Reversing and arresting the epidemic of HIV are a challenge for any country. Early diagnosis and rapid initiation of treatment remain a key strategy in the control of HIV. Technological advances in the form of low-cost rapid point-of-care tests have completely transformed the diagnosis and management of HIV, especially in resource limited settings, where health infrastructure is poor and timely access to medical care is a challenge. Point-of-care devices have proven to be easy to transport, operate, and maintain, and also lower-skilled staff is equally able to perform these tests as compared to trained laboratory technicians. Point-of-care tests allow rapid detection of HIV allowing for rapid initiation of therapy, monitoring of antiretroviral therapy and drug toxicity, and detection of opportunistic infections and associated illnesses. 1. Introduction Testing and treatment are key elements in the effort to control HIV, and testing services are rightly considered as the gateway to the treatment facilities. Data suggest that HIV-infected individuals who are aware of their status are more likely to adopt risk reduction behaviour than those who are not as discussed by Higgins et al. [1]. With a diagnosis of AIDS, consideration may be given to the initiation of antiretroviral treatment, which reduces viral load and infectivity as discussed by Rotheram-Borus et al. [2]. From a public health perspective, it is advisable to recommend testing to those at risk for HIV and to make testing easily accessible. The idea is to detect every HIV positive whether it belongs to high risk group, a pregnant woman, or a patient of tuberculosis or reproductive tract infection approaching the health system for health needs and refer him/her to the nearest antiretroviral therapy (ART) centre. Providing quality laboratory services for HIV testing to all those who need it is a challenging task. 2. Point-of-Care Tests for HIV Point-of-care (POC) testing of HIV refers to the practice undertaken by health care professionals of providing pretest counseling, posttest counseling, and a preliminary HIV antibody result at the time of testing outside of a designated laboratory. The standard methods of HIV testing (enzyme linked immunosorbent assay (ELISA) or western blot with confirmatory testing using p24 antigen detection or viral nucleic acid detection) can take several days for result availability as discussed by Arora et al. [3]. A significant proportion of individuals who agree to undergo HIV serologic testing do not return to the HIV testing site to receive their test results as
References
[1]
D. L. Higgins, C. Galavott, K. R. O’Reilly, et al., “Evidence for the effects of HIV antibody counseling and testing on risk behaviours,” Journal of American Medical Association, vol. 266, no. 17, pp. 2419–2429, 1991.
[2]
M. J. Rotheram-Borus, P. A. Newman, and M. A. Etzel, “Effective detection of HIV,” Journal of Acquired Immune Deficiency Syndromes, vol. 25, no. 2, pp. S105–S114, 2000.
[3]
D. R. Arora, V. Gupta, S. Gupta, and B. Arora, “Laboratory diagnosis of acquired immunodeficiency syndrome (AIDS)—a review,” Indian Journal of Sexually Transmitted Diseases, vol. 21, pp. 59–68, 2000.
[4]
R. O. Valdiserri, M. Moore, A. R. Gerber, C. H. Campbell, B. A. Dillon Jr., and G. R. West, “A study of clients returning for counseling after HIV testing: implications for improving rates of return,” Public Health Reports, vol. 108, no. 1, pp. 12–18, 1993.
[5]
Centers for Disease Control and Prevention, “Update: HIV counseling and testing using rapid tests—United States, 1995,” Morbidity Mortality Weekly Report, vol. 47, pp. 211–215.
[6]
G. Tao, B. M. Branson, W. J. Kassler, and R. A. Cohen, “Rates of receiving HIV test results: data from the U.S. National Health Interview Survey for 1994 and 1995,” Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, vol. 22, no. 4, pp. 395–400, 1999.
[7]
S. C. Kagulire, P. D. Stamper, P. Opendi et al., “Performance of two commercial immunochromatographic assays for rapid detection of antibodies specific to human immunodeficiency virus types 1 and 2 in serum and urine samples in a rural community-based research setting (Rakai, Uganda),” Clinical and Vaccine Immunology, vol. 14, no. 6, pp. 738–740, 2007.
[8]
B. Taye, Y. Woldeamanuel, and E. Kebede, “Diagnostic detection of human immunodeficincy virus type-1 antibodies in urine, Jimma Hospital, south west Ethiopa,” Ethiopian Medical Journal, vol. 44, no. 4, pp. 363–368, 2006.
[9]
S. J. S. Pascoe, L. F. Langhaug, J. Mudzori, E. Burke, R. Hayes, and F. M. Cowan, “Field evaluation of diagnostic accuracy of an oral fluid rapid test for HIV, tested at point-of-service sites in rural Zimbabwe,” AIDS Patient Care and STDs, vol. 23, no. 7, pp. 571–576, 2009.
[10]
R. L. Hamers, I. H. de Beer, H. Kaura, M. van Vugt, L. Caparos, and T. F. Rinke de Wit, “Diagnostic accuracy of 2 oral fluid-based tests for HIV surveillance in Namibia,” Journal of Acquired Immune Deficiency Syndromes, vol. 48, no. 1, pp. 116–118, 2008.
[11]
N. Garg, V. Gautam, P. Sgill, B. Arora, and D. R. Arora, “Comparison of salivary and serum antibody detection in HIV-1 infection by ELISA and rapid methods in India,” Tropical Doctor, vol. 36, no. 2, pp. 108–109, 2006.
