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Development of an evidence-based model of rapid testing, counseling and referral patients with HIV, HVC and other STDs in Mexican addiction treatment centers.

INTRODUCTION

In Mexico, epidemiological monitoring systems estimate that there are approximately 200,000 people living with HIV/AIDS (PLHIV), equivalent to .24% of the general population. Estimated prevalence of the Hepatitis C virus (HCV) is 1.4% with an annual incidence of approximately 19,300 cases; whereas for the hepatitis B virus (HBV) it has been estimated at between .16% and .33%; while a prevalence of 1.53% has been found for syphilis (Nattional Center for the Prevention and Control of HIV and AIDS [CENSIDA, by its acronym in Spanish], 2019; Fundacion Mexicana para la Salud Hepatica, 2011).

It is also known that in Mexico, as in many parts of the world, the HIV epidemic focuses on key populations (CENSIDA, 2019): men who have sex with other men (MSM), persons deprived of their liberty (PDL) or incarcerated, sex workers (SW), transgender people (TP), and people who use drugs of abuse (particularly people who inject drugs [PWIDs]), the latter being one of the major public health concerns, since it is associated with clinical and psychosocial complications that hamper the detection, diagnosis and treatment of any STI or blood-borne viruses (BBV) (Marin-Navarrete, Magis-Rodriguez, & Strathdee, 2017).

SUDs and their relationship with HIV and other STIs

International reports estimate that over 50% of PLHIV have had a substance use disorder (SUD) (Rabkin, McElhiney, & Ferrando, 2004).

Although it is true that it is necessary to differentiate between a SUD and non-problematic use of alcohol, tobacco and/or other substances of abuse, it has been found that substance use in PLHIV is generally associated with health risk behaviors, immunosuppression, poor adherence to antiretroviral treatment, an increase in the disease burden, greater morbidity and mortality and higher medical care costs (Chander, Himelhoch, & Moore, 2006). It should also be borne in mind that the use of substances of abuse constitutes an indirect and direct transmission vector. The former is characterized by increasing the likelihood of participating in risky sexual behaviors (unprotected sex, multiple sexual partners, group sex, among others) since it inhibits judgment, heightens sexual arousal and increases impulsivity. The latter is associated with the use of injectable drugs, since PWIDs frequently exchange syringes and other drug paraphernalia, thereby significantly increasing the risk of transmission (Klinkenberg & Sacks, 2004; Strathdee et al., 2008).

In addition to HIV, the most prevalent BBV in people with SUD is HCV, since a prevalence of over 90% has been estimated in PWIDs, in addition to the fact that it is associated with a higher risk of co-infection. In this regard, there is evidence that HCV/HIV coinfection accelerates the course of HCV infection with fatal outcomes of terminal liver disease (Altice, Kamarulzaman, Soriano, Schechter, & Friedland, 2010).

Studies have reported that the prevalence of co-infection between HIV and HBV in the general population ranges from 5% to 20%, but that in PWIDs it is just under 30% (Singh et al., 2017; Thio et al., 2002). As with other diseases, HBV/HIV coinfection is common, causing a greater risk of developing liver cirrhosis and hepatocellular carcinoma, with up to sixfold progressions of liver disease (Sulkowski, Thomas, Chaisson, & Moore, 2000). HIV infection affects the immune system in many ways, which directly or increase: a) HBV liver fibrosis, (depleting CD4 cells, which in turn cause liver damage), b) hepatotoxicity caused by medication, and c) the presence of opportunistic infections (Benhamou et al., 1999; Sulkowski et al., 2000).

Another important STI in drug users is syphilis, for which a prevalence of 3% is estimated, rising to between 8% and 20% for PWIDs (Rhodes et al., 2006; Centers for Disease Control and Prevention, 2019). Since primary syphilis acts as a facilitator of both HIV transmission and acquisition, it is a matter of concern in the expansion of the HIV epidemic in key populations. It has therefore been hypothesized that the increase in the syphilis rate is associated with the increase in recreational use of psychostimulant drugs (such as cocaine, amphetamines, methamphetamines and synthetic cathinones) and alcohol, which can be mitigated by safe sex practices (condom use), whether oral, anal and/or vaginal (Wong, Chaw, Kent, & Klausner, 2005; Marcus et al., 2006).

Like other infectious conditions, syphilis shows transient increases in viral load and reduces the CD4 cell count. These increases contribute to the risk of HIV transmission, facilitating concordance between the two viruses. (Quinn et al., 2000).

