Review Article

HIV Testing Care and Treatment: A Guide for Health Care Providers in Pakistan

Ayesha Anwar1
Guthrie/Robert Packer Hospital, Geisinger Commonwealth School of Medicine, PA, USA
Hammad Ali2
University of Queensland, Australia
Fozia Qamar3
University of Massachusetts Medical School, Massachusetts, USA
Saima Abbas4
Space Coast Infectious Disease Care, Florida, USA
Bushra Jamil5
Aga Khan University, Karachi, Pakistan
Nasim Akhtar6
Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Asma Nasim7
Sindh Institute of Infectious Diseases & Transplantation, Karachi, Pakistan
Somia Iqtidar8
King Edward Medical University, Lahore, Pakistan
Joseph M Garland9
Alpert Medical School of Brown University, Rhode Island, USA
Fizza S Gillani9
Alpert Medical School of Brown University, Rhode Island, USA

✉ Correspondence: Ayesha Anwar Email: ysh.anwar@gmail.com

DOI https://doi.org/10.70302/jpsim.v4i1.2303
Volume: 4, Issue 1 Pages: 6–14 Published: 13 Feb 2023
Received: 07 Nov 2022 Accepted: 19 Dec 2022 Published Online: 13 Feb 2023

Abstract

Human Immunodeficiency Virus (HIV) is an evolving epidemic and a major public health challenge in Pakistan. Currently, the HIV epidemic is growing not only in key populations such as injection drug users and sex workers, but it is also spreading to Pakistan's general population. Poor infection control practices, including reuse of needles for therapeutic injections, poor screening of blood products, and usage of contaminated equipment at healthcare facilities, remain a significant source of iatrogenic spread of HIV in Pakistan's general population. There are global strategies in place to help countries take control of and curb HIV outbreaks. Pakistan is working towards achieving global standards of HIV control by providing free ART medications to all HIV diagnosed patients registered with its HIV antiretroviral therapy (ART) centers in the country. It is a proven fact that ART is highly effective in achieving a patient's viral load suppression, thus breaking the chain of transmission as well as ensuring a remarkably high quality of life for patients. Yet Pakistan faces social, economic, and religious barriers to controlling its rapidly evolving HIV epidemic due to testing and treatment delays. There is, therefore, a dire need to raise awareness among Pakistan's general population about HIV transmission and to educate physicians on proper HIV testing and management, including detailed history taking, identifying at-risk patients, counseling, and ensuring continuity of care for HIV patients. Physicians also serve as key influencers for the public and can positively influence the general public's attitudes and behaviors, with the goal of reducing HIV stigma to help curb Pakistan's rapidly evolving HIV epidemic.

How to Cite This Article

Anwar A, Ali H, Qamar F, Abbas S, Jamil B, Akhtar N, et al.. HIV Testing Care and Treatment: A Guide for Health Care Providers in Pakistan. J Pak Soc Intern Med. 2023;4(1):6–14. doi:10.70302/jpsim.v4i1.2303

