Testing Times: Detecting HIV In Resource-limited Settings

Researchers from Harvard Medical School and the non-governmental organisation Partners In Health, both based in Boston, USA set out to see if HIV diagnosis was delayed because doctors missed opportunities to test people who were at risk of HIV during clinic visits.

The team works with the Haitian Ministry of Health to improve patients' access to primary care in central Haiti. This includes "provider-initiated HIV testing" (offering patients HIV tests when they visit primary care clinics) and the provision of free HIV treatment if required. The researchers then looked back at records from a single primary care clinic to examine the 'missed opportunities' and delays in diagnosing patients with HIV.

The researchers found few missed opportunities for diagnosis in the clinic - 85% of the first 112 patients found to have HIV were diagnosed on their first visit to the doctor. Patients with HIV who were not diagnosed on their first visit had to wait a median of just 62 days until diagnosis.

In the developing world, much HIV testing is done through maternity clinics or special HIV clinics that perform voluntary counselling and testing (i.e. on request of the individuals themselves) but that often do not provide other medical services or comprehensive HIV treatment. The authors suggest that provider-initiated testing at primary care clinics can be an effective way to identify patients with HIV infection.

They write: "HIV prevention and treatment programs will not achieve success without addressing the urgent need for individuals to be aware of their HIV status in a timely manner and provider-initiated testing can be a successful strategy to address this concern."

Article: Louise C Ivers, Kenneth A Freedberg and Joia S Mukherjee, Provider-initiated HIV testing in rural Haiti: low rate of missed opportunities for diagnosis of HIV in a primary care clinic , AIDS Research and Therapy (in press)