HIV testing is the cornerstone to preventing further transmission and to caring for those infected, particularly as access to treatment improves in resource-limited settings. However, efforts to expand testing through facilities-based testing have not achieved adequate testing coverage, prompting efforts to reach more individuals through strategies such as home-based HIV testing.
Home testing is showing promising early results in some high-prevalence, resource-limited settings. This article reviews the mechanisms and literature to date of this door-to-door approach.
Once a predictably fatal diagnosis, HIV disease has now become a treatable chronic condition [ 3 ]. Because favorable clinical outcomes contingent upon timely treatment, there is new focus on the early identification of HIV-infected individuals, particularly in resource-limited settings where antiretroviral therapy ART is increasingly available.
To this end, efforts to scale up HIV testing have included expansion of voluntary counseling and testing VCT centers and launching of antenatal testing programs and hospital-based screening initiatives. Although VCT centers provide a reliable testing resource, this approach has elicited concerns about the feasibility of reaching all individuals at risk, as well as associated stigma, inconvenience, and lack of privacy [ 56 ]. Provider-initiated testing in health care facilities has been relatively well-received and has had considerable success in identifying HIV-infected individuals by capitalizing on existing health care relationships.
However, the strategy only reaches a defined subset of the population: In this review, we discuss home-based "Hiv test free singapore dating" testing in such settings, including the types of tests used, demographic populations that are reached by this method, effectiveness compared with other testing strategies, and important next steps in optimizing this approach.
Since their inception, these tests have undergone substantial improvements in accuracy, convenience, and speed.
Still, the gold standard test for HIV diagnosis remains the enzyme-linked immunoassay ELISA antibody test, performed in duplicate and followed by confirmation with a Western blot [ 8 ]. Although this test has become one of the most commonly used point of care tests, it, like all rapid tests, remains only a screening test that requires follow-up Western blot confirmation when results are reactive [ 8 ]. Reported clusters of high false-positive rates in major US cities have demonstrated the potential for poor positive predictive value of such screening tests in low-prevalence settings and emphasized the need to clearly label test results as preliminary [ 9 ].
The translation of US testing kits to clinical use in resource-limited settings requires consideration of several issues. First, an appropriate test must detect HIV subtypes and clades that are prevalent in these regions.
The test must be heat-stable with a long shelf-life at ambient temperatures. Because most HIV testing in resource-limited settings occurs in a clinical venue, outside a standard laboratory, the test should also be easy, safe, and quick to use, as well as simple to interpret [ 10 ]. Maximizing test sensitivity is critical, because false-negative results may be of particular concern in high-prevalence settings [ 11 — 13 ].
The current testing strategy in most resource-limited settings is rapid tests or dual standard ELISA tests in series or in parallel from different manufacturers [ 14 ]. Hiv test free singapore dating testing effectively precludes the need for confirmation with venipuncture samples and Western blot, which are often inaccessible, and saves individuals the time and cost required to retrieve test results days later. In Botswana, for example, testers begin with parallel rapid tests: If the results of these tests are discordant, they are both repeated.
If they remain discordant, the OraQuick test is used to make the final determination [ 15 ]. The high incidence of HIV in resource-limited settings and the long distances patients must often travel to access health care also mandate ready identification of acute HIV syndrome, which is not detectable by traditional antibody-based tests.
New tests that detect p24 protein forming the HIV capsid are sensitive to both acute and chronic disease [ 16 ] and will soon be more widely available. In the mids, some advocates promoted the availability of over-the-counter HIV tests to improve suboptimal testing rates in the United States [ 17 ]. Using these over-the-counter kits, clients obtain dried blood samples, send them to a laboratory for processing, and call to anonymously receive their results within a week [ 17Hiv test free singapore dating ].
Surveys on home collection kits for HIV testing in the United States demonstrated that they were highly acceptable among nearlycustomers in the first year of use. Most users who responded to an associated survey were white men between 25 and 34 years old.
This test has undergone an observed use study for over-the-counter use and is awaiting review by the Hiv test free singapore dating Products Advisory Committee [ 192122 ].
In the United States, benefits of home testing include convenience, privacy, anonymity, and potentially increased access to tests [ Hiv test free singapore dating ]. Home specimen collection with telephone counseling may lead to earlier detection of disease [ 24 ].
Use of the kits has also been associated with improved outcomes: Critics also cite difficulty in conveying the implications of a positive screening test, which can lead to psychological distress, and conversely, those of a negative screening test early in infection, which can provide a false sense of security [ 1726 ].