From this perspective, the use of alcohol and other drugs is a transversal axis of utmost importance since virtually all groups in a situation of vulnerability (adolescents, orphans, children in street situations, people with disabilities, migrants, women and indigenous people) and key populations (MSM, PDL, SW, TP and PWIDs) are susceptible to use substances and develop SUDs (Scheinmann et al., 2007).

Barriers to access to STIs treatment services in substance users

Among substance users, there are barriers that limit help seeking, which impacts detection, diagnosis and treatment. In this regard, the specialized literature identifies the following as barriers: a) lack of knowledge of medical comorbidities and their impact on health, b) misperceptions about STIs and their treatment, c) lack of symptoms, d) employment status (self-employment/unemployment), e) unstable housing (people in street situations, etc.), f) social stigma and g) difficulties accessing specialized health services (Grebely & Tyndall, 2011; Treloar, Newland, Rance, & Hopwood, 2010). In relation to access, HIV is known to disproportionately affect people with limited economic resources, who generally lack social security or insurance policies for medical expenses.

Fortunately, in Mexico, HIV treatment is free, which is not the case for other viruses such as HCV, since access to public services for detection, diagnosis and treatment is limited, a situation associated with the increase in morbimortality due to HCV (Centra de Investigation en Enfermedades Infecciosas [CIENI], 2011).

Another common structural barrier in health systems is the disconnection between programs for the care of SUDs and other mental disorders in programs for the care of HIV/AIDS and other STIs. The absence of effective reference and counter-reference algorithms makes it difficult and complex for patients to navigate health services (Szerman et al.,2017).

As in other countries, the ability of the Mexican state to respond to major public health problems is limited (Marin-Navarrete, Medina-Mora, Perez-Lopez, & Horigian, 2018), as is the case with chronic-degenerative and infec-to-contagious diseases, and mental and addictive disorders.

However, Mexico has a growing health system for the care of SUDs, HIV and other STIs. For SUDs, the supply of treatment consists of private care (very expensive for most of the people affected), public care (more than 400 outpatient centers and just under 30 residential units) and mutual assistance (over 20,000 groups based on the 12 AA steps and approximately 2,000 residential community care and peer assistance centers) (Marin-Navarrete, Medina-Mora, & Tena-Suck, 2014). For HIV/AIDS and other STIs, the supply of public treatment comprises 78 outpatient units (CAPASIT by its acronym in Spanish) and 63 hospital units (SAIH by its acronym in Spanish), which currently lack easily accessible programs for the treatment of HCV (CENSIDA, 2019).

Despite the progress achieved to date, there is a marked gap between both public care systems, due to the absence of reference and counter-reference algorithms to facilitate patients' navigation. This situation highlights the need for inter-institutional models and programs based on scientific evidence that will contribute to the integration of public health systems and facilitate interaction between centers for the treatment of SUDs and centers for the care of HIV and other STIs, with the goal of strengthening the care cascade.

The purpose of this article is to present the narrative of the process for the development of a standardized model based on scientific evidence for the detection, orientation and reference of people with HIV, HBV, HCV and syphilis at addiction treatment centers in the public health system in Mexico.

METHOD

Study design and sites

As part of a strategic plan for the development of the model, two collaborative work teams were formed, one consisting of medical science researchers at the Clinical Trials Unit on Addictions and Mental Health of the Ramon de la Fuente Muniz National Institute of Psychiatry (UEC-INPRFM by its acronym in Spanish), which served as the leading team for the implementation of the study and a team of experts on HIV and other STIs from the National Center for the Prevention and Control of HIV/AIDS (CENSIDA by its acronym in Spanish), who served as specialized advisors. Under a collaborative work scheme, a development methodology of the model was established: a) review of the scientific literature, b) feasibility study, c) integration of the final version of the model.

Procedure

Section 1: Review of the scientific literature

A systematic review of the scientific literature was undertaken to identify: a) basic concepts of HIV and other STIs, b) their relationship with the use of alcohol and other drugs of abuse, c) evaluation of risky sexual behaviors, d) application of rapid testing to detect HIV, HCV and other STIs, and e) specialized psychological counseling. The review of the scientific literature was conducted through a systematized search of information from the past five years, using the PubMed, Scielo, and Google Scholar search engines. To this end, a search algorithm was generated that included keywords on the study topics. Articles, guides and scientific manuals were selected through a process of consensus between members of both collaborative work teams, on the basis of their quality and scientific relevance, to ensure that the guides and manuals were written using scientific methods and bases, in addition to being products agreed on by experts and endorsed by prestigious scientific organizations in this field of health knowledge. Following the selection and review of the literature, a group of key recommendations for the development of the model was drawn up: a) general principles of psychological counseling and the application of rapid testing (Table 1), b) considerations for the psychological counseling process and the application of rapid testing (Table 2), c) considerations regarding users of substances of abuse (Table 3), and d) considerations for giving back results and referral to health services (Table 4). Lastly, the systematic review of the scientific literature made it possible to use scientific evidence to construct a model of Brief psychological counseling for the application of rapid testing (OPB-APR by its acronym in Spanish) comprising three key components: a) brief psychological counseling, b) application of rapid testing for the detection of HIV and other STIs, and c) the exploration of risky behaviors (sexual practices and injected drug use), which will be described later.