⭳ Download PDF

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Country progress report - Pakistan Global AIDS Monitoring 2020 [Internet]. UNAIDS. 2022 [cited 2022Feb1]. Available from: [https://www.unaids.org/sites/default/files/country/documents/PAK_2020_countryreport.pdf]
  2. Rabold EM, Ali H, Fernandez D, Knuth M, Schenkel K, Asghar RJ et al. Systematic review of reported HIV outbreaks, Pakistan, 2000–2019. Emerg Infect Dis. 2021;27(4):1039.
  3. Altaf A, Pasha S, Vermund SH, Shah SA. A second major HIV outbreak in Larkana, Pakistan. J Pak Med Assoc. 2016;66(12):1510-1.
  4. Pakistan. UNAIDS. [Updated 2020 cited 2022Feb1]. Available from: [https://www.unaids.org/en/regionscountries/countries/pakistan]
  5. Abdullah MA, Shaikh BT, Ghazanfar H. Curing or causing? HIV/AIDS in health care system of Punjab, Pakistan. Plos one. 2021;16(7):e0254476.
  6. National AIDS Control Programme. [cited 2022 Feb1]. Available from: [https://nacp.gov.pk/]
  7. Ahmed A, Hashmi FK, Khan GM. HIV outbreaks in Pakistan. The Lancet HIV. 2019;6(7):e418.
  8. Resources H, Administration S, Centers for Disease Control and Prevention (CDC, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America. Recommendations Reports. 2003;52(RR-12):1-24.
  9. HIV testing [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [Updated 2020 cited 2022Feb1]. Available from: [https://www.cdc.gov/hiv/testing/index.html]
  10. Group HE, Committee on Obstetric Practice. ACOG Committee Opinion No. 752: Prenatal and perinatal human immunodeficiency virus testing. Obstet Gynecol. 2018;132(3):e138-42.
  11. Min S, Gillani FS, Aung S, Garland JM, Beckwith CG. Evaluating HIV viral rebound among persons on suppressive antiretroviral treatment in the era of “undetectable equals untransmittable (U= U)”. In Open Forum Infect Dis. 2020;7(12):ofaa529.
  12. Insight Start Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New Eng J Med. 2015;373(9):795-807.
  13. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Van Lunzen J et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171-81.
  14. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428-38.
  15. Bavinton BR, Pinto AN, Phanuphak N, Grinsztejn B, Prestage GP, Zablotska-Manos IB et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438-47.
  16. Weber B, Mbargane Fall EH, Berger A, Doerr HW. Reduction of diagnostic window by new fourth-generation human immunodeficiency virus screening assays. J Clin Microbiol. 1998;36(8):2235-9.
  17. HIV treatment as prevention [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [Updated 2022 cited 2022Nov22]. Available from: [https://www.cdc.gov/hiv/risk/art/index.html ]
  18. Couples HI. testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples. Geneva. World Health Organization. 2012.
  19. Stekler JD, Swenson PD, Coombs RW, Dragavon J, Thomas KK, Brennan CA, Devare SG, Wood RW, Golden MR. HIV testing in a high-incidence population: is antibody testing alone good enough?. Clin Infect Dis. 2009;49(3):444-53.
  20. Engel N, Pant Pai N. Qualitative research on point-of-care testing strategies and programs for HIV. Expert Rev Mol Diagn. 2015;15(1):71-5.
  21. Arora DR, Maheshwari M, Arora B. Rapid point-of-care testing for detection of HIV and clinical monitoring. Int Scholarly Res Notices. 2013; doi: 10.1155/2013/287269 doi:10.1155/2013/287269
  22. Hellard M, Ryan KE, Stoové M. Point-of-care HIV testing can help achieve UNAIDS targets. Lancet HIV. 2020;7(4):e216-7.
  23. Pakistan Country Strategy for HTC; Testing Criteria for Children; WHO Consolidated guidelines on HIV Testing Services 2015. National AIDS control programme . [Updated 2015 cited 2022Mar29]. Available from: [https://nacp.gov.pk/howwework/technicalguidelinesttc.html]
  24. World Health Organization. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection 2015.
  25. Tan WS, Chow EP, Fairley CK, Chen MY, Bradshaw CS, Read TR. Sensitivity of HIV rapid tests compared with fourth-generation enzyme immunoassays or HIV RNA tests. Aids. 2016;30(12):1951-60.
  26. World Health Organization. Consolidated guidelines on HIV testing services, 2019 WHO, Geneva.
  27. Continuum HC. HIV. 2017. Available from: [https://www. hiv. gov/federal-response/policies-issues/hiv-aids-care-continuum]
  28. The HIV test-and-treat cascade [Internet]. The HIV test-and-TREAT CASCADE – AIDS [Updated 2020 cited 2022Feb1]. Available from: [https://aids2020.unaids.org/chapter/chapter-2-2020-commitments/the-hiv-test-and-treat-cascade/]
  29. UNAIDS. Geneva: UNAIDS; 2014. 90-90-90: an ambitious treatment target to help end the AIDS epidemic.
  30. Jamieson D, Kellerman SE. The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?. J Int AIDS Soc. 2016;19(1):20917.
  31. UNAIDS. Understanding fast-track: accelerating action to end the AIDS epidemic by 2030. UNAIDS Geneva.. 2015.
  32. National HIV and AIDS strategic framework-2007 – 2012. National AIDS Control Programme. [cited 2022Mar28]. Available from: [https://nacp.gov.pk/repository/howwework/Strategies/NSF-NACP%20(2007-2012).pdf]
  33. Ahmed A, Hashmi FK, Khan GM. HIV outbreaks in Pakistan. Lancet HIV. 2019;6(7):e418.
  34. Lavreys L, Baeten JM, Chohan V, McClelland RS, Hassan WM, Richardson BA et al. Higher set point plasma viral load and more-severe acute HIV type 1 (HIV-1) illness predict mortality among high-risk HIV-1–infected African women. Clin Infect Dis. 2006;42(9):1333-9.
  35. Le T, Wright EJ, Smith DM, He W, Catano G, Okulicz JF et al. Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy. New Eng J Med. 2013;368(3):218-30.
  36. Strain MC, Little SJ, Daar ES, Havlir DV, Günthard HF, Lam RY, Daly OA, Nguyen J, Ignacio CC, Spina CA, Richman DD. Effect of treatment, during primary infection, on establishment and clearance of cellular reservoirs of HIV-1. J Infect Dis. 2005;191(9):1410-8.
  37. Council A. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. [https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines]
  38. Zash R, Holmes L, Diseko M, Jacobson DL, Brummel S, Mayondi G et al. Neural-tube defects and antiretroviral treatment regimens in Botswana. New Eng J Med. 2019;381(9):827-40.
  39. Standard operating procedures for HIV treatment and care centers 2006 [Internet]. Strategies - national AIDS control programme. [cited 2022Mar28]. Available from: [https://nacp.gov.pk/howwework/standardoperatingprocedures.html]
  40. Consolidated guidelines for the prevention and treatment of HIV and AIDS in Pakistan 2020. Technical guidelines - national AIDS control programme. [cited 2022Mar28]. Available from: [https://nacp.gov.pk/howwework/technicalguidelinestac.html]
  41. WHO. Consultation on HIV Differentiated Service Delivery Models for Specific Populations and Settings: Pregnant and Breastfeeding Women, Children, Adolescents and Key Populations.
  42. Centers for Disease Control and Prevention: US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 Update: a clinical practice guideline. Available from:[https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf.]
  43. About prep. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [Updated 2021 cited 2022Mar28]. Available from: [https://www.cdc.gov/hiv/basics/prep/about-prep.html]
  44. Centers for Disease Control and Prevention. HIV prevention pill not reaching most Americans who could benefit—especially people of color [Press Release]. National center for HIV/AIDS, viral Hepatitis, STD, and TB prevention. Atlanta, GA: Centers for Disease Control and Prevention. 2018.
  45. A snapshot of PrEP scale-up, registration and resources for Pakistan. Available from: [https://www.prepwatch.org/country/pakistan/
  46. Learn about pep [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; [Updated 2022 cited 2022Mar29]. Available from: [https://www.cdc.gov/hiv/clinicians/prevention/pep.html]
  47. Dominguez KL, Smith DK, Thomas V, Crepaz N, Lang K, Heneine W et al. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016.
  48. Pebody R. How effective is post-exposure prophylaxis (PEP)? [Internet]. aidsmap.com. [Updated 2019 cited 2022Feb1]. Available from: [https://www.aidsmap.com/about-hiv/how-effective-post-exposure-prophylaxis-pep]
  49. Baqi S, Abro AG, Salahuddin N, Ashraf Memon M, Qamar Abbas S, Baig-Ansari N. Four years of experience with antiretroviral therapy in adult patients in Karachi, Sindh, Pakistan. Int Health. 2012;4(4):260-7.
  50. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available from: [http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf]