[12]
J. P. Shott, R. M. Galiwango, and S. J. Reynolds, “A quality management approach to implementing point-of-care technologies for HIV diagnosis and monitoring in sub-Saharan Africa,” Journal of Tropical Medicine, vol. 2012, Article ID 651927, 8 pages, 2012.
R. P. Walensky and A. D. Paltiel, “Rapid HIV testing at home: does it solve a problem or create one?” Annals of Internal Medicine, vol. 145, no. 6, pp. 459–462, 2006.
N. P. Pai, R. Barick, J. P. Tulsky et al., “Impact of round-the-clock, rapid oral fluid HIV testing of women in labor in rural India,” PLoS Medicine, vol. 5, no. 5, article e92, 2008.
[18]
F. A. Bello, O. O. Ogunbode, O. A. Adesina, O. Olayemi, O. M. Awonuga, and I. F. Adewole, “Acceptability of counselling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria,” African Health Sciences, vol. 11, no. 1, pp. 30–35, 2011.
[19]
M. H. Cohen, B. Branson, Y. Olszewski, et al., “Effective Point—of—care Rapid HIV testing at labour and delivery,” in Proceedings of the 9th Conference on Retroviruses and Opportunistic Infections at Program and Abstracts, Foundation for Retrovirology and Human health, Boston, Mass, USA, 2003.
[20]
D. R. Arora and B. Arora, “Retroviridae,” in Textbook of Microbiology, pp. 586–604, CBS Publishers, New Delhi, India, 4th edition, 2012.
[21]
S. R. Kendrick, K. A. Kroc, D. Withum, R. J. Rydman, B. M. Branson, and R. A. Weinstein, “Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic,” Journal of Acquired Immune Deficiency Syndromes, vol. 38, no. 2, pp. 142–146, 2005.
[22]
D. R. Arora, V. Gautam, P. S. Gill, B. Arora, and V. Gupta, “Haryana state in India, still a low HIV prevalence state,” Sexually Transmitted Infections, vol. 80, no. 4, pp. 325–326, 2004.
[23]
S. C. Kagulire, P. Opendi, P. D. Stamper et al., “Field evaluation of five rapid diagnostic tests for screening of HIV-1 infections in rural Rakai, Uganda,” International Journal of STD and AIDS, vol. 22, no. 6, pp. 308–309, 2011.
[24]
S. Kabra and R. Kanugo, “Monitoring quality of HIV testing at point of care facilities in India,” Indian Journal of Medical Microbiology, vol. 30, no. 2, pp. 129–130, 2012.
[25]
G. D. Sanders, A. M. Bayoumi, V. Sundaram et al., “Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy,” New England Journal of Medicine, vol. 352, no. 6, pp. 570–585, 2005.
[26]
P. A. Volberding and S. G. Deeks, “Antiretroviral therapy and management of HIV infection,” The Lancet, vol. 376, no. 9734, pp. 49–62, 2010.
[27]
D. Moore, A. Awor, R. Downing, et al., “CD4(+) T cell count monitoring does not accurately identify HIV-infected adults with virologic failure receiving antiretroviral therapy,” Journal of Acquired Immne Deficiency Syndrome, vol. 49, pp. 477–484, 2008.
[28]
S. Mtapuri-Zinyowera, M. Chideme, D. Mangwanya et al., “Evaluation of the PIMA point-of-care CD4 analyzer in VCT clinics in Zimbabwe,” Journal of Acquired Immune Deficiency Syndromes, vol. 55, no. 1, pp. 1–7, 2010.
[29]
I. V. Jani, N. E. Sitoe, P. L. Chongo et al., “Accurate CD4 T-cell enumeration and antiretroviral drug toxicity monitoring in primary healthcare clinics using point-of-care testing,” AIDS, vol. 25, no. 6, pp. 807–812, 2011.
[30]
B. A. Rohrman, V. Leautaud, E. Molyneux, and R. R. Richards-Kortum, “A lateral flow assay for quantitative detection of amplified HIV-1 RNA,” PLoS ONE, vol. 7, no. 9, article e45611, 2012.
[31]
2013, http://www.omegadiagnostics.com/CD4.
[32]
D. R. Arora, V. Gautam, P. S. Gill, and N. Mishra, “Recent advances in antiretroviral therapy in HIV infection,” Journal of the Indian Medical Association, vol. 108, no. 1, pp. 29–34, 2010.
[33]
C. C. Moore, S. T. Jacob, R. Pinkerton et al., “Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda,” Clinical Infectious Diseases, vol. 46, no. 2, pp. 215–222, 2008.
[34]
J. Yu, L. Ge, J. Huang, S. Wang, and S. Ge, “Microfluidic paper-based chemiluminescence biosensor for simultaneous determination of glucose and uric acid,” LAb on a Chip, vol. 11, pp. 1286–1291, 2011.
[35]
D. R. Arora, V. Gautam, S. Sethi, and B. Arora, “A 16-year study of HIV seroprevalence and HIV-related diseases in a teaching tertiary care hospital in India,” International Journal of STD and AIDS, vol. 15, no. 3, pp. 178–182, 2004.