Section 2: Feasibility Study

Cognitive laboratories

In order to systematically capture the procedures of the OPB-APR model, a standardized manual/guide was developed, which underwent a cognitive laboratory process to ensure that the theoretical content, support materials and graphic resources were cognitively ergonomic (clear, understandable and intuitive), for the health professionals who would be trained in the model.

Each cognitive laboratory was made up of at least ten people, including health professionals (doctors, nurses and psychologists). The cognitive laboratories were carried out in three stages: content presentation, information gathering and consensus groups. In the first stage, each participant read the information corresponding to the components of the model, with the aim of identifying words, ideas or fragments that were difficult to understand. In the second stage, participants received semi-structured questionnaires (which included open-ended and multiple-choice questions) to express their comments, which included recommendations to improve the understanding of the fragments identified.

In the third stage, a member of the collaborative work team presented the problematic words, ideas or fragments, as well as the recommendations made. Subsequently, a discussion between the participants was coordinated with the aim of agreeing on the recommendations that would be used to increase understanding of the documents presented. Lastly, the collaborative work team incorporated the suggested modifications for each component, which resulted in the final design of the OPB-APR model manual/guide.

Field team formation and training

Three field teams were formed, each comprising six non-specialized health professionals (psychologists, nurses and general practitioners), with the aim of conducting feasibility tests on the OPB-APR model.

Likewise, specific training was developed for the field teams in order for their members to develop the skills (knowledge, attitudes and skills) required for the implementation of the procedures and components of the OPB-APR model.

The training lasted 42 hours, divided into seven six-hour sessions. The first session consisted of the presentation of basic aspects of HIV and other STIs, as well as their relationship with SUDs. The second session focused on the basic characteristics of psychological counseling. The third session addressed the exploration of risky sexual behaviors in people who use alcohol and other substances of abuse. The fourth session dealt with the brief, specific psychological counseling for the application of rapid HIV, HBV, HCV and syphilis tests. Sessions five and six focused on the management and application of rapid testing. Session seven provided a detailed explanation of the study and model procedures and implemented skills development strategies such as modeling and role play. At the end of the training, participants' understanding of OPB-APR model procedures was tested.

Field tests

For the field tests, the collaborative work teams of UEC-IN-PRFM and CENSIDA formed three field work teams, each consisting of five psychologists and a supervisor (a doctor or a psychologist). All members of the field work team were certified in the OPB-APR model procedures. Field tests were carried out in residential (n = 31) and outpatient (n = 10) treatment centers in four states in Mexico (Mexico City, Puebla, Mexico State, and Hidalgo), achieving a total of 600 applications of OPB-APR model procedures. For more information on the research protocol and results, see the associated articles (Sanchez-Dominguez, Villalobos-Gallegos, Felix-Romero, Morales-Chaine, & Marin-Navarrete, 2017; Villalobos-Gallegos et al, 2019; Marin-Navarrete, Magis-Rodriguez, Medina-Mora, & Uribe-Zuniga, 2019; Marin-Navarrete, Villalobos-Gallegos, Medina-Mora, & Magis-Rodriguez, 2019).

Section 3: Integration of the final version of the OPB-APR model

Throughout the process, meetings were periodically held between the collaborative work and field teams to identify procedures that might experience complications when implemented in real treatment scenarios for SUDs. During the meetings, the procedures were evaluated and field staff were given feedback to increase adherence to the OPB-APR model components. Lastly, comments and recommendations that had arisen during the meetings were used to draft the final version of the OPB-APR model manual/guide.

Ethical considerations

This study was implemented with the approval of the IN-PRFM Research Ethics Committee (CEI/C071/2016). Likewise, all procedures were performed in accordance with good research practices in human subjects, and both participating patients and health professionals gave their written consent for inclusion in the study (Marin-Navarrete, Villalobos-Gallegos et al., 2019).

RESULTS

After the multi-stage process, the final version of the OPBAPR model was obtained, whose main objective is the detection of new cases of HIV infection and other STIs to refer them to antiretroviral treatment. It also seeks to increase the perception of risk of situations and behaviors associated with contracting or transmitting a STI or BBV, in addition to promoting the development of personalized strategies to prevent and reduce the risk of infection.