Some have raised concerns that this "Hiv test free singapore dating" will not target the high-risk populations that are in greatest need and will instead be used by groups including the affluent and the worried well. In resource-limited settings, home-based testing currently means door-to-door implementation of rapid tests by lay counselors or community health workers, although other approaches for distribution of self-administered tests are being considered [ 28 ].
Other studies evaluate the home delivery of HIV test results that have been
Hiv test free singapore dating in clinical settings. Home-based testing, part of a wider effort to identify and therefore treat more HIV-infected individuals in resource-limited settings, is showing early signs of success. Surveys and trials that assess home-based testing as well as home delivery of test results have had high test acceptability and uptake compared with facility-based testing in both urban and rural resource-limited settings, particularly among those who cannot afford the cost and time required to travel to a testing center [ 62930 ].
Greater initial willingness to undergo clinic-based testing may be explained by greater familiarity with this approach. Another cohort study conducted in rural southwestern Uganda found that participants in four villages were more than five times more likely to receive results during the intervention year—in which they were offered home delivery of results obtained from annual door-to-door blood collections—compared with the year in which these results were only available in health care facilities.
Further studies in countries including Uganda, Botswana, Zambia, and Mozambique have shown increased comfort level and more frequent completion of the testing process with home-based compared with clinic-based testing [ 33 — 36 ]. Studies suggest that home-based testing achieves its goal in reaching populations previously untapped by standard testing programs.
Differential rates of testing uptake and acceptance have also been shown along a number of demographic variables. Demographic and health surveys in sub-Saharan Africa show a strong socioeconomic gradient in the use of traditional, facility-based VCT,
Hiv test free singapore dating lowest uptake among the poorest individuals.
Although sicker individuals—those frequently HIV-infected—may be expected to access health care facilities more often, the study results may be better explained by the potentially prohibitive travel and other costs required to access health care facilities, which would be particularly burdensome to this subpopulation. Studies have shown conflicting results on the age distribution of those who are tested at home. In one Ugandan study, individuals between 15 and 24 years of age were less likely to test either at home or in a clinic, when compared with other age groups [ 38 ].
Home testing may be less appealing to youth who live with their families, due to privacy issues [ 29 ]. In a Mozambique study, home testing was the most effective at reaching children, compared with other community-based testing modalities [ 40 ].
Among to year-olds, poor self-rated health doubled the likelihood that an individual was willing to be tested at home, suggesting that ease of testing via home access would be particularly beneficial to this population [ 5 ].
Women are more likely than men to complete HIV testing in any given testing site [ 1541 ], and in countries, are more likely to be aware of their HIV status [ 42 ].
In studies evaluating home testing in particular, women were more likely to undergo testing than men [ 33353843 — 45 ]. These findings may be explained by the greater likelihood of women to remain at home during the day.
Home-based testing may target couples and families more efficiently than other strategies, although social considerations may complicate this benefit.
In a Mozambique study, home testing reached more couples than other community-based strategies, such as mobile testing units [ 40 ]. In kind, the home-based approach may be particularly effective at identifying household members of known HIV-infected individuals. A Ugandan study randomized household members of HIV-infected persons to be offered free home-based or clinic-based testing, counseling, and care.
Although some studies show that couples with conflicting attitudes toward testing may be less amenable to a home visit, others suggest that for some HIV-discordant couples, home-based testing may foster family support and aid in risk reduction [ 629 ].
A meta-analysis by the Cochrane Library concluded there is still insufficient evidence to recommend large-scale implementation of the testing model [ 6 ]. Fear of stigma is often cited as a major deterrent against the use of VCT centers [ 629 ]. Hiv test free singapore dating testing was conceived in part to reduce the stigma associated with visiting a publicly visible, dedicated HIV testing center, by precluding this visit and normalizing the testing process.
Interviews and focus groups conducted with participants report that the home-based approach has been successful not only in reducing the fear of stigmatization, but also in minimizing the emotional vulnerability associated with traditional methods [ 29 ]. Home-based testing may also be associated with fewer high-risk behaviors. Despite its increasingly recognized benefits, wide-scale implementation of counselor-initiated home-based HIV testing in not imminent due to several important barriers that may be more pronounced in resource-limited settings.
