Home and hospital.

PIP: Most countries have significant numbers of people with HIV-related illnesses who are placing an increasingly heavy burden upon health services. Health services, nongovernmental organizations, and mission hospitals have developed programs to enable people with chronic illnesses to be cared for at home. These programs can reduce costs and demand on in-patient facilities, but saving money is not their primary goal. Although providing high quality home care is not easy, many people simply prefer to be cared for home, albeit given adequate resources and support, while people with incurable illnesses often choose to die at home, where they can be with their family and spiritual or religious advisor. Most HIV-related infections such as diarrhea, coughs, and fever can be treated at home with support and advice from visiting health workers. For many people, staying at home is also their only option since hospital care is not always available or accessible. The article describes the continuum of care involving hospital, clinic, and welfare services, as well as members of the wider community, needed to provide effective home care service; a home care program through St. Martin's Clinic in Agomanya, Ghana; and experience in HIV prevention and care.^ieng

Proposed national HIV testing policy.

PIP: The National AIDS Control Organization of India is preparing a draft policy document on a national HIV testing policy. This paper presents some of the pertinent issues proposed for incorporation into that policy. Any testing procedure undertaken in the country must be in accordance with and part of the comprehensive control program on HIV. Testing upon an individual may be done to identify an individual infected with HIV for the diagnosis of clinically suspected AIDS, voluntary testing at the behest of the client, and for non-health purposes. For example, testing is also permitted to monitor the trend of HIV infection in a population or subgroup to guide eventual intervention; to test blood, organs, or tissue destined for donation; and for research on HIV infection. Such testing must be supported by social support and the means for intervention even if the testing is refused and ultimately not performed. All mandatory linked testing should be discouraged when it tends to identify an individual. Transfusion safety should be ensured throughout the country, with a single ESR test sufficing to avoid the risk of false negative results. The establishment of voluntary testing centers will be encouraged; the testing protocol using three ESR or three ESR with WB is considered scientific for identifying an infected individual; and surveillance is to be designed by the state epidemiologists/state program officers and carried out by the staff of the selected health institutions with samples tested in any HIV testing facility suitably situated and easily approachable by the staff of the surveillance site. Testing procedures for research must follow the highest international standards for scientific protocol. Test kits must be evaluated before they are manufactured indigenously. Finally, the existing HIV testing network will have to be restructured to carry out objective-wise testing, with internal and external quality assurance of the program rigorously implemented on a regular basis.^ieng