Friday, August 19, 2011

Kelsey: How-to Friday! How to test for HIV.

Welcome to Mpumudde Health Center!

Step number one: Go to this place. This is our local health center. We offer HIV testing and counseling and family planning services. And they let me do all those things. Just follow the signs.

If you are not pregnant then you get to sit outside for hours and hours and wait at the out patient center to get your test done. 

If you are pregnant you get to wait inside the maternity ward in the same room where women are in labor. All pregnant women who come for prenatal visits are tested. This is to prevent mother to child transmission.

This is my lovely midwife friend sitting at the testing table.

These are the supplies:

Most people test with a finger prick. I usually draw blood because the lancets are always running low and I am one of the only people who knows how to draw blood (most of the people working are students). I tend to follow around the head midwife and bother her until she teaches me things. It works well.

These are Determine strips. They are the first in a series of three tests. If this test comes back negative then the person is HIV neg and no further tests have to be done at the time.

Clean the finger with an alcohol wipe. Sometimes we run out of these and clean the finger with cotton. I feel like this probably does not have the same effect...

Prick the finger and then squeeze some blood onto the test strip. I have to say that it is much easier to prick people than I thought it would be. Picking fingers, sticking needles into arms, giving injections it is all surprisingly easy. I thought I would feel bad sticking sharp objects into human skin, but I really dont. Does that say something about me?

Or if you can draw some blood. I really like blood when it is in tubes. I like it way less when it is gushing out of a person. That is just gross.

Take a dropper and put one drop of blood onto the end of the test strip.

Add a drop of buffer to it and wait for the test result.

The top line is the control and if the test is negative then only the top line appears. These tests (for the same person) are both positive. I redid the test just to make sure.  

This is the second test in the series, called Stat Pack. This test ended up being negative. This means we have to go to the third test, Uni-gold, to get the final result. Basically whatever the uni-gold result is is the final result.

But of course the hospital was out of Uni-gold. First I made this woman wait like 30 minutes for her results while I did her tests multiple times. And then I had to tell her to come back tomorrow, she may or may not have HIV. I guess its not really worse news than she had before. Except it really is. Its nerve wracking. The whole process feels very unfinished to me even when we have the third test. Like some lines appeared on a strip of paper and now I can tell you that you are HIV positive? Seems likes machines should be involved. Can anything really be accurate without a machine involved anyway? I suppose so.

I almost always get a negative result and get to tell people good news. We only get a few people who test positive each month. So testing is generally a really positive experience. I have learned how to communicate the good news even if I dont speak the language of the woman I am testing (which happens sometimes). I look quizzically at the strip for a couple seconds and then up at the woman and give her a big smile and a thumbs up. She looks relieved and I move onto the next person.

I have more stories to tell about testing but my hands hurt from doing laundry this morning. No more typing. Can't go on.


  1. What happens if a person is positive after all 3 tests?

  2. If they test positive on the first two tests or pos on the third test then we have to tell them they are HIV positive and counsel them. The moms start on prophylaxis so they dont pass the HIV on to the baby.

    We do like 30 minutes of counseling, tell her to bring back any sexual partners, then she has to come back once a month (whereas most only need to come in 3 or 4 times during their whole pregnancy) and we refer them to TASSO which is a really good organization working with people who are positive.

    Oh we also have to asses which stage they are at according to the World Health Org.

    We also give the mom a pill to take as soon as she goes into labor but I can' remember the name of it right now.

    Do you want more info?

    _ Kels

  3. Do you only deal with mothers? Do you have mothers who don't come back? Do they keep coming back after the birth? How do they get prophylaxis? What does the pateint get/do each month they have to come back?

  4. Almost entirely mothers. People can also come to get tested at our outpatient center. The people I test who aren't pregnant usually have been tested before in maternity an come back to that ward because they are familiar with us. A couple times a week a woman brings her spouse. Earlier this week a man was with his wife and he was super agitated. It seemed she had told him that the hospital required HIV testing of spouses (we def do not). And when he got there he claimed he was afraid of needles and like jumped out of the chair as soon as he found out it was not required for him to be there. Midwives made fun of him when he left saying all men are afraid of the results, not the needles.

    We have a lot of mothers who never come back. A couple weeks ago we had a mother leave before her third test was finished. Some student nurse was doing the testing and he made her wait for 2 hours and then I am pretty sure he forgot about her. Her result came back positive. I went to find her to tell her and she had left. I felt a little bit panicky knowing she was out there positive and pregnant and did not know it. But apparently it is not uncommon for that situation to happen. No one else worried.

    We also have lots of mothers who get their results and never come back. We hope they are getting pre natal care at another clinic but there is no way to tell. For regular HIV positive patients we have a mobile HIV team that goes to their homes and does check ups administers ARVs and so on. I have only seen this team go out a couple times, not sure how many people they reach.

    We give the women all the pills they need during their counseling. Its all free because it is a government hospital. But we are often out of stock of drugs and tests because we are a government hospital. Some women come to us already knowing their positive status and we have to retest them just for confirmation.If they are started on ARVs then we administer those drugs as well as prophylaxis. I am blanking on the name of the drug we commonly use. It starts with an E it will come to me.

    When the women come back they get a normal check up just a little more thorough to track their weight and the baby's size. We test them more frequently for malaria and sometimes other diseases because complications are worse for them.

    All mothers are supposed to keep coming back to us after delivery for at least two years to check on the baby and do vaccines and such. So the HIV pos patients also have to come. Their babies are tested after delivery I have never seen a case where HIV has been passed onto the baby. Sometimes we get women who come in to deliver who have not been to any pre natal visits. They usually have used some sort of local medicine. I've heard that these babies are most at risk for transmission.

    When I am testing I have to ask a bunch of questions including status of partner and when tested and how many sexual partners and yada yada. It is really surprising to me how many couples have one positive but the other not positive. Especially when the woman is preggers so they are clearly having unprotected sex. I mean its definitely possible but it makes me wonder if someone has gotten a faulty test result.

    Ooops I wrote a lot!

    - Kels

  5. Wow. How many hours a week are you there? How far away from your house? Do you get paid?

  6. I am just volunteering. I work 2 or 3 days a week. It depends when they have students and how qualified the students are. Basically I just come in when they are short staffed. It is really close to my house. Probably half a kilometer away. I keep waiting to see people I know there but the women come from pretty far to our clinic.

    - Kels