|Counselling and Voluntary HIV Testing for Pregnant Women in High HIV Prevalence Countries - Elements and Issues (UNAIDS, 1999, 24 p.)|
|5. Operational considerations|
Visiting a clinic often requires considerable travel time and expense. Adding to this burden by requiring a woman who has chosen to be tested to return for her HIV test results may be unhelpful. It is likely to result in a high proportion of women not returning to collect their results - a waste of time and resources from the point of view of the service provider. In addition, sending specimens to a laboratory for testing can lead to lost samples and uncertain quality control.
Reliable rapid test kits for on-the-spot testing for HIV are now widely available at prices similar to laboratory test kits. These kits do not need highly trained staff or sophisticated laboratory equipment, although most do require refrigeration. Training clinic staff to use these kits can cut down on time and paperwork involved in sending specimens for lab testing, and can avoid doubling travel time for clients. In terms of quality, they have been shown to be as reliable on a national level as laboratory testing services.
There are, however, some difficulties associated with rapid test kits. Firstly, on-the-spot testing may provide more opportunities for breaches of confidentiality than outside laboratory testing. The need to maintain confidentiality should be central to all staff training around testing and counselling for HIV.
Secondly, it is possible that women will feel obliged to undergo a test offered on the spot, without having thoroughly thought through the consequences. They may also want to discuss the implications of testing with their partners, and opt for couple counselling and testing. It is therefore suggested that women are told about rapid testing during the pre-test counselling, and are then given the opportunity to make an appointment to come back at a convenient time if they decide they want to go ahead with the test. More information on rapid tests is available in the WHOs Weekly Epidemiological Record (1998, 73:321-326).