A Report of
Consultative Meeting on Community Based HIV Testing
29 June 2015
Hotel Orchid, Teku
Organized by
National Association of PLHIV in Nepal in association with
AHF Nepal
Background, Introduction and rationale:
People access HIV treatment, care and prevention through the gateway of HIV testing and
counseling. It is currently estimated globally that about half of the people living with HIV do not
know their HIV status. The people who do know often test late, and poor linkages from HIV testing
and counseling to care – including failure to assess rapidly for ART eligibility – mean that many
people start treatment when they are already significantly immunocompromised, resulting in poor
health outcomes and ongoing HIV transmission.
The overall HIV testing and counseling goal for a national HIV programme should be to identify as
many people living with HIV as early as possible after acquiring HIV infection, and link them
appropriately and in a timely manner to prevention, care and treatment services. The people tested
who are not infected should be linked to appropriate prevention services, such as voluntary male
medical circumcision in the priority countries in sub-Saharan Africa, or harm reduction services for
those who use drugs, and encouraged to retest at a later time.
Diverse models of HIV testing and counseling services are available to increase access to HIV
diagnosis, including testing services in health care facilities, freestanding sites and a wide range of
community-based approaches.
use of rapid HIV diagnostic tests that can be used at point of care has become an important strategy
to expand access, increase the return of same-day results and enable appropriate referral and
follow-up. Countries should choose a strategic mix of service delivery models to achieve equitable
access to HIV testing and counseling, based on the local context, the nature of the epidemic, cost–
effectiveness and available resources. The mix should facilitate diagnosing as many people living with
HIV as early as possible to enable timely linkage to ART. Strategies should be able to reach the people
who are most vulnerable, most-at-risk and marginalized.
The use of a single HIV test to diagnose HIV infection is not sufficient; it must be confirmed by
following the steps outlined in the updated WHO 2012 HIV testing strategies (algorithms)
Quality assurance systems should be put in place to minimize false-positive and false-negative
results. Failure to do this will lead to people being given incorrect test results, with potential serious
adverse long-term consequences. Quality assurance and quality improvement measures are also
important for the counseling process to ensure that HIV testing and counseling is always conducted
in an acceptable and effective manner.
Objectives of the Meeting:


To forge a consensus on adopting innovative and workable model of Community Testing for the
country
To mark the Global Week of HIV Testing.
Proceedings:
Inaugural Session
Mr. Madhav Adhikari, Program Manager, NAP+N started the program by thanking Mr. Prakash Nath Yogi
whom he referred as a Permanent MC of NAP+N and paid tribute to the legendary MC for his
outstanding work at various events NAP+N has organized, welcomed all the invitees from Government
Agency and various I/NGOs and other networks and Community Based Organizations (CBOs). He shared
objectives of the Consultative Meeting on Community Based HIV Testing and highlighted the importance
of meeting like this to move ahead for the betterment of our community.
Deepak Dhungel, Country Manager, AHF Nepal, highlighted the role Community Based HIV Testing can
play to fulfill 35% gap which we have to cover. Furthermore he insisted on following WHO Guideline for
Community Based HIV Testing and shared AHF’s ongoing Community Based HIV testing Campaign. He
added agreement on workable model of Community Based Testing and revision of National
Consolidated Guideline are the two important things we must do as soon as possible.
Geeta Shakya, Director, National Public Health Laboratory used this forum to clear things with the
community people that NPHL is not against Key Affected Population’s(KAP) involvement in Community
Based Testing. She further added it can be done in two steps. KAP doing screening test and Laboratory
doing the confirmatory test.
Dr. Dipendra Raman Singh, Director, NCASC started his remarks by saying how can we treat people
without testing. He added Community Based HIV Testing is the most effective program which helps to
bridge the gap we been talking from sometimes. Furthermore he added how important it is to improve
governance and coordination among the HIV stakeholders to combat this problem and thanked the KAP
for making a meaningful contribution in National HIV/AIDS response.
Mr. Achut Sitaula President of NAP+N concluded the inaugural session by stressing on the involvement
of KAP in Community Based HIV Testing. He further elaborated why KAP’s involvement makes it more
effective, economic and friendly.
