagnosis or measure the patient’s viral load. A blood sample has to be collected and, in many cases, transported to a laboratory that can perform a wider variety of tests. In that case, one must consider how longer storage at the clinic and transport to the laboratory may affect diagnostic outcome.
Laboratory staff pose in front of an incubator unit.
Source: Photo courtesy of GPHP staff

Samples from several clinics, for a variety of tests, may be transported to the same laboratory. To handle the testing load, the lab managers are charged with keeping the lab up and running. Staffing shortages, equipment malfunction and issues like unreliable electricity can bottleneck the testing flow.

Lab personnel have to be trained on storage, handling and disposing of samples. Technicians must know how to prepare the sample, perform the requested tests and read results. Everyone involved must always follow the highest standards of quality and safety.

If quality controls are not in place, all of these factors raise concerns about the reliability of test results. Can patients be sure that their test results accurately reflects their HIV status? Thinking one has HIV from a false positive diagnosis can be just as bad as living with HIV without knowing it.

Once the results are ready, they have to be brought back to the clinic. Then, patients need to connect with the clinic to hear them. Depending on the results, the cycle may have to start all over again for further testing or to begin treatment.

All of these challenges can add up to weeks or months of uncertainty for the patient. If patients are already ill or otherwise part of a vulnerable population, they may not have weeks or months to wait.

Addressing the Challenges of HIV Diagnostics

Through partnerships with local and international stakeholders, ministries of health and subject-matter experts, ASM’s Global Public Health Programs (GPHP) works to bring quality diagnostic services to public health systems that urgently need them.

Sometimes this concept is taken very literally. ASM has worked in countries that simply do not have laboratories in a lot of locations. One approach in this scenario has been to repurpose shipping containers as mobile labs:  outfitting containers with electricity, plumbing, equipment and supplies and then shipping these labs to remote areas. Once there, staff are trained on technical procedures and lab protocols, and a sustainability plan is put into place to ensure the lab can keep running once it has been set up.
A shipping container converted into a mobile laboratory.
Source: Photo courtesy of GPHP staff

Another approach is to harness the power of the digital age. ASM has worked in some locations with local experts to build and roll out an innovative digital platform designed to drastically reduce the amount of time it takes to get results from the lab to the clinic. With faster results comes faster intervention and treatment.

Other countries ASM works in have existing labs, but the labs have gaps in infrastructure, equipment and supplies. In these communities, GPHP consultants partner with lab personnel to update the physical space. GPHP-led program teams have replaced or upgraded lab equipment and partnered with service providers to train laboratorians on equipment use and basic preventative maintenance. In a place where a service call might mean the technician gets to the lab next week or next month, being able to deal with minor issues in-house has a big impact. GPHP also works with labs to determine supply gaps and help to address them.
Laboratory equipment.
Source: Photo courtesy of GPHP staff

In some places, assisted self-testing is a way to get the services to the people who need them. GPHP has partnered with organizations that provide assisted self-testing to work on quality management systems and evaluation frameworks. Ensuring standardization of quality training leads to ensuring that quality testing leads to reliable results that guide accurate treatment decisions.
Members of the ASM Global Public Health Program with local laboratory staff.
Source: Photo courtesy of GPHP staff

In all cases, ASM recognizes that personnel are key. Without the people, the labs stop functioning. Education and mentorship programs led by GPHP consultants address technical knowledge and practice gaps, and the training-of-trainer approach equips mentees to become mentors for their colleagues. Lab personnel and GPHP consultants work together to improve processes and protocols. In a number of labs, the goal has become not only excellence but also international accreditation.
Personnel are key to a successful lab.
Source: Photo courtesy of GPHP staff

World AIDS Day

So why is it important for everyone to keep in mind the ‘World’ in World AIDS Day? No one nation, no one group of scientists or public health experts has the full solution, but all of them have pieces of it. With collaboration, knowledge transfer and experience sharing, the world can work to put the pieces together for improved global health.

Learn more about GPHP's work

Author: ASM Global Health Programs

ASM Global Health Programs
ASM Global Health Programs