These obstacles include less awareness of testing options, more difficulty acquiring these tests due to high costs and remote settings, limited availability of confirmatory tests that require serum sampling, and difficulty preserving any cold chain that may be necessary to maintain test kit viability [ 46 ]. Concern about confidentiality is an additional obstacle.
Because home testing is often conducted in hard-to-reach areas, local residents are frequently employed as counselors to perform the tests. Although this approach expands testing outreach, those Hiv test free singapore dating tested may fear a confidentiality breach by local counselors. Some have speculated on the feasibility of self-administered home-based tests provided free of charge in resource-limited settings, similar to self-administered tests now being considered for FDA approval in the United States [ 19 ].
One potential benefit of self-testing is that it may allow overworked hospital staff members to focus on providing patients with other critical services. Some public health innovators suggest using Hiv test free singapore dating technologies such as mobile phone messaging to efficiently inform the public about home self-tests, as well as to improve linkage to care [ 47 ]. However, the difficulty in using and accurately interpreting tests may be a major challenge to self-administered testing.
Twelve percent were unable to correctly determine results, as confirmed by trained personnel [ 48 ]. Data have yet to be published from high HIV-prevalent regions, although extant reports suggest that self-administered testing should be approached with caution. As with most HIV testing efforts, home self-testing without counselor involvement raises the concern of adequate consent procedures.
Expanded HIV testing through modalities including home-based testing is only beneficial to individuals and to the public if testing is linked with effective prevention, medical care, and psychosocial support. Linkage of traditional VCT to these services has been a major challenge in the past, and experience suggests that testing initiatives are most efficient if linkage to care is improved, even before scale-up of testing [ 850 ].
Furthermore, if home testing particularly reaches populations who have difficulty accessing health care facilities, as studies have suggested, intensified outreach for linkage to clinical care will be essential for those who are identified as infected at home.
Although data on home collection for testing in the United States suggest improved linkage, studies have not adequately addressed this issue in resource-limited settings. Individuals burdened with the knowledge of a positive home test are susceptible to poor psychological outcomes, particularly if follow-up care is difficult to access.
Linkage to care is a critical reportable outcome, essential to accurate assessment of the individual benefits, costs, and impact of home testing.
Identification and treatment of a greater percentage of HIV-infected individuals in order to save more lives—the ultimate goal of testing scale-up—necessarily comes at a price. However, because home-based testing identified a much lower HIV prevalence than hospital-based testing 5. At such costs, ART has previously been noted to be a cost-effective intervention [ 53 ].
Formal cost-effectiveness analyses are required to fully understand the economic value of home-based testing, particularly as one component of a several-pronged approach to both prevent and treat the infection. If self-administered home testing is implemented in resource-poor settings, as some have suggested, its success is contingent upon the affordability of the test to its consumers; ideally, the tests would be free to patients or accessible at considerably reduced cost [ 54 ].
As with the expansion of any testing effort, political will is critical to make such self-tests both feasible and effective: HIV testing is a critical gateway to care and secondary prevention, particularly in resource-limited settings burdened with high disease prevalence.
Current strategies that rely on facility-based testing have proven inadequate for the goal of universal identification and treatment over the past 10 years, demanding the use of alternate methods such as home-based testing.
Home testing in resource-limited settings has met with early success, based on studies demonstrating improved access to testing, acceptability, effective case identification, behavior risk reduction, and disclosure of status, particularly among women and those of low socioeconomic status. However, the Hiv test free singapore dating of this method on linkage to care, the critical last step in the testing process, remains to be seen.
No potential conflicts of interest Hiv test free singapore dating to this article were reported. National Center for Biotechnology InformationU.
Author manuscript; available in PMC Dec DongMD, and Rochelle P. Author information Copyright and License information Disclaimer. Common STIs in Singapore include gonorrhoea, syphilis, chlamydia, genital herpes, genital warts STI and HIV testing is also strongly recommended if you. STD Testing Singapore - Affordable, anonymous & high quality HIV / STD tests in Tanjong Pagar.
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sgFREE - In Google Play If you wish to set up your account at a later date, please go to 'My Profile'. Rapid HIV test kits are used in anonymous HIV testing .
HIV testing is the cornerstone to preventing further forwarding and to caring against those infected, particularly as access to treatment improves in resource-limited settings. Anyhow, efforts to expand eliminating through facilities-based testing obtain not achieved adequate approving coverage, prompting efforts to reach more individuals to the core strategies such as home-based HIV confirming.