The OPB-APR model consists of two parts: the first part explores and provides feedback on risk behaviors and situations (risky sexual behavior and substance use) for contracting STIs or BBVs. The second part focuses on providing feedback on the rapid testing results, as well as offering specific recommendations for risk prevention and reduction. The whole procedure lasts approximately 30 minutes. Specifically, the OPB-APR model consists of five focused steps (Figure 1):

* Step 1. Presentation and description of the procedure: In this step, the counselor provides general information on the procedure, requests written informed consent and provides answers on the information provided.

* Step 2. Application of rapid tests: This involves aseptic procedures, blood sampling through finger pricks, using a reagent kit and disposing of materials.

* Step 3. Exploration of and feedback on risk behaviors: This consists of applying the questionnaire on risky sexual behaviors and the use of alcohol and other substances of abuse.

* Step 4. Reporting results: This step involves reviewing and analyzing the results of the rapid testing, considering the information obtained in the forms. In addition, feedback is provided on the results and a risk reduction plan is drawn up.

* Step 5. Reference to services and delivery of information brochures: This final step is designed to provide patients with brochures with general information on STIs and safe sex practices. Cases with reactive results are informed about public care services where they can have confirmatory tests and receive comprehensive treatment that includes ART.

DISCUSSION AND CONCLUSIONS

Using substances by any route of administration increases the risk of contracting a STI, co-infections, medical complications, poor adherence to antiretroviral treatments and therefore increases morbidity and mortality rates. In this respect, SUDs form a transverse axis that significantly impacts vulnerable groups and key populations (Marin-Navarrete, et al., 2017; Marin-Navarrete, Magis-Rodriguez, et al., 2019).

The purpose of this article was to present the narrative of the process for the development of a standardized model based on scientific evidence for the detection, orientation and referral of people with HIV, HBV, HCV and syphilis at addiction treatment centers in the Mexican public health system. This aim is based on the theoretical assumption that the detection of probable cases increases access to antiretroviral therapy (ART), which is associated with a reduction in the transmission, progression and death of people due to advanced immunological disease. It also seeks to adhere to the recommendations of the US Preventive Services Task Force on the application of rapid testing to all those at increased risk of contracting HIV, HCV and other STIs (Moyer, 2013), and of WHO for the implementation of harm reduction strategies (The Joint United Nations Program on HIV/AIDS [UNAIDS], 2016).

As a result of the process, the OPB-APR model was obtained, which was developed with the goal of constructing a standardized model based on scientific evidence that will contribute to strengthening the public health system in Mexico as a fundamental element in achieving the goal established by UNAIDS known as 90-90-90, which sets three specific goals in the HIV/AIDS care cascade for 2020:

(1) 90% of all PLHIV will know their serological status;

(2) 90% of all people diagnosed with HIV will receive sustained ART; and 90% of all people receiving ART will achieve viral suppression (The Joint United Nations Program on HIV/AIDS [UNAIDS], 2014), and HIV will have been eradicated worldwide by 2030 (UNAIDS, 2014).

Likewise, having a detection, orientation and referral model, based on scientific evidence, contributes to the reduction of barriers that exist in health services (Schneider et al., 2006; Rawat, Uebel, Moore, Cingl, & Yassi 2018), and the personal barriers that influence the initiation of ART (Posse, Meheus, Van Asten, H., Van Der Ven, & Baltussen, 2008; Johnson et al., 2015). Barriers reported by various studies include lack of training in the application of rapid tests. This can be offset by basic training to offer psychological guidance, provide feedback on safe sexual behaviors to reduce the likelihood of transmission of HIV and other STIs, and liaise with health services for the application of supplementary (confirmatory) tests and/or initiating ART (Posse et al., 2008; Rawat et al., 2018; Johnson et al., 2015) to prevent late diagnoses and ensure that PLHIV improve their quality of life through early detection (Magis-Rodriguez, Villafuerte-Garcia, Cruz-Flores, & Uribe-Zuniga, 2015).

In Mexico, implementing a permanent program for monitoring risk behaviors and detecting HIV, HCV and other STIs in the population of people receiving treatment for SUDs can be a major task for a single system (CAPASIT and SAIH), since the universe of people with SUDs is larger than that of people with HIV, HCV and other STIs. Thus, incorporating professionals from addiction treatment centers in the public system into a permanent program for detection, orientation and referral could significantly strengthen the actions for achieving the eradication of HIV by 2030, in addition to significantly impacting the detection and care of HCV and other STIs.

