DIAGNOSIS AND INVESTIGATIONS

HIV testing is the point of entry into comprehensive care HIV services. Since an early diagnosis is fundamental for early treatment, good prognosis and reduction in
transmission, HIV testing should be offered to all patients at any level of care and at any occasion possible: provider initiated HIV testing and counselling.

Pre and post counselling and consent are needed except in the following situations:

  • Diagnostic testing: test carried out on very sick, unconscious, symptomatic or mentall ill by attending health care team for the purpose of better patient
    management
  • Routine testing: for individuals likely to pose a risk of HIV infection to others e.g. pregnant and breastfeeding mothers, sexual offenders and survivors, blood or body tissue or organ donors. Individuals tested using this
    appraoch must be given an opportunity to know their status.

If a patient is positive, he/she must be IMMEDIATELY connected to HIV care services.

In adults and children >18 months, testing is based on serological (antibody) testing.

Due to the window period between infection and production of detectable levels of antibodies, patients who are negative should be re-tested after three months if they had a possible exposure in the 3 months before the test.

In children below 18 months, testing is virological, that is based on direct detection of viral DNA (DNA-PCR). Virological testing (DNA-PCR and viral load) is done on DBS (dried blood spots) samples which can be collected from HC2 and are sent to a central national laboratory through the hub system.

HIV testing in children less than 18 months

The recommended test for children <18 months is virological (DNA-PCR) testing, since antibody tests will detect antibodies passed to the child from the mother (so the test can give a false positive).

If the mother is HIV negative:
  • The child is classified was HIV negative
If the mother if positive:
  • Do DNA PCR at 6 weeks of age or at an earlier opportunity thereafter
    • Start cotrimoxazole prophylaxis till HIV status is confirmed
  • If PCR is positive, enroll child for ART
  • If PCR is negative and child never breasfed: child is negative.
    • Stop cotrimoxazole.
    • Follow up every 3 months and do HIV rapid test (serological) at 18 months.
  • If PCR is negative BUT child is breastfeeding/has breasfed in the last 6 weeks, re-check PCR 6 weeks after cessation of breastfeeding.
If mother’s status is unknown:
  • Test the mother and continue management according to the result
If mother unavailable:
  • Perform rapid antibody testing on the child. The result will give indication on the mother’s status:
    • If the test is negative: mother and child negative
    • If the test is positive, follow algorithm for positive mother.
Other tests in HIV management
TEST DESCRIPTION
CD4 It measures the level of CD4 T
lymphocytes, a subtype white blood cell.
It reflects the level of compromise of
the immune system. It is used for initial
assessment pre ART and for monitoring of
ART effect.
Viral
Load
It measures the quantity of virus in the
blood. It is used to monitor the effect of
ARVs. It is currently done by DBS (Dried
Blood Spot)