5.3 Types of testing
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,