In this respect, the OPB-APR model can serve as a key element in the implementation of risk and harm reduction strategies in people who use substances of abuse by any route of administration.

Another advantage of this proposal is that the OPBAPR model would enable the homologation of procedures between health professionals who are specialized in HIV and other STIs and those who are not (general practitioners, nurses, psychologists, etc.) for their performance in clinical and community settings. Since it is a standardized procedure, it would be feasible to transfer the implementation of the model to community agents who have direct contact with members of key populations, including PWIDs and thus strategically contribute to the country's efforts to prevent HIV and other STIs.

Funding

This study was funded by the National Council of Science and Technology (CONACYT) grant number 262500 awarded to RMN. During the development of the manuscript, LVG received funding from the National Council of Science and Technology (CONACYT) through doctoral award no. 383294.

Conflict of interest

The authors declare they have no conflict of interest. Neither INPRFM nor CENSIDA took part in the analysis of the information, preparation of the manuscript or the decision to publish. This paper reflects the opinions of the authors alone.

Acknowledgements

The authors express their gratitude to Centros de Integration Juvenil A.C., the Institute Mexiquense Contra las Adicciones, the Institute para la Atencion y Prevention de las Adicciones de la CDMX and the Consejo Estatal Contra las Adicciones de Puebla, for their institutional support in implementing this study.

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Rodrigo Marin-Navarrete, (1) Carlos Magis-Rodriguez, (2) Luis Villalobos-Gallegos, (3) Adriana Villafuerte-Garcia, (2) Alejandro Perez-Lopez, (1) Karen Ruiz-Herrera, (2) Ricardo Sanchez-Dominguez, (1) Marisol Ponce-Ramos, (2) Anette Morales-Careano, (2) Enrique Bravo-Garcia, (2) Patricia Uribe Zuniga, (2) Maria Elena Medina-Mora (1)

(1) Unidad de Ensayos Clinicos en Adicciones y Salud Mental, Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz. Ciudad de Mexico, Mexico.

(2) Centro Nacional para la Prevencion y el Control del VIH y el Sida. Ciudad de Mexico, Mexico.

(3) Facultad de Medicina y Psicologia, Universidad Autonoma de Baja California-Campus Tijuana, Mexico.

Correspondence: Rodrigo Marin-Navarrete

Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz, Unidad de Ensayos Clinicos en Adicciones y Salud Mental.

Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, Ciudad de Mexico, Mexico.

Phone: +52 55 4160 - 5480

Email: rmarin@imp.edu.mx

Received: 23 July 2019

Accepted: 20 August 2015

DOI: 10.1771/SM.0185-3325.2019.025
Table 1
General principles of psychological counseling and application of quick
tests

Guidelines for the management
of HIV and other STIs  Country

CDC, 2016              United States
HEALTH, 2015           South Africa
WHO, 2015              International
NACP, 2013             Tanzania
CENSIDA, 2006          Mexico
CDC, 2016              United States
NICE, 2016             England
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
NACP, 2013             Tanzania
HAS, 2009              France
BHIVA, 2008            British
HAS, 2008              France
CENSIDA, 2006          Mexico
NICE, 2017             England
CDC, 2016              United States
NICE, 2016             England
WHO, 2016              International
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
CENSIDA, 2006          Mexico
NICE, 2017             England
CDC, 2016              United States
NICE, 2016             England
HEALTH, 2015           South Africa
MSSSI.2014             Spain
NACP, 2013             Tanzania
HAS, 2009              France
CENSIDA, 2006          Mexico
NICE, 2016             England
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
HAS, 2009              France
HAS, 2008              France
NICE, 2016             England
CDC, 2016              United States
HEALTH, 2015           South Africa
WHO, 2015              International
MSSSI, 2014            Spain
NACP, 2013             Tanzania
CENSIDA, 2006          Mexico
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
CDC, 2016              United States
NICE, 2016             England
WHO, 2015              International
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
HAS, 2009              France
CDC, 2016              United States
NICE, 2016             England
HEALTH, 2015           South Africa
WHO, 2015              International
NACP, 2013             Tanzania
CDC, 2016              United States
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
NACP, 2013             Tanzania
CENSIDA, 2006          Mexico

