Guidelines>Zambia HIV National Guidelines>

• Routine offer of HIV testing in health care settings: Should be provided to all patients:
• -Attending sexually transmitted infection (STI) services.
• -Attending antenatal clinic (ANC) and other reproductive health services.
• -Attending TB clinic services (i.e to all patients suspected of having or diagnosed with TB infection).

• Counselling and testing in a clinical setting: Should be considered standard of care in following situations:
• -Diagnosing HIV for appropriate TB and HIV management.
• -Patients who present with symptoms or signs that could be attributed to HIV.

• Routine testing of outpatients and inpatients may improve uptake and better integrate HIV testing as part of clinical diagnosis and patient management.
• Patient-initiated HIV testing through VCT remains critical to effectiveness of HIV prevention.
• Pre-testing counselling may be provided either on individual basis or in group settings with individual follow-up.
• Patients have right to "opt out" (decline testing).
• "Opt-in" testing: HIV test routinely recommended and offered to each patient; patient must explicitly consent to testing.
• "Opt-out" testing: HIV test routinely recommended and provided to each patient; patient informed of his/her right to refuse testing

• National blood transfusion policy supports mandatory screening for HIV and other blood-borne viruses of all blood destined for transfusion or manufacture of blood products.
• Mandatory screening of donors required prior to all procedures involving transfer of bodily fluids or body parts(e.g. artificial insemination, corneal grafts and organ transplant.
• National HIV policy does not support mandatory testing of individuals on public health grounds.

• Mainly conducted in national surveys for purposes of ascertaining prevalence of disease burden through population-based methodologies.

• Confidentiality is key concern for patients. Essential that confidentiality be maintained when conducting HIV testing of any type.
• All information about individual should be kept strictly confidential.
• Careful record management is prerequisite for confidentiality

• Recommended test kits from Ministry of Health: Abbott Determine HIV-1/2 Test, Uni-Gold HIV Test, Bioline HIV 1/2 Test
• 1st test: Abbot Determine. If negative report as negative.
• If positive, perform 2nd test: Uni-Gold
• If Uni-Gold positive, report as positive
• If Uni-Gold negative, perform 3rd test: Bioline, or repeat test 6 weeks later

• All HIV+ patients should be referred to ART clinic for care.
• National HIV Counselling and Testing guidelines encourage use of rapid tests so results are provided in timely fashion and can be followed up immediately with 1st post-test counselling session for both HIV-negative and HIV+ individuals/couples.

• Consider referral of patients who that test positive to other organisations for psychological, social and spiritual support. These may include PLHA support groups, religious circles, etc.

• Important consideration in providing HIV testing services. Any result, whether positive or negative, carries major implications in patient's life.
• All components of QA must be adhered to.
• Zambia moving towards using finger-prick blood collection and testing method, which has allowed non-medical staff to conduct HIV testing. Requires use of dried blood spots (DBS) on filter paper for QA procedures (DBS performed on every 20th patient).

REFERENCED WITHIN THIS GUIDE

• HIV Diagnosis