As the fight against HIV/AIDS continues, Guyana will this month launch a pilot self-testing project at four locations in Region Four and according to Programme Manager of the National AIDS Programme Secretariat (NAPS) Dr Tariq Jagnarine, while there may be some reservations it is a best-practice recommended service.
The existing reservations about self-testing, especially as it relates to tracking of persons, Dr Jagnarine said, are behind the decision to first launch it as a pilot project, which would give an opportunity for evaluation in order to see what issues may exist and put systems in place to correct them.
“The service in itself is a best-practice recommended service that is done in most first world countries. It’s… like if you are doing a pregnancy test. [However] … you need lots of tracking to ensure that persons get sufficient counselling, linking that person once they are positive with care and proper follow-ups…,” Jagnarine told Sunday Stabroek.
He also pointed out that a positive result may not mean the person is HIV positive and a second test would be necessary to confirm or dispel the earlier results as there may be issues that come up with the test.
According to the United States Centers for Disease Control and Prevention (CDC), HIV self-testing allows people to take the test and find out their result in their own home or other private location. The CDC said that the availability of HIV self-tests in the US may help increase awareness of HIV infection for people who would not otherwise get an HIV test.
Guyana’s pilot project will be done slightly differently as people will not do the tests in their homes, but rather in private spaces at four select locations in Georgetown.
According to Jagnarine, for the project, which he described as a ministerial activity, meaning it will be done directly under Minister of Health Dr Frank Anthony, the test will be administered at the National Care and Treatment Centre, the Campbellville Health Centre, the Midway Clinic and the Guyana Responsible Parenthood Association.
The pilot project will be guided by the Caribbean Med Labs Foundation, a non-governmental organisation based in Trinidad and Tobago, which was established in response to a request from Caricom Ministers of Health in June 2007.
The NAPS Programme Manager said Guyana will have a slow approach to self-testing and ensure there is a policy in place, proper protocol and the involvement of multiple stakeholders inclusive of faith-based organisations, civil society, NGOs and the LGBT community.
Explaining how it will be done, Jagnarine said persons will be counselled first, then given the test to be done in a private space, after which assistance will be given in interpreting the results and post-counselling. If there is need for additional testing or linking the individual to testing and treatment, this will also be done.
In the second phase of the project, once persons are evaluated and counselled, meet certain criteria and are easy to track, they will be allowed to take the tests home and administer them there.
“Of course we would have a way of tracking you if you take it home. You do it and then we contact you or you come back to us to give us that result, we track it and we link you,” Jagnarine explained.
The test is oral, which involves testers swabbing the insides of the cheeks before placing the swab in a solution. After a few minutes, like a pregnancy test, stroke lines appear, a singular indicating negative and double lines a positive result.
Jagnarine stressed that each candidate will be evaluated and the healthcare workers must be satisfied before they are allowed to do the self-testing. If there are doubts then the person will be directed to the normal testing sites. Like everything to do with HIV treatment and care, the test is free of cost.
Very constant
Meanwhile, Dr Jagnarine said Guyana’s HIV prevalence over the past five years has been very constant at 1.4% and while this is good, if the country wants to eliminate HIV by 2030, which is guided by the National Strategic Plan, it has to be reduced to less than 0.5%.
Last year, some 82 people died as a result of AIDS-related illnesses, but so far for this year, he said, there have not been any alarming increases.
While he has only been at the helm of NAPS for a short period, Jagnarine said he has no intention of re-inventing the wheel but rather building on what exists, bringing more of a best-practice approach and trying to think outside of the box.
He said they have been improving on Pre-exposure prophylaxis, a daily medication which prevents people who are at high risk of contracting HIV from getting the virus. Also they are ramping up index-testing, which involves mapping the sexual partners of every new positive person (with their consent) so that they can make those persons aware of their status.
Also being applied is recency testing, which can tell people if they became infected within a one year period and they are then able to pinpoint with some accuracy where they got the infection.
