Point-of-Care (POC) testing spans so many areas of medicine that it is best defined by where it’s done – anywhere outside the centralised laboratory – rather than by the kinds of tests performed. Generally, it is delivered where the patient is and the results are quick and opportunistic so that they can be acted upon without delay.

This course is aimed at community organisations, pharmacies and other groups willing to deliver rapid HIV and syphilis point-of-care testing to the communities they serve. Our goal is to upscale and standardise the delivery of community-led testing services and referral pathways and reach individuals where they are, reducing HIV testing stigma and geographic and socio-economic barriers to testing and care.

This course encompasses four modules, each containing additional resources, and a quiz at the end of the course for knowledge retention. After completing it, an in-person or online Q&A session with Body Positive staff will be arranged and certification, provided.

• Understand the fundamentals of the science of HIV testing and prevention methods
• Consider your client’s needs and their risk of HIV infection
• Explain the test and ensure that the client provides informed consent to HIV testing
• Conduct rapid POC testing for HIV and syphilis
• Provide initial emotional support for people who have a reactive test
• Offer referral to services such as prevention, care and testing for other STIs

In this module, we will dive into the details of different types of tests, their window periods, and their importance in making HIV testing accessible.

• Screening tests are a quick and simple method to assess the health of a large group of people, by identifying those who are negative and those who need further testing. Our POC test is a screening test.
• Diagnostic tests confirm infections through more complex lab procedures.
• POC tests measure HIV antibodies to detect infection. Specific lab tests can also detect HIV directly.
• POC tests detect 90% of infections at 28 days and require final testing at three months. Antibodies plus antigens lab tests detect 99% of infections at six weeks. No test can detect HIV within the first two weeks of infection.
• Pre-Exposure Prophylaxis (PrEP) is the use of antiretroviral drugs to prevent HIV. It can be used daily or on-demand (PrEP 2-1-1). Consistent use of PrEP virtually eliminates the risk of infection through sexual activity and reduces the risk of infection through needle sharing by nearly half.
• Post-exposure Prophylaxis (PEP) is the use of antiretroviral drugs to prevent HIV after a potential exposure. Clients must start taking PEP as soon as possible and no later than 72 hours after exposure. The risk of HIV infection is reduced by 80% if taken consistently for 28 days. PEP can currently be accessed through GPs and Emergency Departments.

PrEP Provider Section

This module will walk you through the steps to perform a POC Test using the INSTI Multiplex rapid test for syphilis and HIV.

• The INSTI Multiplex rapid test is internationally certified and provides reliable results for HIV and syphilis in 60 seconds.
• It is an efficient screening tool that can be used outside medical facilities by non-medical personnel and can accurately determine if someone is negative. Reactive results need to be confirmed by lab tests but should not be underestimated as false positives are rare (0.7%).
• The test kit includes an alcohol swab, lancet, pipette, membrane unit and three test reagents. Follow the instructions on the cheat sheet to conduct the test and read its results. Always check the kit expiry date before proceeding.
• Syphilis is more common than HIV and it has a cure. A reactive result will likely indicate a current infection but could be a reaction to a previously treated infection so further confirmatory tests are required. Syphilis is easily treated with Antibiotic treatment provided by your local Sexual Health Clinics. Refer to the Resources.

Module 2 - INSTI HIV Training Pack
Module 2 - Quick Reference Guide
Watch a Video of the Testing Procedure

This module will guide you through the process of delivering an HIV test result. You will be confident to provide appropriate support and information especially in the rare case of a reactive result.

• Most tests you perform will be non-reactive. If possible, review if the client should return for further testing, recap prevention strategies so they can stay negative, and refer them to appropriate services.
• If you deliver a positive result, be direct and considerate, and provide immediate comfort, support and connection to care.
• Emotions towards a reactive result such as disbelief, anger, guilt, and fear are normal and should be expressed and acknowledged.
• Remind them that there are many simple and convenient treatments for HIV that are free for all and help people live long, healthy lives, but there is no cure
• HIV care is provided by Infectious Disease and Sexual Health Clinics. Refer to the Resources to make an appointment as soon as possible, ideally within 72 hours, and offer to follow up afterwards.
• Let them know about peer support, available at Body Positive.
• Clients don’t need to disclose their status straight away, but partners will need to be notified, which will be discussed by secondary care.
• When HIV positive The legal system requires this information to be shared with sexual partners when having unprotected sex, this is currently defined as having sex without a condom.

Module 3 - Contact List
Peer Support
I’m Healthy and I Live With HIV

This module guides you through the understanding of high-risk exposures and the importance of routine testing.

• Testing is recommended after any high-risk exposure to ensure early detection and treatment.
• Routine-based is recommended over event-based testing and it could be every three, six or 12 months, depending on individual circumstances.
• For transmission to occur, three conditions must be met (3 Ps): Partner (HIV-positive with a detectable viral load), Practices (high-risk exposure with exchange of body fluids), and Protection (gaps in protection strategies).
• New Zealand is a low-prevalence country, with HIV being more common among men who have sex with men (MSM) but not exclusively.
• Effective anti-retroviral therapy (ART) stops HIV replication, reducing an individual’s viral load to undetectable levels where the risk of further sexual transmission is zero. This is U=U, or Undetectable equals Untransmittable.
• If you suspect sexual assault, suggest PEP initiation within 72 hours, and additional support. Clients who inject drugs may be referred to the NZ Needle Exchange Programme.

Safe to Talk NZ for Sexual Assault Victims
NZ Needle Exchange Programme
HANLR - Worried Well