The policy development for The policy development for introducing of the oral fluid introducing of the oral fluid based rapid HIV test kit in based rapid HIV test kit in

ThailandThailand

The policy development for The policy development for introducing of the oral fluid introducing of the oral fluid based rapid HIV test kit in based rapid HIV test kit in

ThailandThailand

Writers in the 2009 Write WorkshopWriters in the 2009 Write Workshop

(WHO Bulletin)(WHO Bulletin)

Topic

• New option for HIV screening system

- The introducing of the oral fluid based rapid HIV test kit in Thailand, an analysis for policy development• Why Thailand is an interesting place to study this topic?

•Thailand is a developing country which face a big problem of HIV/AIDS. The study which propose policy suggestion in Thailand should be useful for other developing countries.

Puzzle

Many studies in the international literature encourage

people not only in developed countries but also developing

countries to use the test as HIV self-testing.

• The important issues should be concerned by policy maker, if introducing the technology of oral fluid based, rapid HIV test kit in Thailand based on the current situation.

• Policy recommendation for making an introduction of HIV self-testing is feasible in Thailand in the future.

Research Questions

• How do we properly make a policy development for introduction of the oral fluid based, rapid HIV test kit in Thailand ?

Oral fluid based rapid HIV test kit

Figure 2 : Method of collecting oral fluid sample

Figure 1 : The component of oral fluid HIV test kit

Figure 3 : Interpreting the result form oral fluid HIV test kit

Pros and Cons of the test

Advantages• Non-invasive technique, conveniently collecting sample • Easy to interpret the result accurately even in an untrained people • Shortly interpreting result in 20 minute• No adverse effect from blood collection for clients • No risk to be exposed to blood for health provider.

Disadvantages and negative consequences• Person would not receive face to face pre & post counseling. • Misuse by testing someone without their consent.• Illegal distribution of the test to unsuitable setting. • Public misunderstanding about HIV virus can communicate via

saliva • Over utilization and burden of health expenditure

Objective

• Objectives of this study is to provide policy suggestion on properly adopting the oral fluid based rapid HIV test to health care service. The policy analysis based on societal perspective

MethodologyQualitative study: Focus group discussion among stakeholders related to the issue, including • Health providers responsible for HIV screening,• Decision maker in the area of HIV/AIDS policy, • Third party payer, • Manufacturer in private company• Leaders of non-governmental organizations

and • Clients who sought HIV test.

Result: The requirement system for adopting the test in each level of

health setting

Health

setting

Additional requirement systems

Hospital

Meet the standard requirement**

Private clinic

1. Anonymous system. Meet minimum requirement*

Community

Center

1. Pre and Post counseling system with trained personal.2. Anonymous system.3. Referral system for client with reactive result to hospital.

Surveillance

1. Pre & Post counseling system with trained personal.2. Referral system for client with reactive result to hospital.3. Preparation of screening area to be confidential for client

All level

1. Support the appropriate information for client. 2. Providing training program to health provider. 3. Penalty system of illegal distribution.

Standard requirement of

HIV screening premises

1. Pre and Post counseling*

2. anonymous system

3. referral system to hospital*

4. confirmatory system

5. follow up system

* Minimum requirement

DiscussionThe study proposed an argument against previous literature encouraging public to use the test as self-testing. Thailand is

not well prepared for self-testing regarding the barriers below.- Need more trained counselors.

- Need more strongly understanding

about HIV/AIDS among people.

- Need more access to innovative counseling

- Need more effectively supportive system

Product launch to the market

Product distribution

Product be used in health setting

Pre-counseling in group at health settingHIV/AIDS background, Important of HIV test, HIV risk reductionHow to do the test, Recommendation after getting the test result

Clients was offered of self test after counseling

Come to hospital for - post counseling and - confirmatory testing

Self test reactive Self test negative

Follow-up for repeat test in

next 3 months

Hotline telephone counseling

4. Supportive system along side the path of self testing ?

2. Trained counselors ?

1. Patient ?

3. Health care facilities

?

Control for the product

Control for distribution

Control for pre-services

Self-testing

for HIV infection

Preventive system for undesirable effect

Required system after their HIV self-testing

Positive result

Negative result

Government sector responsible for regulating the quality standard of health product

Government sector responsible

for controlling health product

distribution to legally setting

Government sector responsible for controlling HIV/AIDS services and regulating health personal ethics

Concerning sector

Government sectors

NGO, Community worker,

Community hospital setting and government sector responsible for developing HIV/AIDS policy

• Regulating quality standard of product in pre and post marketing process

• Controlling a comprehensive content on the label of HIV testing product

• Defining the type of health care setting can be provide HIV self test

• Controlling and monitoring product distribution to legally permitted setting

• Establishing penalty system and complaint service for illegal distribution

• Rendering Hotline services for post counseling to clients who use the test and referral system to standard requirement system.• Monitor undesirable outcome resulting from HIV self testing

• Establishing protection systems for misuse in vulnerable group• Support consumer protection activities, Strengthen in patient right

• Providing essential information for consumer through various

communication: brochures telephone, computer program, etc

Government sectorsManufacturer/ product supplierCommunity hospital setting

• Providing communication media with standardized high quality counseling

media for pre-group counseling such as video tape recorder or other media

• Training health personal for providing pre-counseling for self-testing properly

• Regulating health professional practice and rendering complaint service

Regulating health professional to provide health care practice

based on standard requirements of HIV screening premises.

(+) System for confirmatory test, anonymous system, comprehensive post

counseling and referral system to hospitalization for patient with HIV

infection.(-) Follow up system in 3-6 months after the test

High potential health care sectors such as community hospital,province hospital,private hospital, etc

Recommendation on the requirement system for properly use the oral fluid based rapid HIV antibody test kits in each process of adoption

Policy for public relation Disseminating essential information to enhance the knowledge and

create good understanding in society on the related issue of HIV/AIDS

Government sector responsible

for controlling HIV/AIDS services

Government sectors

mass media and local journalists

Government sectors

Manufacturer/ product supplier

Conclusion• For Thailand, the introduction of oral fluid based rapid

HIV test kit should be adopted in order to increase accessibility to the HIV screening system.

• The progression of using the technology should make step by step, the more hasty the more mistake

– First step: using the test in the defined setting, hospital & clinic (current situation)

– Second step: using in the program of provider initiative for HIV testing

– Third step: self-testing with supportive system from hospital

– Last step: self-testing with over the counter purchases

• A further study is needed to answer the critical questions about cost-effectiveness analysis of the using the test in provider initiative program. (2nd step)