Mixed reactions among health professionals

MONTEGO BAY, St James — THOUGH some health professionals in this parish have welcomed the re-introduction of HIV self-test kit, OraQuick, they are conflicted about its in-home use by citizens.

The Food and Drug Administration-approved oral swab test for HIV-1 and HIV-2, which promises results in 20 minutes, is now available at select pharmacies islandwide for those who wish to self-test.

Pointing out that residents have been eager to learn more about the rapid testing product, community peer educator with the St James Public Health Services, Kimone Sutherland, told the Jamaica Observer that this may be due to the convenience and privacy it allows. However, she disclosed that there are many factors individuals must consider for proper testing, so she believes a health professional is better suited to conduct HIV tests.

“As it relates to convenience and privacy, I think it is a plus because the stigma that is attached to going to the health centre to get a test of this magnitude done, persons choose not to [go]. It is still frowned upon even today, so I do understand,” Sutherland, who was part of the health team assigned to conduct surveys and build awareness across communities in St James, told Your Health Your Wealth.

The trained phlebotomist continued: “On the other hand, persons really don’t understand how to effectively conduct the test. So, in order to get the correct reading, you should also bear in mind that the environment [must] be conducive to conduct the testing. If those factors are not in place, you could get a false reading and what would that person do once they see the double line come up [indicating a positive result]?” she questioned.

She insisted, too, that individuals should visit a health facility for a confirmatory test to be done by a doctor.

“They must bear in mind that rapid testing is a screening test, so it basically tells your status for the last three months of sexual practice,” she said, adding that certain things must be in place for an accurate reading.

“The area must be conducive for the testing; meaning, the room is at the right temperature and the test is done properly. So with all [those] factors in place, if you get a positive [result], remember it is a screening test. You must do some form of confirmatory testing to know if the virus is indeed there.

“I know persons will be alarmed and the first thing to do is panic, that is [the] human reaction. Just bear in mind that it is a screening test, it must be confirmed for you to know if you are positive or negative, and from there you can take the necessary steps,” Sutherland advised.

The community peer educator also shared that with an individual who is trained to offer the service conducting the HIV test, that person would immediately know how to reassure a patient and advise on the way forward.

“They would be able to take it to the next step immediately, once you give them to go ahead. But if you are at home and you see that double line, what do you do?” she added.

The community peer educator said that if a person wanting to know their HIV status does a self-test in the comfort of their home, that person can consider reaching out to a health professional for additional support.

“It is very imperative that persons know their status, to take care of themselves and the ones they love. If it is a case where they would be most comfortable doing it at home, then yes, because knowing your status is the best thing you can do for yourself, but do not be afraid to seek outside help. You have community health aides and community peer educators who are available to assist, so even if they conduct the test on their own, just to have somebody to explain what you are seeing and what the reading means,” Sutherland told Your Health Your Wealth.

A medical doctor, who spoke on condition of anonymity, said while he thinks OraQuick can be helpful in the health sector, he is not in support of it being made available to the general public.

“As a medical doctor, I do not think [this] is something that the patient should have access to. I think it should only be given to medical doctors and health professionals to use. The idea is for us doctors [to] use it so we would get our results quicker. I think that is the very basic advantage to it, but I am totally against people doing the test at home,” he doctor said.

Citing depression, stigmatisation, lack of pre-counselling and follow-up management of individuals diagnosed with the virus as his reasons for not supporting self-testing, the doctor also explained that in-office testing helps health professionals track the number of cases in the country.

“We might have that kind of patient that does it at home, find out he or she is positive, and she stays at home. We need all these cases for surveillance in the health centres from WHO [World Health Organization] and MOH [Ministry of Health and Wellness]. We are going to lose count because they are going to do it at home, and this is unlike pregnancy where two or three months and it might show so you have no choice but to do a follow-up at a health facility.

“Somebody might do the test during their window period and when it is done during your window period, it will come out negative [or] a person does the test, but it isn’t done properly so the person gets a false negative. That person would automatically assume they do not have the virus. So based on all of that, I would not encourage this test for the general population.

“Even if we going to have it, and we are going to say a [patient] can access it at your private doctor’s office where you will get immediate results. Come to us, we will do the test, and we know who to refer you to immediately if there is a positive result,” he said.

Meanwhile, pharmacist and managing director of C’J Professional Pharmacy in St James, Jerry Golding, while speaking to Your Health Your Wealth, said the introduction of OraQuick to local pharmacies is a good move, as it allows for privacy and some level of comfort among people with a fear of blood.

“It is good to have a non-invasive way to test and to get a reliable test, where you don’t have to worry about a finger prick because that was one of the reasons why people shied away from HIV testing in the [doctor’s] office. And you know a lot of people are afraid of blood, so they find every reason not to get tested because of that [fear],” explained Golding.

He, too, noted that counselling should be a top priority if a person receives a positive HIV result after using the OraQuick self-testing kit, and a confirmatory test at a health facility.

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