Mobile delivery of drugs and testing are also being explored, if people are having challenges and, as has been the case from the inception of the virus being in Guyana, the stigma and discrimination policy is also being addressed.
“Without curbing that phase of the HIV battle, we would be unable to actually stymie that infectious rate of HIV. And so having a policy helps persons to better understand about HIV and they can be a little more open to persons who are HIV positive,” the NAPS head said.
Key specific groups have been targeted to build awareness when it comes to HIV stigma and discrimination and these include the police, army, judiciary, magistracy, schools and the adolescent population.
Civil society organisations, NGOs and faith-based organisations continue to play an integral part in the work of NAPS, as according to Jagnarine they are the ones on the ground and budgetary allocations are made to assist them in their work.
Eliminate
Guyana has been working towards eliminating mother-to-child transmission of the virus and according to the NAPS Programme Manager the country came very close to meeting that target as in 2020 the prevalence of positive cases of pregnant mothers and babies remained at just around 1.3%, which translates to just about 75 new cases. He said last year as well there were 111 positive pregnant mothers who already knew their status and in terms of babies becoming positive the incidence was at 0.5%
Jagnarine said that means not more than five babies were positive and while it will take some work, eliminating mother-to-child transmission is achievable. He said the babies becoming positive had a lot to do with the geography of the country as people move from region to region and do not do follow-ups at clinics. Also the mothers might not be on the treatment that prevents them from transmitting HIV to their babies. While pregnant, HIV-positive mothers have to be on antiretroviral treatment, which helps to keep the mother virally suppressed and prevents transmission to the baby.
He pointed out that if the mother is not on treatment and has a high viral load close to her delivery time, that’s when there is a high probability of transmission occurring during delivery or just after delivery if she breastfeeds the baby.
“Many times it is about knowledge. Some of them don’t know and they end up breastfeeding, some of them, if they have a lot of injury during delivery it can happen as well…,” he said.
As to where Guyana is as it relates to the 95-95-95 strategy which was announced by UNAIDS in 2014, aiming to end the AIDS epidemic by 2030 by achieving 95% of all people living with HIV (PLWH) being diagnosed, 95% on antiretroviral therapy (ART) among the diagnosed, and 95% virally suppressed among those treated, Jagnarine said the country is well on its way.
He disclosed that 94% of Guyana’s population know their status, 72% of PLWHA are on treatment and 83% of the infected persons are virally suppressed.
“So there is some work we have to do…, we want people to be on treatment but there are many reasons why they don’t remain on treatment,” he pointed out adding that these may include geography, doubting they have HIV and taking alternative treatment not validated by best-practice research.
Budgetary allocation
Asked about NAPS’ budgetary allocation, Jagnarine said there has been more financial support from the government, with some $1.2 billion being allocated in the last budget for activities, overhead costs and purchasing antiretroviral treatment, which can run to hundreds of millions of dollars. NAPS also receives funding from donor agencies, such as the Global Fund and PEPFAR.
Assistance is given to PLWHA and this can include nutrition care packages. On average, 325 people receive such assistance every month. He did say, however, that there is a lot more that can be done in this area as it is not a sustainable approach. Therefore, NAPS is trying to empower persons who have problems with employment and link them to places where they can be employed.
“We will slowly try to reduce those numbers because NAPS is not equipped with a large storage area to have lots of food hampers so it can be challenging at times,” Jagnarine said.
There is no longer a shortage of drugs as systems have been put in place to prevent this, but Dr Jagnarine noted that when it comes to shipment that can be a challenge and he pointed out that the most bottlenecks that existed had nothing to do with procurement but rather with supply and delivery.
He noted that with ARVs there is always a need to have a six-month stock on hand and sometimes almost a year’s supply might be purchased. An order was placed for next year in September and there is enough in stock to last until September next year.
Dr Jagnarine, who is a clinician and a specialist in family medicine, endocrinology and diabetes, took over from Dr Rhonda Moore a few months ago. He also works at the Georgetown Public Hospital, holds a clinic at the National Care and Treatment Centre two days a week and lectures at the University of Guyana.
