HIV Prevalence among Medical Inward Patients in the National Hospital of Sri Lanka (NHSL) with the Assessment of Patient Acceptance, the Feasibility and Challenges of the Hospital Based Rapid HIV Diagnostic Test

Introduction: Hospital based HIV Rapid Diagnostic Testing (RDT) was introduced in 2018, following programmatic decision. However, being the province with the highest HIV prevalence in the country, the number of hospital based rapid testing carried out in Western province was not impressive, leading to missed opportunities and late diagnosis. Therefore, RDT was re-implemented in selected medical wards of NHSL.

Objective: To assess the case detection rate, the feasibility and challenges of the rapid HIV testing services among inpatients of medical wards of NHSL.

Method: A descriptive demonstration study, carried out among consecutive 3,395 new admissions to selected medical wards of the NHSL within three months period. HIV status was tested on finger prick blood, using FDA and WHO approved 4th generation HIV RDT (with 100% sensitivity, 99.7% specificity) following informed consent. Patient information were extracted from bed head tickets. Focus Group Discussions (FGD) were carried out with the relevant hospital staff to assess the challenges. Confidentiality of patients ensured by training all the health care workers involved in RDT and followed up of the positive test results, according to the national guidelines

Results: Among the 3395 participants, eight (8) were found to be positive, with the HIV prevalence of 0.23 %. The patient acceptance rate was 96%. Out of the positives, majority were males (n=6) and married (n=5) and half of them were from the Colombo district. Only two (25 %) had AIDS defining symptoms while the majority (n=5) had baseline CD4 count less than 200 cells/μl . Work overload, consent taking, lack of confidence in post-test HIV counselling were identified as major areas of concern.

Conclusions: Hospital-based HIV rapid testing is one of the high yielding programmatic strategies implemented in the country so far. The positivity rate of the study sample was 0.23% which is higher than the HIV positivity rate reported through different testing strategies including the general public (0.03%), and STD samples (0.1%). Further, beating up the challenge of missed opportunities and late diagnosis was highlighted. Therefore, addressing the identified barriers through policy and administrative support and further scaling up of hospital-based HIV testing is highly recommended.