The Role of HIV Testing in Preventing the Spread of HIV

Human immunodeficiency virus (HIV) is an infection that targets the immune system. It mainly targets the white blood cells, weakening the immune system. Thus, this makes it easier to contract diseases such as tuberculosis, infections, and certain malignancies. HIV affects communities in every region of the world, thereby making it a serious global public health issue, claiming millions of lives. For individuals with a positive HIV test result, early HIV diagnosis improves patients’ health outcomes as they can promptly begin treatment, that is the antiretroviral therapy (ART).  ART lowers the amount of HIV in the blood (known as viral load), minimizes HIV-related illnesses, and prevents transmission to others. Moreover, early testing allows asymptomatic individuals to know their HIV status and helps prevent unintentional spread to their partners. Thus, early testing is a crucial preventive strategy in HIV transmission and also aids in lowering the HIV-associated morbidity and mortality.

Understanding HIV Testing 

There are 3 main types of tests that can diagnose HIV infection: Antibody tests, Antigen/antibody tests, and Nucleic acid tests (NAT). 

• Nucleic acid tests (NAT): These tests detect the RNA (genetic material) of HIV in a sample of your blood as soon as 10 to 33 days following exposure to the virus. Also known as the viral load test, this test is considered in individuals who have recently been exposed or may have been exposed with early HIV symptoms to help determine the quantity of HIV virus (viral load) in the blood. This test is also indicated in individuals who have tested negative on an antibody or antigen/antibody test.  
• Antigen / antibody tests: HIV particles, when enter the body, act as antigens that trigger your immune system to respond by formation of antibodies. Antigen/antibody tests, which are the most commonly done HIV screening tests, detect both HIV antigens such as p-24 and HIV antibodies in your blood. A lab-performed antigen/antibody test on venous blood usually detects HIV 18 to 45 days after exposure. Antigen/antibody tests done with blood from a finger stick can take anywhere from 18 to 90 days following exposure to detect HIV. 
• Antibody Tests: Antibody test detect HIV-specific antibodies 23 days to 90 days after exposure to the virus. This can be done by collecting a sample of your blood, saliva or urine. 

Usually, HIV tests are very accurate. However, no test can detect the virus immediately after an infection. The speed with which a test detects HIV varies depending on the type of test utilized.

The Impact of Early HIV Detection 

People who are unaware of their HIV status account for nearly 40% of new HIV infections. For people with undiagnosed HIV, testing is the first step toward living a healthy lifestyle and preventing HIV transmission. Commencing HIV treatment once diagnosed can pose significant advantages to an individual. They can receive ART in earlier stages and stay healthy for many years. According to research, the sooner people begin HIV therapy after being diagnosed, the better their chances of success. Beginning treatment for HIV before the development of advanced immunodeficiency can reduce the risk of significant cardiovascular disease, renal illness, hepatic disease, and cancer, as well as the risk of death. 

HIV Testing as a Preventative Health Measure 

People who are unaware that they have HIV (asymptomatic individuals) are more likely to spread the virus to others. Not knowing earlier will also delay treatment that can lead to severe immunodeficiency and major medical issues. Early HIV testing not only helps protect your health and wellbeing, but also helps protect others from HIV. Increasing the number of people who are aware of their HIV status is critical to ending the epidemic. People with HIV who take their HIV medication as prescribed maintain an undetectable viral load (or remain virally suppressed) and will not transfer HIV to their sexual partners. 

To stop the HIV epidemic, health departments were encouraged to develop new HIV testing procedures and regimens, as well as expand the reach of existing programs. The Centers for Disease Control and Prevention (CDC) has recommended the following guidelines to target the high-risk populations: 

• All pregnant women should be tested for HIV so they can take actions to be healthy and safeguard their child. 
• Individuals who are IV drug users or have shared needles or syringes should get tested atleast once a year. 
• More frequent testing (every 3-6 months) is recommended in sexually active gay or bisexual men. 
• High-risk individuals (individuals with multiple sexual partners, IV drug users, individuals diagnosed with any STD, hepatitis B, hepatitis C or tuberculosis, individuals who have received blood transfusions, transplants, etc) should get tested at least once a year.

Pre-exposure prophylaxis (PrEP) to be considered in all high-risk populations as it is a highly efficient in HIV prevention. 

Barriers to HIV Testing and How to Overcome Them 

Approximately 75% of people who are at ongoing risk for HIV are not getting tested every year. The reasons attributed to individuals not opting for testing include factors  such as social stigma and fear, inability to afford treatment, lack of access to testing in rural areas, and anxiety waiting for results. To overcome these barriers and encourage more people to become aware of their HIV status, some initiatives have been taken. These include the availability of fast testing, urine testing, home self-testing, permitting telephone results and making pretest counseling optional.

Overall, the initiatives and health policies improving accessibility that can help to combat HIV can be mainly divided into three main strategies: 

• Increasing routine screening in healthcare settings: Healthcare encounters offer valuable chances to encourage HIV screening. CDC advises that everyone between the ages of 13 and 64 get tested for HIV at least once as part of normal health care, and more frequently if they are at a higher risk of contracting HIV. 
• Focusing on increasing the frequency of testing for those who are more likely to contract HIV: The CDC recommends that those who engage in high-risk activities test for HIV at least once a year. 
• Promoting self or at-home testing: Self-testing allows individuals to obtain HIV results in a private setting, such as at home, to facilitate early treatment and improve the acceptance of HIV testing. Self-test kits are available in the market which allow you to test yourself. Some labs also provide free home sample collection facility. This increases accessibility, at the same time ensuring accurate and fast tests results.

Technological Advances in HIV Testing 

With the availability of HIV self- testing, you can now get tested at the comfort of your own home or in a private location. There are 2 types of HIV self-tests: rapid self-tests and mail-in/at-home tests.  With an HIV rapid self-test, you can get your test results within 20 minutes. To perform an HIV self-test, you must swab your gums to collect an oral fluid sample, which is tested. However, if your result is positive, further testing is required for confirmation. With the mail-in or at-home testing facility, you either collect the sample yourself or a certified eMedic will arrive at a location chosen by you to collect your sample, which will be sent to a lab for analysis. This is usually more accurate and you get your results promptly via WhatsApp and email. Amongst the various types of HIV tests, the antigen-antibody tests or the fourth-generation tests are usually considered as gold standard for HIV testing. They allow for earlier detection of HIV infection compared to previous antibody-only tests. This test offers better accuracy and earlier diagnosis. Additionally, they can differentiate between HIV-1 and HIV-2 infection. PCR tests are also reliable, however these require special equipment and are quite expensive.

These advances in HIV testing ensure confidentiality of test results, reasonable cost, fast and accurate results, and test convenience. 

Conclusion

Routine HIV testing is a crucial first step toward early detection and can promote quick access to HIV care and therapy. Individuals diagnosed with HIV can get treatment, which can help them live a long and healthy life. HIV treatment lowers the amount of HIV in the blood and reduces HIV transmission to others. Moreover, in high-risk individuals, HIV medication known as pre-exposure prophylaxis, can be beneficial in preventing HIV. Testing is also crucial for asymptomatic individuals to prevent unintentional spread of infection to their partners. Hence, HIV testing is important for all sexually active individuals as it aids in initiating important preventive programs that will help them stay HIV-free.  Get tested today to stay healthy and promote the well-being of others as well!

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