Guidelines for the management
of HIV and other STIs  Recommendations
CDC, 2016              Both psychological counseling and
HEALTH, 2015           rapid testing should be carried
WHO, 2015              out with professional and ethical
NACP, 2013             responsibility, based on human
CENSIDA, 2006          rights and developed in a
                       supportive environment.
                       Accordingly, every person
                       must be treated with
                       dignity and equality,
                       not discriminated against
                       and receive fair work practices.
CDC, 2016              Ensure and underline the fact that all
NICE, 2016             information concerning the user
HEALTH, 2015           is strictly confidential (health
MSSSI, 2014            status, results, treatment,
NACP, 2013             risk practices).
HAS, 2009
BHIVA, 2008
HAS, 2008
CENSIDA, 2006
NICE, 2017             The user's consent can be verbal, except
CDC, 2016              in the case of research, children,
NICE, 2016             or people with cognitive impairment,
WHO, 2016              in which case it will have to be written
HEALTH, 2015
MSSSI, 2014
CENSIDA, 2006
NICE, 2017             Psychological counseling and rapid
CDC, 2016              testing are voluntary processes,
NICE, 2016             the user has the right to request
HEALTH, 2015           information and ask questions at
MSSSI.2014             any time. They also have the
NACP, 2013             right to withdraw their consent
HAS, 2009              at any time during the process
CENSIDA, 2006          without their decision having
                       an impact on access to health
                       services and they must be
                       provided with sufficient
                       information and referrals
                       to other health services
                       which they can seek at
                       a later date.
NICE, 2016             In order for the user to decide
HEALTH, 2015           whether or not to give their
NACP, 2013             consent, they must be given
HAS, 2009              clear, concise information,
HAS, 2008              about the forms of infection,
                       transmission, timely diagnosis,
                       treatment, as well as the benefits,
                       implications and procedures for
                       psychological counseling and
                       rapid testing.
NICE, 2016             Psychological counseling and rapid
CDC, 2016              testing services should
HEALTH, 2015           sufficient, accurate user-centered
WHO, 2015              information that addresses their
MSSSI, 2014            needs and risks.
NACP, 2013
CENSIDA, 2006
HEALTH, 2015           Psychological counseling and rapid
NACP, 2013             testing services must be regulated
                       by standardized operating procedures
                       to ensure the quality and
                       reliability of the process
                       to provide correct results
                       to users, meaning that they
                       must be monitored and evaluated.
CDC, 2016              A counselor can be anyone who has been
NICE, 2016             trained to provide orientation
WHO, 2015              services and apply rapid testing.
HEALTH, 2015
NACP, 2013
HAS, 2009
CDC, 2016              Counselors should have supervision and
NICE, 2016             training, at least once a year, to
HEALTH, 2015           perform proce- dures safely and
WHO, 2015              effectively.
NACP, 2013
CDC, 2016              Simple, clear language that is
HEALTH, 2015           understandable and appropriate
MSSSI, 2014            for the user should be  used.
NACP, 2013             A friendly, respectful, sensitive
CENSIDA, 2006          and discreet approach should be adopted.

Notes: CDC: Centers for Disease Control; HEALTH: the National
Department of Health Republic of South Africa; WHO: World Health
Organization; NACP: National AIDS Control Program; CENSIDA: National
Center for the Prevention and Control of HIV and AIDS; NICE: National
Institute of Clinical and Healthcare Excellence; MSSSI: Ministry of
Health, Social Services and Equality; HAS: Haute Autorite de Sante;
BHIVA: British HIV Association, British Association of Sexual Health
and HIV, British Infection Society; PEP: Post-exposure prophylaxis;
PrEP: Pre-exposure Prophylaxis.

Table 2
Considerations for the process of counseling and application of quick
tests

Guidelines for the management
of HIV and other STIs  Country

CDC, 2016              United States
HAS, 2008              France
CDC, 2016              United States
HEALTH, 2015           South Africa
CDC, 2016              United States
HEALTH, 2015           South Africa
BHIVA, 2008            British
CDC, 2016              United States
HEALTH, 2015           South Africa
NOM-045                Mexico
NOM-087                Mexico
CDC, 2016              United States
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
NACP, 2013             Tanzania
CDC, 2016              United States

NACP, 2013             Tanzania
HEALTH, 2015           South Africa
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
NOM-087                Mexico

