December 2: In India, of the approximately 2.35 million people living with HIV (PLHIV), only 1.78 million know their status. Important gains made in HIV testing nationwide have also been threatened over recent years, with people facing obstacles to accessing diagnostics during the pandemic. Bridging India’s testing gap is essential to strengthen the nation’s infection response and help meet the UNAIDS’ first goal – to diagnose 95% of all HIV-positive patients, which can lead to effective treatment for those diagnosed, prompting viral suppression and an end to new HIV infections by 2030.

Early and accurate detection of HIV positive patients is important to simplify the patient journey to access the needed care as quickly as possible. More so, it prevents future HIV transmissions, with individuals who are unaware of their infection 3.5 times more likely to transmit the virus to someone else. It also reduces the risk of patient morbidity and mortality.

Dr. Ishwar Gilada, Consultant in HIV in Infectious Diseases, Unison Medicare and Research Centre Mumbai and President of AIDs Society of India, said, “Across India, the HIV burden is significant. Yet, only 79.4% of the total estimated people living with HIV nationwide have been diagnosed positive. There remains a clear need to bridge the availability of diagnostic solutions so more people can have access to testing services. By using simple and scalable HIV testing offerings like rapid point-of-care tests under robust regulatory processes, we can plug such gaps in testing. Early testing and detection of infection, especially in acute cases where individuals have higher risk of transmission owing to high viral load, is critical. This facilitates timely treatment which can support better patient outcomes, while also curbing the spread of infection.”

Innovations like point-of-care testing, which refers to rapid HIV screening performed in clinical settings by professionals, are crucial to ensure timely infection detection. It also improves access to diagnostics, empowering people to easily know their infection status with accurate results in just 20 minutes. Rapid point-of-care solutions are especially critical in a nation like India, where access to diagnostics is limited in remote or rural areasof the country, and voluntary testing is also low.

Today, point-of-care testing standards continue to evolve, with the introduction of evidence-backed 4^th generation technology-based rapid tests, surpassing the previous era of 2^nd and 3^rd generation tests. These new tests are simple-to-use and identify 28% of infections missed by current 3^rd generation rapid tests, ensuring a larger segment of the population is aware of their infection status so they can swiftly access quality healthcare to manage their conditions. The test assists early detection, capable of identifying both HIV antibodies and the antigen, which can appear even 15-25 days after infection. Thus, it is more accurate in a shorter period of time. This is also crucial in blood bank screenings, where the window period of HIV detection can be almost halved.

Sunil Mehra, General Manager for Abbott’s Rapid Diagnostics business in India,commented, “Abbott is committed to scaling access of HIV diagnostic solutions to individuals at the point of care, ensuring fast and accurate results at critical points of infection. We believe that the 4^th generation of point-of-care testing reflects a new standard of testing, which supports earlier detection of HIV-positive cases, even when viral load is lesser, making way for new possibilities in patient care. In India, we are supporting private and government hospitals and diagnostic centres with these next-generation tools to help address the country’s HIV burden.”

4^th generation testing, equipped with high sensitivity and specificity, detects more acute infections,which account for 5 to 20% of all HIV infections among people seeking testing, compared to the previous generation of tests. This helps close the window period of detection earlier, within as early as 12 days of living with the HIV infection, as compared to a typical 20 days or later time period of detection seen by 3^rd generation tests.

Thus, HIV-positive patients can be quickly identified and linked to care. The chain of transmission can also be broken, which is especially important as acute infections are associated with higher viral load and risk of transmission.

Innovation in testing is thekey to supporting India’s efforts to reduce the national HIV burden, eliminate stigma, and enhance patient outcomes through access to early and appropriate treatment.

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