Publication: Las pruebas rápidas del VIH en España: descripción de programas, evaluación de impacto y análisis de su potencial como estrategia para promover el diagnóstico precoz
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2017-08-17
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Universidad Complutense de Madrid
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Abstract
En ausencia de una cura o una vacuna preventiva eficaz frente al VIH, el diagnóstico precoz de la enfermedad es el eje en torno al cual pivotan las estrategias de prevención y la puerta de entrada al tratamiento, para poder así modificar el curso de la epidemia. Se considera a las pruebas de VIH prevención secundaria a nivel del individuo, ya que el tratamiento consigue reducir la morbi-mortalidad, y prevención primaria a nivel poblacional, puesto que disminuye la carga viral haciendo a los seropositivos menos infecciosos y además ofrece la posibilidad de adoptar estrategias sexuales más seguras para proteger a sus parejas. Con el fin de promover el diagnóstico precoz y reducir la fracción no diagnosticada, el centro para el control y prevención de enfermedades de Estados Unidos (CDC) puso en marcha en 2003 una estrategia que consistía en ofertar las pruebas de VIH fuera de los entornos clínicos1. Utilizando las pruebas rápidas, se pretendía facilitar el acceso a la prueba a ciertos grupos afectados de manera desproporcionada por la enfermedad y que, además, se enfrentaban a ciertas dificultades a la hora de acceder al sistema sanitario (como los hombres que mantienen relaciones sexuales con otros hombres y/o las minorías étnicas). Desde entonces, esta estrategia ha sido incluida de forma habitual en todas las guías y recomendaciones nacionales e internacionales2;3. En España, han existido programas que ofrecen la prueba del VIH fuera de los entornos clínicos desde mediados de los años 90. Sin embargo, fue la aprobación del uso de las pruebas rápidas en 2006 lo que llevó a una rápida expansión de esta estrategia. A partir de ese momento, se han implementado muchos programas de pruebas rápidas de VIH fuera de los entornos comunitarios llevamos a cabo, en su mayoría, por organizaciones no gubernamentales (ONG). Existe una enorme heterogeneidad dentro de éste grupo de programas, tanto en términos de población diana, como requerimiento de cita previa, tipos de pruebas utilizadas, etc. Algunos se dirigen a poblaciones especialmente vulnerables (hombres que tienen relaciones sexuales con otros hombres, inyectores de drogas, inmigrantes, etc.), mientras que otros han centrado su actividad en la población general. La mayor parte se realizan en sedes fijas, habitualmente en las sedes de las ONG, mientras que otros han puesto en marcha distintos tipos de programas de “outreach” o acercamiento de la prueba ofreciéndola en localizaciones que resultan más atractivas y accesibles que los servicios sanitarios convencionales...
Lacking a cure or an effective vaccine for HIV, early diagnosis is the linchpin for prevention and treatment and consequently, to modify the course of the epidemic. HIV testing is considered secondary HIV prevention at the individual level, since the treatment reduces morbidity and mortality, and primary HIV prevention at the population level, since it diminishes viral load making seropositive individuals less infectious and also offers the chance to adopt safer sex strategies to protect their partners. In order to promote timely diagnosis and reduce the undiagnosed fraction of the epidemic, the United States Centers for Disease Control and Prevention (CDC) proposed in 2003 taking testing for HIV outside the clinical context1. With the use of HIV rapid testing kits, this strategy aimed to facilitate testing for certain groups disproportionately affected by the epidemic who also faced barriers to access the health system (i.e. men who have sex with men and/or ethnic minorities). Since then, this strategy has been commonly included in both national and international guidelines and recommendations2;3. In Spain, programmes offering testing for HIV outside the clinical context have been working since the late nineties. However, it was the approval of rapid testing kits in 2006 that led to a rapid expansion of this strategy. Since then, many rapid testing programs in non-clinical settings have been implemented mostly, but not exclusively, by community-based organizations (CBOs). There is a huge heterogeneity within this group of programs in terms of target populations, appointment requirement, type of test used, etc. Some serve especially vulnerable populations (men who have sex with men, drug injectors, immigrants, etc.), while others focus their activities on the general population. Most of these programmes are located indoors, on the premises of CBOs, and some have developed different types of outreach services offering testing in locations that are more attractive and accessible than conventional health settings. In this sense, Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies, where the pharmacists are in charge of the whole testing process as a part of their everyday routine. These programmes have been working in regions that are very different in terms of demography, sociological characteristics, HIV new diagnosis rates and availability of testing services...
Lacking a cure or an effective vaccine for HIV, early diagnosis is the linchpin for prevention and treatment and consequently, to modify the course of the epidemic. HIV testing is considered secondary HIV prevention at the individual level, since the treatment reduces morbidity and mortality, and primary HIV prevention at the population level, since it diminishes viral load making seropositive individuals less infectious and also offers the chance to adopt safer sex strategies to protect their partners. In order to promote timely diagnosis and reduce the undiagnosed fraction of the epidemic, the United States Centers for Disease Control and Prevention (CDC) proposed in 2003 taking testing for HIV outside the clinical context1. With the use of HIV rapid testing kits, this strategy aimed to facilitate testing for certain groups disproportionately affected by the epidemic who also faced barriers to access the health system (i.e. men who have sex with men and/or ethnic minorities). Since then, this strategy has been commonly included in both national and international guidelines and recommendations2;3. In Spain, programmes offering testing for HIV outside the clinical context have been working since the late nineties. However, it was the approval of rapid testing kits in 2006 that led to a rapid expansion of this strategy. Since then, many rapid testing programs in non-clinical settings have been implemented mostly, but not exclusively, by community-based organizations (CBOs). There is a huge heterogeneity within this group of programs in terms of target populations, appointment requirement, type of test used, etc. Some serve especially vulnerable populations (men who have sex with men, drug injectors, immigrants, etc.), while others focus their activities on the general population. Most of these programmes are located indoors, on the premises of CBOs, and some have developed different types of outreach services offering testing in locations that are more attractive and accessible than conventional health settings. In this sense, Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies, where the pharmacists are in charge of the whole testing process as a part of their everyday routine. These programmes have been working in regions that are very different in terms of demography, sociological characteristics, HIV new diagnosis rates and availability of testing services...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública (Historia de la Ciencia), leída el 19-01-2016