Guidelines for the management
of HIV and other STIs  Recommendations

CDC, 2016              Rapid testing can be applied in
HAS, 2008              various non-clinical settings,
                       since they do not require specialized
                       equipment or invasive sample
                       collection, and they can be
                       applied and the results
                       given back the same day.
CDC, 2016              The application manuals, material
HEALTH, 2015           and brochures used must be
                       available and accessible
                       to the counselor.
CDC, 2016              Services must be offered in a private
HEALTH, 2015           space that guarantees
BHIVA, 2008            confidentiality, has adequate
                       infrastructure (clean conditions,
                       good lighting and temperature)
                       and is comfortable for the
                       user.
CDC, 2016              Counselors must carry use universal
                       safety procedures for fluid
                       handling such as: Washing hands
                       before and after handling blood.
                       If soap and water are
                       unavailable, hand sanitizer
                       gel must be used.
HEALTH, 2015           Wearing latex gloves and putting
                       on a new pair for each user.
                       Not eating, drinking or handling
                       contact lenses in the test area.
NOM-045                Disinfecting the work surface with
NOM-087                chlorine. If the counselor has
                       direct contact with the user's
                       blood, they must report it to
                       their supervisor and seek
                       medical assistance.
CDC, 2016              The manufacturing instructions
HEALTH, 2015           contained in the packages of
NACP, 2013             each test must be followed.
NACP, 2013             Counselors must use the specific
                       diluting liquid for each test,
                       making sure it has not passed
                       its expiry date. If they have
                       expired, they should not be used.
CDC, 2016              Quick tests can be performed in the
                       same place where the counseling
                       is provided. In this case,
                       the tests must be covered or
                       put in an area not visible to
                       the user while waiting to
                       see the result.
NACP, 2013             Test results must be read within the
HEALTH, 2015           period of time specified in the
                       manufacturers' instructions.
                       Ensure that the red test control
                       line appears. If it does not
                       appear, this indicates that the
                       test has failed to meet the
                       quality criteria.
HEALTH, 2015           Used materials, lancets, gauze,
NACP, 2013             cotton or any material that may
NOM-087                contain blood must be disposed of in
                       specific containers.

Notes: CDC: Centers for Disease Control; HEALTH: the National
Department of Health Republic of South Africa; WHO: World Health
Organization; NACP: National AIDS Control Program; CENSIDA: National
Center for the Prevention and Control of HIV and AIDS; NICE: National
Institute of Clinical and Healthcare Excellence; MSSSI: Ministry of
Health, Social Services and Equality; HAS: Haute Autorite de Sante;
BHIVA: British HIV Association, British Association of Sexual Health
and HIV, British Infection Society; NOM: Official Mexican Standard.

Table 3
Considerations regarding of substance users

Guidelines for the management
of HIV, HCV and other STIs  Country

WHO, 2016                   International
NICE, 2016                  England
HEALTH, 2015                South Africa
WHO, 2014                   International
MSSSI, 2014                 Spain
NACP, 2013                  Tanzania
HAS, 2009                   France
NICE, 2016                  England

WHO, 2016                   International

NICE, 2016                  England

Guidelines for the management

of HIV, HCV and other STIs  Recommendations
WHO, 2016                   Psychological counseling
                            and application of rapid
                            testing should be offered
                            and recommended
NICE, 2016                  for anyone as part
                            of routine general health
                            care or for those taking part in a
HEALTH, 2015                substance management program,
                            as an effective, efficient way
                            to identify STIs (such as
WHO, 2014                   HIV, hepatitis B, hepatitis
                            C, syphilis, lymphoma and
                            tuberculosis).
MSSSI, 2014
NACP, 2013
HAS, 2009
NICE, 2016                  It is recommended to offer and
                            recommend the tests to people
                            with a high risk of contracting
                            or transmitting a STI in the
                            event that no screening tests
                            have been performed in the
                            past year.
WHO, 2016                   It is not recommended to apply
                            rapid testing to users who are
                            already under antiretroviral
                            treatment, have taken the PEP
                            or PrEP, as there is a potential
                            risk of an incorrect diagnosis.
NICE, 2016                  People who are under the
                            influence of drugs, alcohol
                            or other mental disorders
                            should not be evaluated,
                            since they are not in a
                            position to give their consent.

Notes: CDC: Centers for Disease Control; HEALTH: the National
Department of Health Republic of South Africa; WHO: World Health
Organization; NACP: National AIDS Control Program; CENSIDA: National
Center for the Prevention and Control of HIV and AIDS; NICE: National
Institute of Clinical and Healthcare Excellence; MSSSI: Ministry of
Health, Social Services and Equality; HAS: Haute Autorite de Sante;
BHIVA: British HIV Association, British Association of Sexual Health
and HIV, British Infection Society; PEP: Post-exposure prophylaxis;
PrEP: Pre-exposure Prophylaxis.

