Adult HIV was developed by doctors and nurses with wide experience in the care of adults with HIV, under the auspices of the Desmond Tutu HIV Foundation at the University of Cape Town. It covers: introduction to HIV infection, management of HIV-infected adults at primary-care clinics, preparing patients for antiretroviral (ARV) treatment, ARV drugs, starting and maintaining patients on ARV treatment, opportunistic infections

1. 6A
Skills workshop:
Screening tests
for HIV
B. The method of performing
Objectives the HIV rapid test
When you have completed this unit you 1. Clean a fingertip with an alcohol swab and
should be able to: allow the finger to dry.
• Screen a patient for HIV. 2. Remove a test strip from the foil cover.
• Interpret the results of the screening test. 3. Prick the skin of the fingertip with a lancet.
Wipe the first drop of blood away with a
Whenever possible, patients should be offered sterile gauze swab.
and encouraged to accept screening for HIV. 4. Collect the next drop of blood with the
An HIV rapid test can be used in any clinic, as EDTA tube. Either side of the tube can be
no sophisticated equipment is required. Prior used to collect blood. Fill the tube from
to testing, patients need to be counselled and the tip to the first black circle (i.e. 50 μl of
consent must be obtained. blood). Avoid collecting air bubbles.
5. Apply the 50 μl of blood from the EDTA
tube onto the sample pad marked with an
A. Equipment needed to
arrow on the test strip.
perform an HIV rapid test
6. Wait one minute until all the blood has
1. The Abbott Determine HIV-1/2 Whole been absorbed into the sample pad and
Blood Assay. Each kit contains 10 cards then apply one drop of Chase Buffer. It is
with 10 tests. The Chase Buffer (2.5 ml important that the bottle is held vertically
bottle) is supplied with the kit. (upside down) above the test strip when
2. EDTA capillary tubes marked to indicate the drop of buffer is dropped onto the
50 μl, lancets, alcohol swabs and sterile sample pad.
gauze swabs. These are not supplied with 7. Wait a minimum of 15 minutes and then
the kit. read the results. The maximum waiting
time for reading the test is 20 minutes.
The kit needs to be stored at room temperature
After 20 minutes the test becomes invalid.
between 2 °C and 30 °C. Storage in a fridge is
required during summer. The kit cannot be
used after the expiry date. C. Reading the results of the HIV rapid test
1. Positive: A red bar will appear within
both the Control window and the Patient
window on the test strip. Any visible

2. SK ILLS WORKSHOP : SCREENING TESTS FOR HIV 103
red bar in the Patient window must be E. Management if the HIV
regarded as positive. The result is positive rapid test is positive
even if the patient bar appears lighter or
1. Explain to the patient that the first
darker than the control bar.
screening test for HIV is positive but that
2. Negative: A red bar will appear within the
this should be confirmed with a second test.
Control window and but no red bar is seen
2. Proceed with a second test using a kit from
in the Patient window.
a different manufacturer.
3. Invalid: If no red bar appears in the
3. If the second test is also positive, the
Control window, even if a red bar is visible
patient is HIV positive.
in the Patient window. The result is invalid
4. Proceed with post-test counselling for a
and the test must be repeated.
patient with a positive test.
D. The interpretation of the HIV rapid test
F. Management if the first HIV rapid test
The test is a specific test for HIV and will is positive but the second is negative
become positive when there are antibodies
1. A blood sample for an ELISA test must be
against HIV (the virus that cause AIDS) in
sent to the laboratory.
the blood.
2. The patient must be informed that
1. A positive test indicates that a person has the results of the HIV rapid tests are
antibodies against HIV (HIV positive). inconclusive and that a laboratory test
Therefore the person is infected with HIV. is required to finally determine her HIV
2. A negative test indicates that a person status.
does not have antibodies against HIV 3. If the ELISA test is positive the patient is
(HIV negative). Therefore the person is HIV positive (i.e. HIV infected).
not infected with HIV, unless infected very 4. If the ELISA test is negative the patient is
recently and the HIV antibodies have not HIV negative (i.e. not HIV infected).
appeared yet. 5. Proceed with appropriate counselling.