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Rural areas without labs pose challenges in HIV testing access

Decades ago, the mere mention of HIV/AIDS meant closed door conversations. The initial years of the epidemic were characterised by confusion, fear, and discrimination, overburdened with stigma and low awareness. But today, with more awareness, treatment advancements and technological interventions, the landscape has evolved.

As the world observed yet another HIV/AIDS Day on Friday, here’s a reminder of where we are in the process of curbing the epidemic and what should be the action next.

While there is no cure for HIV, ensuring AIDS is no longer a threat to society seems like an achievable goal. This progress has been fueled by global efforts, innovative testing methodologies and local community engagement. In India, there are reasons to be optimistic.

As per the latest report released by UNAIDS, there has been a decline of new HIV infections in India by more than 42% since 2010, higher than the global average of 38%. As we continue to take strides to fight this epidemic, we also move closer to the ‘95-95-95’ targets set by UNAIDS. This means that 95% of all people living with HIV know their status, 95% of all people with diagnosed HIV infection receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy have viral suppression by 2030.

Where are we now
As of 2022, 79% of all people living with HIV in India were aware of their status, and of these, 86% were receiving antiretroviral treatment. About 93% people on treatment who had viral load testing achieved viral suppression. This means people living with HIV are able to lead healthier lives, with lower risk of transmission. To translate these goals into a reality, it is important for us, as a nation, to move forward with purposeful action. There are steps we can take – from accelerating testing to care delivery.

Testing is where to start as it is vital for more people living with HIV to know their status. The earlier the diagnosis, the sooner they can seek life-saving care, protecting themselves and others. This brings us to two key questions — how do we encourage more people (particularly those at risk) to get tested? and how do we make sure we reach them with reliable options?

It is clear that we need to innovate both our testing strategies and our approach to engaging with communities.

People in remote or rural areas without any labs in close proximity, face challenges in accessing testing. It can be hard for them to travel long distances to a lab — which can put a physical and financial burden on them. Therefore, the Point-of-Care and self-tests can be key solutions in improving access to testing for these patients.

One promising sign of what the future of HIV testing in India can hold was highlighted by a recent pilot project by PATH, which showed great acceptance for self-testing over other testing methods. People found self-tests easy to use and interpret, which can make it especially useful for those who have not tested in the past. Supported by the Government, in select clinics and medical centres, this could be an encouraging move to promote testing. It gives care practitioners more ways to screen high-risk groups, too.

Beyond this, there is a new standard in point-of-care testing with 4th generation rapid tests. We have seen that these kits are particularly effective in smaller towns and villages, as this test can detect infection with a simple finger prick, giving results within 15-20 mins. It also helps detect more acute infections compared to previous tests.

Why is this important
This ‘acute’ phase is when half of all HIV transmission events happen and infection is in its early stages, which is 12-14 days. Therefore, these tests help people know their HIV status sooner, helping them seek care and minimise disease progression. To put it briefly, it can help save lives and cut down on costs, subsequently helping lower the burden on health systems and people. The impact of rapid test results is further increased through self-tests, which help remove barriers to access reliable results and treatment, often driven by social stigma.

There are also scenarios where knowing someone’s HIV status is crucial — like in the case of pregnancy. An expecting mother in a remote region of India has several challenges that stop her from reaching the lab. This is where an innovation like dried blood spot testing comes in handy. Here, a few drops of blood can be simply collected by pricking her finger, toe, or heel, and these are placed carefully on a special paper (which is part of an easy-to-order kit). Then, the blood samples can be easily transported and do not require refrigeration. Testing innovations such as these can make HIV more manageable.

As we introduce more options for testing, one thing is clear — the focus needs to be on key high-risk groups. From awareness drives to screening programs and counselling services, creating safe spaces and supporting people is important to ensure them get tested and receive appropriate care.

Empowering them with information is one thing, but we must also continue to fight the stigma that still surrounds HIV by building partnerships across the continuum of care. Let’s stay focused on driving awareness towards removing stigma, barriers to testing so people receive the care they need. It will be a persistent fight with collaborative efforts to help end this epidemic, but it is one as a nation we must continue. CNBCTV18

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