Table 4
Considerations for giving back results and referral to health services

Guidelines for the management

of HIV and other STIs  Country

NICE, 2016             England
MSSSI, 2014            Spain
NOM-010                Mexico
HAS, 2008              France
NICE, 2016             England
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
NON-reactive result    Country
NICE, 2016             England
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
CDC, 2016              United States
NICE, 2016             England
WHO, 2016              International
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
HAS, 2009              France
HAS, 2008              France
CENSIDA, 2006          Mexico
WHO, 2016              International
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
Invalid result         Country
CDC, 2016              United States
WHO, 2016              International
HEALTH, 2015           South Africa
NACP, 2013             Tanzania
CENSIDA, 2006          Mexico
Reactive result        Country
CDC, 2016              United States
WHO, 2016              International
NICE, 2016             England
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
HAS, 2008              France
CENSIDA, 2006          Mexico
Re-testing             Country
WHO, 2016              International
HEALTH, 2015           South Africa
MSSSI, 2014            Spain
HAS, 2009              France
BHIVA, 2008            British
WHO, 2016              International
NICE, 2016             England
BHIVA, 2008            British

Guidelines for the management

of HIV and other STIs  Recommendations

NICE, 2016             Results must always be given
                       back as part of counseling,
                       clearly, directly and without
MSSSI, 2014            redundancy, regardless of
                       the test result. Behavior
                       focusing on the user's
                       health should be
NOM-010                promoted, and referrals
                       made to health services
                       considered necessary.
HAS, 2008
NICE, 2016             Counselors should be aware
                       of and have information on
                       the health centers and places
HEALTH, 2015           where they can refer users
                       to obtain information on STIs,
                       sexual health, conducting con-
NACP, 2013             firmatory tests, interventions for
                       behavioral change, reviewing
                       health status, psychosocial
                       support and/or rehabilitation
                       for substance use, among
                       other aspects.
NON-reactive result
NICE, 2016             Users who obtain non-reactive
                       results in their tests should
                       be provided with information
HEALTH, 2015           on prevention, risk reduction
                       and referral to health services
                       in order to be able to access
MSSSI, 2014            various care and prevention
                       options.
CDC, 2016              If the user obtains non-reactive
                       results in their rapid testing,
                       but has recently engaged in
NICE, 2016             risky behaviors or been
                       exposed to risk, repeating
                       the tests once the window
                       period has
WHO, 2016              passed, and providing
                       information on care and
                       prevention is recommended.
HEALTH, 2015
NACP, 2013
HAS, 2009
HAS, 2008
CENSIDA, 2006
WHO, 2016              If the user obtains a
                       non-reactive result, and does
                       not report risk behaviors,
                       it is not necessary
HEALTH, 2015           to repeat the test.
                       They should be provided
                       with information on health
                       services in
NACP, 2013             case they wish to repeat
                       them at a later date.
Invalid result
CDC, 2016              If the user obtains an invalid
                       result in any of their tests,
                       which means that a human error
WHO, 2016              or a mistake involving the
                       test properties has occurred,
                       the test must immediately be re-
HEALTH, 2015           peated using a new kit.
NACP, 2013             If an invalid result is obtained
                       forthe second time, information
                       must be provided to the user
CENSIDA, 2006          so that they can have a
                       confirmatory test.
Reactive result
CDC, 2016              Rapid tests do not provide
                       a definitive diagnosis. Users
                       who obtain reactive results
                       should
WHO, 2016              be referred to health services
                       that provide confirmatory tests.
                       They should be given infor-
NICE, 2016             mation on safe sex practices
                       and risk behaviors.
HEALTH, 2015
MSSSI, 2014
HAS, 2008
CENSIDA, 2006
Re-testing
WHO, 2016              Recommend people who are
                       at risk of contracting or transmitting
                       an STI or who are at risk
HEALTH, 2015           of exposure to take the tests annually.
MSSSI, 2014
HAS, 2009
BHIVA, 2008
WHO, 2016              MSM are recommended to have
                       tests done annually. In the event
                       that they have unprotected
NICE, 2016             sex or casual sexual
                       partners, they are recommended
                       to have tests every three
BHIVA, 2008            months

Notes: CDC: Centers for Disease Control; HEALTH: the National
Department of Health Republic of South Africa; WHO: World Health
Organization; NACP: National AIDS Control Program; CENSIDA: National
Center for the Prevention and Control of HIV and AIDS; NICE: National
Institute of Clinical and Healthcare Excellence; MSSSI: Ministry of
Health, Social Services and Equality; HAS: Haute Autorite de Sante;
BHIVA: British HIV Association, British Association of Sexual Health
and HIV, British Infection Society; NOM: Official Mexican Standard.
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Title Annotation:ORIGINAL ARTICLE
Author:Marin-Navarrete, Rodrigo; Magis-Rodriguez, Carlos; Villalobos-Gallegos, Luis; Villafuerte-Garcia, Ad
Publication:Salud Mental
Geographic Code:1MEX
Date:Jul 1, 2019
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