Oral fluid-based rapid HIV testing: Issues, challenges and research directions

Expert Review of Molecular Diagnostics (Impact Factor: 3.52). 08/2007; 7(4):325-8. DOI: 10.1586/14737159.7.4.325
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Available from: Nitika Pai, Oct 21, 2014
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    • "HIVST strategies range from supervised models to unsupervised models [21]. Public health concerns about HIVST include increased risk of unmanaged anxiety; potentially negative impacts from bypassing counseling; potential for coercive testing, lower test accuracy and lower linkage to care following a positive HIV-test-result [22, 23]. Counter arguments based on autonomy, feasibility and coverage, particularly the relevance and acceptability for groups poorly served by current testing strategies (such as men) [20, 24, 25], support HIVST. "
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    ABSTRACT: In sub-Saharan Africa, most new HIV infections occur in stable relationships, making couples testing an important intervention for HIV prevention. We explored factors shaping the decision-making of cohabiting couples who opted to self-test in Blantyre, Malawi. Thirty-four self-tested participants (17 couples) were interviewed. Motivators for HIV self-testing (HIVST) emerged at three main levels. Individual motivations included perceived benefits of access to treatment, and self-checking of serostatus in the hope of having been cured by prolonged treatment or faith-healing. HIVST was considered convenient, confidential, reassuring and an enabling new way to test with one's partner. Partnership motivations included both positive (mutual encouragement) and negative (suspected infidelity) aspects. For women, long-term health and togetherness were important goals that reinforced motivations for couples testing, whereas men often needed persuasion despite finding HIVST more flexible and less onerous than facility-based testing. Internal conflict prompted some partners to use HIVST as a way of disclosing their previously concealed HIV positive serostatus. Thus, the implementation of community-based HIVST should acknowledge and appropriately respond to decision-making processes within couples, which are shaped by gender roles and relationship dynamics.
    Full-text · Article · Jun 2014 · AIDS and Behavior
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    • "Rapid oral fluid based testing method has already been approved and is in use in most HIV testing institutes worldwide [7,21-25]. The testing kits and testing method have further been found to be accurate, much safer and easier to use and therefore recommended for adoption and use in the developing countries due to its simplicity, versatility and, feasibility that enables easier implementation and use even in rural areas and private health institutions [22,23]. Also, incorporation of oral HIV tests could form part of a multi-pronged prevention strategy in transforming the trajectory of the HIV epidemic in China and possibly the world at large [24,25]. "
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    ABSTRACT: Background This study was conducted to ascertain the feasibility of using rapid oral fluid testing as an alternative HIV testing method in China. Method This is a mixed-method study among men who have sex with men (MSM), female sex workers (FSW) and VCT clients, conducted in 4 cities in Shandong Province. A pre-tested questionnaire was administered to 1137 participants through face-to-face interview to assess demographic characteristics, HIV testing histories and willingness to accept rapid oral fluid testing. VCT clients were provided with the saliva test kits for a screening test and errors in operation were recorded. Testing results were compared between oral and blood testing. Short feedback questionnaire was administered to 200 FSW who had undergone oral testing. Results The rate of willingness to take oral-fluid HIV testing among MSM, FSW and VCT clients was 72.8%, 72.1% and 67.4% respectively. Common errors recorded during test kit operation by the 229 VCT clients included: unpreparedness, wrong swab sampling, wrong dilution, wrong testing and inability to read test results. Advantages of oral testing listed by participants included: less intrusive, painlessness, easy self- testing and privacy. Disadvantages included perceived unreliable results (55.5%) and not nationally recognised (9%). Comparison of saliva and the blood testing results recorded a consistency rate of 0.970 (χ2 = 153.348, P < 0.001), implying an excellent consistency. Conclusion Introduction of oral rapid fluid testing as an alternative HIV testing method in China is highly feasible but with some challenges including low recognition and operation errors.
    Full-text · Article · May 2014 · BMC Public Health

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