Improving the Quality of and Access to HIV Rapid Testing in the Caribbean Region: Program Implementation, Outcomes, and Recommendations

Abstract

In 2008, HIV rapid testing (HIV RT) was only minimally used in the Caribbean region. Collaboration with countries and international partners since then has resulted in greater availability and use of HIV RT services. Surveys were conducted in 2012 and 2014 among 11 selected Caribbean countries to inform stakeholders of progress made since 2008 and to identify strategies to further improve access and uptake of high-quality HIV RT in community- and facility-based settings in support of the UNAIDS 90-90-90 targets. Key accomplishments during this period include (1) presence of in-country national HIV RT algorithms, (2) use of the dried tube specimen (DTS) as an external quality assessment (EQA) program, (3) use of standardized logbooks for data collection and monitoring, and (4) use of oral fluid for HIV RT, particularly for key population surveys. Although progress has been made since 2008 to increase access and improve the quality of HIV RT among countries in the Caribbean, some work remains to be done. This includes the development of new policies and implementation of existing ones, task shifting, quality and access to testing, testing strategies, and integration of HIV RT into HIV Testing Services.

Diagnosis of Human Immunodeficiency Virus Infection

“…The quick turnaround time (TAT) of less than an hour allows the provision of counseling and testing during the same visit. Together with other HIV POC testing for VL, EID, and CD4, health care providers at the district or community level can provide multiple testing and treatment services to patients during same-day visits (49,58,59). Achieving this requires comprehensive implementation of national policies, resources, training, education, health care infrastructure, and strategic partnerships with stakeholders.…”

Stability testing of dried Plasmodium falciparum positive quality control samples for malaria rapid diagnostic tests in Liberia and Benin

“…Therefore, a PT programme based on DTS can be used to monitor and improve health worker use of malaria RDTs and could provide an added level of monitoring of health worker performance of RDTs. Precedence for this has been reported for HIV RDT PT [11,12]. Although the study did not aim to specifically assess consequences of operational errors on test reactivity, the data suggest certain deviations from manufacturer instructions for blood and buffer volumes as well as incubation time as observed in this study do not affect sample reactivity.…”

HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review

“…In two articles,37 38 HIV rapid testing (RT) was reported as an HIV testing promotion strategy. Eight of the 11 countries included had policies in place for HIV RT, and all countries were using RT at the main laboratory in the country 37.…”

“…In two articles,37 38 HIV rapid testing (RT) was reported as an HIV testing promotion strategy. Eight of the 11 countries included had policies in place for HIV RT, and all countries were using RT at the main laboratory in the country 37. In the same article, three countries in 2014 reported using oral fluid tests for point-of-care testing versus nine countries that used blood-based test kits 37.…”

“…Eight of the 11 countries included had policies in place for HIV RT, and all countries were using RT at the main laboratory in the country 37. In the same article, three countries in 2014 reported using oral fluid tests for point-of-care testing versus nine countries that used blood-based test kits 37. HIV RT use was evaluated in Trinidad and Tobago, and an increase in testing from 1652 in 2008 to 5253 in 2010 was reported 38.…”