After tea break Technical Session stated. Dr. Bhesh Raj Pokhrel from NCASC started his Presentation HIV
& AIDS Background and Epidemiology. Current scenario of HIV in our country and in the world was
presented alongside information on HCT Centers, ART Centers, PMTCT Centers were also presented. He
also added we must thankful for the role KAP has played so far and shouldn’t be ignored in Community
Based HIV Testing.
Dr. Atul Dahal from WHO highlighted the importance of Community Based HIV testing. He pointed out
How, Where Approach and the involvement of community. He presented some points from the
Guideline which is in a need for a revision as soon as possible. He further added after training anyone
can do it. KAP involvement in testing makes it more meaningful and strongly recommended KAP to get
involved in testing.
Bina Pokharel from UNAIDS started her presentation with the introduction of Community Based HIV
Testing and Counseling. An ambitious treatment target to help end the AIDS epidemic 90-90-90-90 by
2020 and 5% more to that number by 2030. Like everyone she also touched that most debated part
“Who should do it” and revision of guideline is a need. She completed her presentation with footage of
Community Based HIV Testing from Cambodia.
Dr. Durga Bhandari from fhi 360 presented Saath-Saath project work, most importantly Community
Based HIV Testing program they are doing at various places. Furthermore he added the need for an
agreement between all parties to adopt a workable model for Community Based HIV Testing and the
revision of National Consolidated Guideline.
Mr. Shrawan Mishra from NPHL said NPHL is not against non-technical people’s involvement in
Community Based HIV Testing program. If provided proper training anyone can do it and the meaningful
involvement of KAP will make this program more effective. He further stressed on the need to work as a
team and echoed Dr. Geeta Shakya’s version of doing it in two step. KAP doing screening test and
Laboratory doing the confirmatory test.
Mr. Sushil Khatri from SPARSHA Nepal and Mr. Bobby Singh from AHF Nepal shared their experience of
Community Based HIV Testing their organization been doing. AHF Nepal is using Laboratory Technician
to do testing and SPARSHA Nepal is using trained individuals who belong to KAP. Mr. Khatri added they
are reaching KAP as well as general population organizing various health camps with HIV testing facility
Mr. Madhav Adhikari, Program Manager, NAP+N said KAP’s involvement in Community Based HIV
Testing shouldn’t be restricted to outreach and counseling part. If NPHL provides proper training to the
people who belong to KAP they can do the testing part too. He also shared the experience when he was
managing SPARSHA Nepal, who started Community Based Testing back in mid-2000. He further added
KAP’s involvement in overall Community Based Testing run by SPARSHA Nepal kind of proves Orthodox
belief HIV testing demands highly technical skills wrong. He stressed on forging a consensus on adopting
innovative and workable model of Community Testing to identify more cases and treat them.
Moderated Discussion:
Mahesh Sharma highlighted the economical difference between using Lab Technician and
Community people. He said we have no option rather than to revise National Consolidated
Guideline.
Dr. Durga Bhandari raised a key question who should do the test?
Anjay KC said there are many qualified people from KAP who can anything. There must be a
role of NPHL in quality control, provide training to KAP testing and monitoring of their work. He
suggested Drug User should test Drug User, MSM should test MSM.
Madhav Adhikari added 90% of number we have achieved so far is due to the involvement of
Target Group. He made it clear that community people are not blaming NPHL. Both parties
need to work together to make CBT more effective.
Shivlal Acharya also made it clear that the National Consolidated Guideline must be revised to
move forward. He also shared the things that were discussed in Godavari.
Manoj Bhatta stressed on working together, NPHL and the community must sort out the
difference and the revision of National Consolidated Guideline.
Sanjeev Neupane from Save the Children shared the Community Based HIV Testing program
they been doing and pointed out some issues which were unresolved in Godavari. He
elaborated on KAP’s role to make Community Based Testing more effective.
Mathura Kunwar said in order to treat we must test. KAP’s involvement in testing is a must to
make this program more effective. She concluded with her theme “;/]sf]nfO{ dg{ glbp,
g;/]sf]nfO ;g{ ;/]sf]nfO”
Conclusion:
In the end decision was taken that the following points which came out of Consultative Meeting
will be taken to next Technical Working Group (TWG) meeting.




Revision of National Consolidated Guideline.
KAP’s involvement in Community Based HIV Testing.
NPHL role in Community Based HIV Testing.
Prepare effective Model of Community Based HIV Testing.
Photo gallery of the Meeting: