Sok Chantha a former sex worker in Cambodia was devastated when he discovered that he was HIV positive in 2011. Not wanting to believe he had the virus, he went for testing a few more times before finally accepting that he had HIV and starting treatment.
Testing and counselling is the essential first step for people to learn their HIV status and a gateway to access prevention, treatment and care services. However, in Asia, less than half of all people currently living with HIV know their HIV status. For people from key populations like Chantha (men who have sex with men (MSM), transgender people, people who inject drugs and sex workers and their clients, people in prisons and other closed settings), knowledge of their HIV status can be even less.
One reason for this lack of knowledge is that key populations are less likely to seek testing in formal facilities due partly to fear of social stigma and unfriendly service. Very often they also do not return for follow-up because of the long turn-around time to get and confirm results. One alternative to improve and scale up testing services is through community-based testing (CBT) where testing is done outside a formal facility. Rapid diagnostic tests (RDT) are usually carried out using blood from a finger prick. As some RDTs can give same-day results, this can potentially reduce the risk of loss of follow-up.
However, for rapid testing to be effective, it is essential to ensure that there are quality management systems in place to provide confidence in RDT results.
“Without a proper laboratory quality management system (QMS) it becomes very difficult to identify, quantify, and remediate errors made in a laboratory. QMS puts in place mechanisms to ensure the quality of reagents, functionality of equipment, training of personnel, correct execution of screening or diagnostic tests, and proper bookkeeping procedures, among other good laboratory practices. Tracking of clients’ results for counselling and referral, following standard operating procedures to ensure quality of testing and safety of counsellors and clients, as well as ensuring clients’ confidentiality are some of the benefits of implementing QMS in community-based testing,” says Dr Artur Ramos, Senior Laboratory Advisor with the US CDC in Cambodia.
CBT and RDT are being offered in some settings in Cambodia, China, Laos, Papua New Guinea and Vietnam. Countries that are considering or planning to implement CBT in 2015 include the Philippines and Mongolia. In Cambodia, it is estimated that around 70 percent of KPs have been reached through the CBT programme. WHO recommends that more effort needs to be made to increase the uptake of CBT particularly for KPs at higher risk with linkages to prevention, care and treatment, in addition to existing testing, in generalized HIV epidemics and in all HIV epidemics among KPs. For Chantha knowing his HIV status was the first step in the long journey to control the disease and stay healthy. He hopes one day to beat it completely, “I hope and my friends hope there will one day be a medicine that can kill the virus completely. That’s my dream for the future.”