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2023 Journal of Pakistan Society of Internal Medicine.
📃 In This Issue View All
Original Article Prevalence of Hypertension Among Urban Adults in Pakistan: A Cross-Sectional Study Khan TM, Ahmed S, Malik RA Original Article Outcomes of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Retrospective Analysis Raza SH, Butt N, Qureshi AM Original Article Neonatal Sepsis: Bacteriological Profile and Antibiogram in a Tertiary Care Hospital Iqbal M, Rashid T Original Article Serum Ferritin as a Prognostic Marker in COVID-19 Severity: A Hospital-Based Study Rehman N, Sheikh I, Javed K Review Article Statin Therapy in Non-Alcoholic Fatty Liver Disease: A Systematic Review Nawaz F, Cheema HA, Mehmood Y
👥 More by These Authors
Review Article Antibiotic Resistance Patterns in Community-Acquired Pneumonia: Emerging Trends Hussain I, Farooq Z Original Article Impact of Diabetes Mellitus on Post-Operative Wound Healing in General Surgery Siddiqui FA, Noor M, Akhtar W Original Article Cervical Cancer Screening Awareness Among Rural Women in Punjab Bibi S, Anjum R, Hassan F Review Article Thyroid Disorders in Pregnancy: Clinical Implications and Management Strategies Baig BI, Usman A
🔗 Related Articles By Keywords
Original Article Neonatal Sepsis: Bacteriological Profile and Antibiogram in a Tertiary Care Hospital Iqbal M, Rashid T Original Article Serum Ferritin as a Prognostic Marker in COVID-19 Severity: A Hospital-Based Study Rehman N, Sheikh I, Javed K Review Article Statin Therapy in Non-Alcoholic Fatty Liver Disease: A Systematic Review Nawaz F, Cheema HA, Mehmood Y Original Article Comparison of Ultrasound-Guided versus Landmark-Based Central Venous Catheter Insertion Zafar S, Gillani SA