AEGiS-13IAC: Fourfold increase in utilization of voluntary HIV counselling and testing in Malawi with same day results counselling and confirmed, rapid, finger-prick testing.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Fourfold increase in utilization of voluntary HIV counselling and testing in Malawi with same day results counselling and confirmed, rapid, finger-prick testing.

Int Conf AIDS 2000 Jul 9-14; 13:34 (abstract no.. LbPeA7012)

Msowoya K, Marum E, Barnaba A, Feluzi H, Campbell C, Dillon B, Fridlund C, Rayfield M, Nkhoma W
Malawi AIDS Counselling and Resource Organization, Limbe, Malawi. Fax: +265-671-110, E-mail: macro@malawi.net.

BACKGROUND: Voluntary HIV counselling and testing (VCT) is increasingly recognized as a key intervention for HIV prevention and early access to care. Utilization of VCT, however, has been low in Malawi and other countries in Africa, and access to VCT has been limited by inadequate, centralized laboratory facilities. In January, 2000, the Malawi AIDS Counselling and Resource Organisation (MACRO) introduced two, rapid, whole blood HIV tests so that VCT clients can receive same day, confirmed results.

METHODS: After evaluation in a reference laboratory, MACRO began using two rapid tests (Determine and HemaStrip) with finger-prick, whole blood samples. Clients were informed in advance that their results would be available in less than an hour. Confirmatory ELISA testing was done at reference laboratories.

RESULTS: Between January and April 30, 2000, a total of 5117 persons requested VCT at MACRO's two urban sites, compared to 1167 during the same period in 1999, a fourfold increase. Both tests were performed simultaneously, in some cases by trained counsellors. All clients received their results compared with 68% in 1999. 17.4% of clients were HIV+, compared with 16.4% during the same period in 1999. Determine had 100% sensitivity and 99.7% specificity; HemaStrip had 100% sensitivity and specificity, and the combination of both tests was 100% sensitive and specific. Clients and counsellors report a preference for finger-prick tests and same day results with no waiting period.

CONCLUSIONS: On-site, same day, confirmed results have been associated with a fourfold increase in utilization of VCT in Malawi. Two different, simultaneous finger-prick tests gave equivalent results to reference laboratory ELISA testing. Whole blood rapid testing can significantly increase access to VCT as testing may be performed by trained counselors. This methodology has great potential to increase demand for and access to VCT in Africa, especially in rural, under-served areas.

Keywords: AEGIS, Counseling, HIV Infections, Research Design, HIV Seropositivity, Malawi, Time, Acquired Immunodeficiency Syndrome, Africa, Human, utilization, injuries, AIDS
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