Federal ministry of health

Disease control directorate

HIV testing in clinical setting policy

HIV Testing in Clinical Settings

April 2016
 Types of HIV epidemics
Low HIV epidemic
• HIV limit to groups with high risk behavior i.e. SWs,
MSM and IDUs
• HIV prevalence <5% sub-population.< 1% in preg. women

Concentrated HIV epidemic

• HIV spread rapidly in groups with high risk behavior
• HIV prevalence constantly > 5% in at least one Sub-
population but < 1% in Preg. women

Generalized HIV epidemic

• HIV established in the general population.
• Risk behavior among the general pop sufficient to sustain
HIV prevalence over 1% in pregnant women
 HIV epidemiology in Sudan
The HIV epidemic in Sudan is classified as low level
epidemic with overall adult prevalence of 0.25%
and total estimated number of PLHIV of 56,000 in
2017.
However, marked geographical variations in the HIV
epidemic is observed with higher rates in the
eastern zone of the country, namely Kassala and
Red Sea states where prevalence among key
populations at higher risk for HIV infection is higher
than in other states.
Testing and treatment coverage
The HIV Test, Treat, Retain Cascade analysis
“HTTR” of 2013 (updated in 2015) showed
huge gap in the proportion of PLHIV who know
their status; only one third of the estimated
PLHIV were diagnosed and only 13% are
currently on treatment.
This is so far from the global 90,90,90 target.
The HIV Global Target: 90, 90, 90
 Sudan TTR Cascade 2017
HIV cascade
120%

100%
100%

80%

HIV cascade
60%

40%
34%
27%

20%
14%

0%
Estimated number of PLHIV Number of PLHIV who know Number of PLHIV linked to care Number of PLHIV currently on
their HIV status ART
 HIV Testing Modalities
HIV testing in Sudan adopts two main testing modalities
which are

1-Facility-based testing of referred cases of hospitals,

established VCT facilities, and PITC among pregnant
women, TB patients and STIs patients

2-Outreach/community testing which includes

outreach-testing among key populations and the
general population
 HIV Testing Modalities
Analysis of the current testing data showed
that the vast majority of detection of HIV
positive cases happens within health
facilities (93.4%) and that the contribution of
community-based testing is very little (6.6%).
Testing of patients referred from hospitals to
VCT centers contributes to about two-thirds
of the detected positive cases in the country.
The next table shows the contribution of
different modalities of HIV testing in three of
the priority states
 Results of HIV testing by modality:

Referred Voluntary Outreach Total

State Tested Positive PR Tested Positive PR Tested Positive PR Tested Positive PR

Red Sea 742 156 21.0% 378 51 13.5% 2245 39 1.7% 3365 246 7.3%

Gezira 1501 52 3.5% 432 19 4.4% 2297 11 0.5% 4230 82 1.9%

Khartou 5183 707 13.6% 2439 315 12.9% 11360 42 0.4% 18982 1064 5.6%
m

Overall 7426 915 12.3% 3249 385 11.8% 15902 92 0.6% 26577 1392 5.2%
 HIV Testing in Clinical Settings
The National HIV strategic plan (2018- 2020) and the
concept note of Sudan to the Global fund against
HIV(2018-2020) identified different populations of
high yield of positivity and called for scaling up HIV
testing among these populations
One of major interventions is scaling PITC among TB
and STIs patients as well as hospital inpatients.
Eight priority states were selected for initiating
these interventions.
 Mandatory HIV Testing
Mandatory HIV testing is unfortunately
being more common practice in
hospitals.
Mandatory testing often violates the HIV
testing guidelines, and it is not
uncommon to lead to denial of services
to positive patients.
Mandatory testing will lead to testing
people who are less probable to be
infected, while those at risk will avoid
health facilities.
 Mandatory HIV Testing
Mandatory testing often conducted with non
quality approved testing kits and not through
approved testing algorithms.
This type of testing is a clear violation of medical
ethics as well as it breaches the patients’ rights of
getting medical services
This policy aims at replacing this testing practice
through a more regulated, controlled and ethical
approach that proves effectiveness and efficiency.
 Policy Recommendations
The directorate of communicable and non-communicable
diseases in collaboration with the directorate of curative
medicine at the Federal Ministry Health and other partners
of the HIV response in Sudan is rejecting the currently
practiced mandatory HIV testing in all clinical settings in
the country and appeals for changing this practice into
a regulated provider initiated testing and counseling
(PITC) that observes all the principles of HIV testing
particularly obtaining informed consents before testing
and preserving patients’ right for opting out, and ensures
access of patients to quality HIV testing
 Policy Recommendations
This proposed approach is planned to be
implemented in public hospitals (in and out-
patients) in the eight priority states mentioned
above.
The proposed approach of PITC in clinical
settings is expected to be the major
contributor to the HIV testing target as health
facilities in most cases is considered the first
entry point for detecting PLHIV.
 Policy Recommendations
Upon this, the directorate of communicable and non-
communicable diseases recommends:
Abolishing the currently practiced HIV mandatory testing in all
clinical settings
Integrating HIV testing into hospitals laboratories
Implementing provider initiated testing and counseling (PITC)
for in and out-patients in all hospitals
Directorate of communicable and non-communicable diseases
through wider consultation with relevant departments of
Ministry of Health, partners in the HIV response, and health
care providers to develop clear SOPs that describe the flow and
responsibilities at different levels
THANK YOU