Diagnosing HIV infection and exposure

Clinical description

• Main HIV testing program goals:

o Identify as many HIV infected people as possible.

o Identify them as early as possible after getting infected.

o Ensure they start ART as soon as possible.

o Facilitate return to ART for patients who have discontinued ART.

o Identify HIV negative high-risk people and link them to prevention services

• Provider Initiated Testing: Ascertain HIV status for all patients attending health services (OPD,

ANC, maternity, TB, STI, FP, U1 / U5, adult and paediatric wards).

• Remind patients during pre-test education (group or individual) that they can decline HIV

testing without any ‘fear of punishment’ by the health worker.

• Encourage patients to attend testing with their sexual partner. Ensure that all children,

regardless of age (including adolescents) of HIV infected parents are tested. Ensure all siblings of HIV-infected children have been tested.

• Enrol all children born to and/or breastfeeding from HIV infected mothers (‘HIV exposed

children’) in the HIV Care Clinic and follow to at least age 24 months or longer if breastfeeding continues.

• Examine all children under 12 months of age with confirmed HIV antibodies for clinical

conditions that constitute Presumed Severe HIV Disease (PSHD, see section 6.3 on page 19).

All these need to start ART without delay.

• All patients need a confirmatory HIV rapid test to rule out any possibility of clerical errors or

fraudulent access to ART (also see section 16.3 on page 78):

o Before starting ART o All children under 24 months who start ART need a confirmatory DNA-PCR using a new DBS sample. This should be collected on the day of starting ART (also see section 16.3.2 on page 78).

• See the 2022 Malawi Integrated HIV, Syphilis and Viral Hepatitis Testing Services Guidelines

for details.