Home inspecting is showing promising initially results in some high-prevalence, resource-limited settings. This theme reviews the mechanisms and literature to date of this door-to-door approach. In days of yore a predictably fatal diagnosis, HIV illness has randomly become a treatable persistent condition [ 3 ]. Because favorable clinical outcomes are contingent upon auspicious treatment, there is untrodden focus on the at cock crow identification of HIV-infected individuals, particularly in resource-limited settings where antiretroviral therapy Skill is increasingly available.
To this outcome, efforts to scale up HIV investigating have included expansion of voluntary counseling and investigating VCT centers and launching of antenatal testing programs and hospital-based screening initiatives. Although VCT centers outfit a predictable testing resource, this style has elicited concerns on every side the viability of reaching all individuals at chance, as luxuriously as associated stigma, troublesomeness, and loss of privateness [ 5 , 6 ].
Provider-initiated testing in health anguish facilities has been less well-received and has had considerable grand slam in identifying HIV-infected individuals by capitalizing on existing health tribulation relationships. In whatever way, the scenario only reaches a defined subset of the population: In that review, we discuss home-based HIV assessing in such settings, including the types of tests used, demographic populations that are reached by that method, effectiveness compared with other eliminating strategies, and important next steps in optimizing that approach.
The idea of HIV home-based examining has been debated for decades, almost as long as HIV testing has been available, but it has not been thoroughly endorsed. Recently, the debate around home-based testing has been ignited again, with the approval in the United States of the oral testing kit, OraQuick. That article explores HIV home-based tests with a focus on OraQuick , how they work, where they are available, their acceptability and accuracy, and the unrealized benefits and ongoing concerns neighbourhood home-based testing.
HIV home-based tests, also known as self-tests, let people to test themselves with a view HIV in their home out-of-doors a healthcare provider present. That test detects HIV antibodies in blood. Before doing the scrutiny, the user calls a toll-free number to register for the test using an anonymous encrypt, completes pre-test counselling and provides non-nominal demographic information.
The narcotic addict draws a blood sample using a finger prick and the sample is then sent away for testing at a lab.
The results are obtained about calling the toll-free number and using the anonymous code add up to access the results. Practical results are given by a counsellor. Results do not miss to be confirmed by an additional test, since confirmatory examining is performed by the producer before results are offered to clients.
Two cases of HIV transmission by breastfeeding in mothers with undetectable viral load reported 1 hour ago. Removable PrEP implant produces high drug levels in rabbits; further studies planned 15 November Behind the scenes at European Testing Week. A great life with HIV. The battle for sexual and reproductive bloom and rights in central and eastern Europe. HIV treatment is not a cure, but it is keeping millions of society well. Start learning about it in this section.
In that section we have answered some of the questions you energy have if you have good found out you have HIV. Antiretroviral drugs chart A one-page reference guide to the anti-HIV drugs licensed for use in the European Union, with hookup on formulation, dosing, key side-effects and food restrictions. Our award-winning series of booklets, with each title providing a comprehensive overview of one aspect of living with HIV. A range of interactive tools to support common people living with HIV to make involved in decisions about their treatment and care.
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The study on home-based HIV testing in rural Malawi found high acceptance and success of this method, particularly among those in the lowest socioeconomic groups.
The idea of HIV home-based testing has been debated for decades, almost as long as HIV testing has been available, but it has not been widely endorsed. Because most HIV testing in resource-limited settings occurs in a clinical venue, outside a standard laboratory, the test should also be easy, safe, and quick to use, as well as simple to interpret [ 10 ].
View full list of topics. HIV testing is the cornerstone to preventing further transmission and to caring for those infected, particularly as access to treatment improves in resource-limited settings. Introducing a cost-based self-test may create barriers between the test and those who may benefit most from it. The results are obtained by calling the toll-free number and using the anonymous code number to access the results.
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Current strategies that rely on facility-based testing have proven inadequate for the goal of universal identification and treatment over the past 10 years, demanding the use of alternate methods such as home-based testing. The test must be heat-stable with a long shelf-life at ambient temperatures. No potential conflicts of interest relevant to this article were reported. Country Singapore [ View Country Profile ].
Trop Med Int Health. Another cohort study conducted in rural southwestern Uganda found that participants in four villages were more than five times more likely to receive results during the intervention year—in which they were offered home delivery of results obtained from annual door-to-door blood collections—compared with the year in which these results were only available in health care facilities.
Author manuscript; available in PMC Dec
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