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Gen Pop and ANC HTC Questions proposed modifications [message #1906] Mon, 07 April 2014 15:22
chabrown is currently offline  chabrown
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Registered: April 2014
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On behalf of the HTC team in the Office of HIV/AIDS at USAID, I would like to propose the following considerations regarding the HTC questions asked re. the antenatal visit and for the general population:

ANTENATAL VISIT
In an effort to scale-up HTC, HIV self-testing (HIVST) is considered an increasingly important potential strategy to increase access and knowledge of HIV status. Studies have demonstrated high acceptability among health workers (HWs) and the general populations and high accuracy of self-testing, with oral fluid HIV rapid diagnostic tests (RDTs). Programmatic approaches are still being explored and may include distribution of test kits directly to consumers by health providers during the next few years. In this context, we propose adding the following question: "Were you offered a HIV test kit to take home as part of your antenatal care?" This question could be asked immediately following the existing question: "Were you offered a test for the AIDS virus as part of your antenatal care?"

We also recommend the addition of the following question:
1. "How often do you test?" (eg. <1/year; 1/year; >1/year)
Rationale: The World Health Organization has developed guidelines on HIV retesting for different population groups. Many HTC stakeholders believe anecdotal reports that the "worried well" are testing much more frequently than the WHO recommendations suggest. Instead of relying on anecdotes, it would be very helpful to understand the frequency of testing and retesting on a population level and can use the information to inform programmatic approaches to improve the rational use of HIV testing & counseling services.

GENERAL POPULATION
1. Please add the following question "Did you receive counseling with your HIV test?" As part of efforts to understand the quality of the HTC being provided across different settings, this question can help to clarify whether or not counseling is routinely associated with HIV testing in clinical (PITC), community, and stand-alone VCT settings. It is difficult to determine this from anecdotal reports, so population-based data would be very useful to inform quality improvement efforts related to HTC.

2. Given increasing attention to self-testing as a programmatic strategy for HTC and the current sale of over-the-counter test kits in multiple low and middle income countries, it would help to understand the degree to which the population is aware of over-the-counter test kits being sold directly to consumers and where they can get them. This information can inform private sector strategies to increase uptake of HIV testing and counseling. By integrating the following phrase "and/or get a rapid test kit to test themselves" into the existing question "Do you know of a place where people can go to get tested for the AIDS virus?" we can start to gather this information and use it to inform private sector interventions related to the conduct and quality of HTC. The final question would read: "Do you know of a place where people can go to either get tested and/or get a rapid test kit to test themselves for the AIDS virus?" The answer options would remain Yes or No. The additional, related questions of "Where is that?" & "Any other place?" would also remain the same.



Charlene Brown, MD, MPH
Medical Officer
Office of HIV/AIDS, USAID
 
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