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PPT Content: HIV Testing & Diagnosis

Source: Park's Textbook of Preventive and Social Medicine

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SLIDE 1 - Title Slide

• HIV Testing Strategies
• ICTC
• HIV Counselling (Pre- & Post-test)
• Diagnostic Tests
• HIV Screening in Special Populations

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SLIDE 2 - Introduction

• The Basic Service Division of the Department of AIDS Control provides HIV counselling and testing services
• National programme offering these services since 1997
• Goal: Identify as many PLHIV as early as possible and link them to prevention, care and treatment
• Introduction of ART services in 2004 gave a major boost to these services
• Three main components:
  1. Integrated Counselling and Testing Centres (ICTC)
  2. Prevention of Parent-to-Child Transmission of HIV (PPTCT)
  3. HIV/Tuberculosis collaborative activities

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SLIDE 3 - HIV Testing Strategies (WHO 5 C's)

HIV testing is the gateway to prevention, treatment, care and support services.

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SLIDE 4 - HIV Testing Strategies

• Client-Initiated Testing and Counselling (CITC): Person voluntarily seeks HIV testing
• Provider-Initiated Testing and Counselling (PITC): Medical provider advises testing to patients
• Community-based screening: Conducted by frontline health workers (ANMs) at sub-centre level
• Compulsory testing: WHO warns against this - leads to social rejection of HIV carriers and psychological consequences
• Diagnostic testing: Used to confirm suspected HIV infection, avoids over-testing

• Unlinked anonymous testing (for surveillance)
• Named testing with informed consent (for clinical care)

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SLIDE 5 - ICTC (Integrated Counselling and Testing Centre)

• Of their own free will (Client-initiated)
• As advised by a medical provider (Provider-initiated)

• Early detection of HIV
• Provision of basic information on modes of transmission and prevention
• Promoting behavioural change and reducing vulnerability
• Linking PLHIV with other HIV prevention, care and treatment services

Currently >15,000 ICTCs in India offering PPTCT services

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SLIDE 6 - Types of ICTC

1. Standalone ICTC (SA-ICTC)
   • High client load
   • Full-time counsellor + laboratory technician
   • Located in medical colleges, district hospitals, sub-district hospitals, CHCs
2. Facility-Integrated ICTC (F-ICTC)
   • Set up below block levels at 24x7 PHCs
   • Existing health facility staff trained in counselling & testing
   • Also includes PPP-ICTCs in private facilities

• Van with examination room, counselling space, blood collection facility
• Team: Health educator/ANM + Counsellor + Lab technician
• Serves hard-to-reach areas with flexible working hours
• Provides: HIV counselling & testing, syndromic management of STI/RTI, ANC, immunization

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SLIDE 7 - Levels of HIV Counselling & Testing in India

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SLIDE 8 - HIV Counselling (Pre-Test)

• Conducted BEFORE the HIV test
• Establishes rapport and ensures informed consent
• Provides information on:
  • HIV transmission modes
  • Meaning of test results (positive/negative/window period)
  • Risk assessment of the client
  • Benefits of knowing one's status
  • Available care and support services
• Addresses fears, misconceptions and stigma
• Voluntary and confidential

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SLIDE 9 - HIV Counselling (Post-Test)

• Explain window period (up to 3 months after exposure)
• Repeat test if recent high-risk exposure
• Reinforce risk reduction behaviour
• Discuss prevention strategies

• Emotional support and crisis counselling
• Disclosure support (partner, family)
• Referral to ART centre for treatment
• Information on PLHIV rights and confidentiality
• Counselling on nutrition, positive living, positive prevention
• Linkage to care and support centres

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SLIDE 10 - Diagnostic Tests for HIV

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SLIDE 11 - HIV Testing Strategy (NACP)

• Strategy I: Single ELISA - for blood bank screening (high sensitivity required)
• Strategy II: Two sequential ELISAs - for surveillance
• Strategy III: Three sequential ELISAs with different antigens - for diagnosis in symptomatic patients

• Rapid HIV tests used (three tests with different principles)
• Testing done on same day - results given on same day
• If all three tests positive = HIV Positive
• If discordant results = repeat testing / Western Blot confirmation

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SLIDE 12 - HIV Screening in Special Populations

• Universal HIV testing offered to ALL pregnant women at ANC
• "Opt-out" approach - routine testing unless refused
• Started in India in 2002
• Goal: Eliminate mother-to-child transmission (MTCT)
• Lifelong ART (TDF+3TC+EFV) for all HIV+ pregnant women regardless of CD4 count
• ARV prophylaxis for infants from birth up to minimum 6 months
• Early Infant Diagnosis (EID) by HIV-DNA PCR at 6 weeks of age

• Joint NACP-RNTCP initiative since 2007-08
• HIV testing of all diagnosed TB patients (states with high HIV prevalence cover ~90%)
• Case fatality rate in HIV+TB = 13-14% vs <4% in HIV-negative TB
• HIV testing offered upstream (when TB symptoms present) since 2012

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SLIDE 13 - HIV Screening in Special Populations (cont.)

• Sample size: 250 (high-risk/bridge) / 400 (general)
• Frequency: Once in 2 years
• Testing strategy for high-risk: Unlinked anonymous with informed consent
• Blood specimen: Dried Blood Spot (DBS)
• Testing protocol: Two-test protocol

• Mandatory HIV screening of all blood donations

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SLIDE 14 - 90-90-90 Targets (UNAIDS)

1. 90% of all PLHIV know their HIV status
2. 90% of all diagnosed PLHIV receive sustained ART
3. 90% of all people on ART achieve viral suppression

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SLIDE 15 - Summary

• HIV testing is the entry point to HIV prevention and care cascade
• ICTC is the backbone of India's HIV testing infrastructure (>15,000 centres)
• WHO 5 C's govern all HIV testing services
• ELISA (screening) + Western Blot (confirmatory) remain diagnostic standards
• CD4 count and viral load are key monitoring tools
• Special populations - pregnant women, TB patients, and high-risk groups - require targeted testing strategies
• India follows "Test and Treat" policy - no CD4 threshold for ART initiation

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