SOUTH AFRICA: Time to rethink testing
JOHANNESBURG, 26 June 2009 (PlusNews) - It has become a given – test more people for HIV and you'll get more people on treatment earlier, plus cut down on risky sex. But recent research on the behaviour of people who test HIV negative, has led some doctors to question the testing gospel.
Speaking at the monthly meeting of the South African HIV Clinicians
society, Dr Francois Venter said what seemed a strong relationship between increased testing, treatment and behaviour change is not necessarily valid in the South African context.
This, coupled with worrying research that has shown a negative HIV test can actually increase risky behaviour, means more work needs to be done before countries look to adopt models like 'provide initiated testing and counselling' (PITC) - in which health workers offer tests to clients rather than waiting for a request.
More testing, better patient outcomes?
"It's absolutely phenomenal how testing has been escalated over the last five years, but the argument that more testing will lead to more people on treatment earlier is not coming to fruition," said Venter.
He added that CD4 counts - which measure the strength of the immune system - in patients initiating antiretroviral (ARV) treatment remained low, often 100 or less in the public sector.
"Donor projects want to know how many people tested and know their status," Venter told IRIN/PlusNews. "Who cares if they tested and know their status if they don't do anything with the information. The people who run those testing programmes must be able to demonstrate that those people entered into system of care or it's pointless."
The need to re-examine testing comes amid on-going calls for countries with generalised epidemics like South Africa to adopt PITC. In 2006, the World health Organisation and UNAIDS released draft guidelines on the PITC model, arguing that it would mean more people tested and therefore began treatment.
Venter said he was sceptical that more testing would lead to bigger numbers on ARVs, and in any case PITC might be unfeasible given the public
sectors limited resources.
A massive scaling up of testing, he stressed, could also do more harm than good if not done right.
The good, the bad and the ugly
Venter cited new research from Uganda that has shown a 50 percent reduction in condom use in participants who tested negative for HIV. It's a finding that he said echoed those out of a recent TB study in Zimbabwe that showed that a negative HIV test increased not only risky behaviour, but the number of sexual partners as well.
The counterpoint is research from the United States about the overwhelmingly positive affects of testing positive, he told IRIN/PlusNews.
"In fact, testing positive is a huge HIV prevention tool," Venter said. "Findings have shown that those who test positive take fundamental steps to protect others whether that is increased condom use, increased disclosure to their sexual partners or abstinence."
In the meantime, he urged a re-examination of what we think we know about testing, and how to roll it out.
"We might be doing a whole lot of harm and we have to think very hard as clinicians about people who test negative," Venter said. "We also need to fix our healthcare system so when people test positive, they want to seek treatment within the system."
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