Why does the VCT test for HIV need to be done for 90 days?

What is the VCT test?

VCT or the abbreviation of voluntary counseling and testing is a series of tests and counseling conducted to find out whether a person is HIV positive or negative. This HIV test can be done at the health center, clinic, or hospital that provides VCT testing services.

VCT screening is voluntary which means the decision to take the test is entirely based on your own initiative and choice. In addition, you can also ask the test administrators to keep the test results confidential.

Based on the Data and Information Center of the Ministry of Health of the Republic of Indonesia, the number of HIV cases continues to increase from year to year. The number of cases reached its peak in 2019 at 50,282 cases.

The highest number of HIV cases reported occurred in the productive age group 25-49 years (70.4%). Most cases were experienced by men (64.5%) than women (35.5%).

HIV infection initially does not cause obvious early symptoms of HIV so that a person often does not realize that he is infected and passes it on to other people. Therefore, it is necessary to have a venereal disease screening test to detect HIV as early as possible so that it can prevent the transmission of this dangerous virus.

Early diagnosis from a VCT examination also helps you get treatment faster so that HIV infection does not progress to AIDS too late.

Who needs a VCT test?

Everyone who is sexually active (has had and / or has had sex frequently) needs to undergo a VCT examination. People who have risky sex, such as unprotected sex and multiple partners are at risk of getting HIV.

Couples planning marriage and pregnancy, and pregnant women also need to undergo this HIV test if they are at high risk for HIV, such as having a history of sexual relations with an infected person.

Early voluntary testing is important because HIV can be life threatening if it is detected too late and you do not get the right HIV treatment.

When is it necessary to do a VCT test?

VCT consists of 3 stages involving pre-test counseling, HIV testing, and post-test counseling.

This test is confidential because you will sign a written consent form before starting the VCT test. After the patient signs voluntarily, a new VCT test can be performed immediately.

In the HIV testing phase, serological tests will be performed to detect the HIV-1 and HIV-2 viruses in the blood. You are advised to have an HIV test at least after 3 months (90 days) of having HIV risky sex to make sure you are really infected.

The body generally starts forming antibodies in the immune system about 90 days after first contracting the HIV virus. This period is known as the HIV window period.

However, how quickly the body makes antibodies can vary from person to person. As for those that take longer or even faster than 3 months.

HIV serology testing rules

According to the Indonesian Ministry of Health Regulation, if the first serological test results show non-reactive results, you can immediately test negative.

However, if you are in a risk group such as having an infected sexual partner, it is recommended that you do a repeat examination after at least 3 months from the first examination and a maximum of 1 year.

A second HIV serology test is required if the first HIV test results are reactive. You will need to do a third serologic test if the second test results are also reactive.

If the results of the second test are non-reactive you will be asked to repeat the first and second serology tests. Regardless of the results of the re-examination, you will still need to have further serology tests (third test) to get the final diagnosis result.

Preparation before the VCT test

The initial stage for VCT testing is counseling. This counseling aims to provide an understanding of AIDS and prepare you for an HIV test. In addition, counseling can also prepare you to anticipate the results of the VCT examination.

HIV pre-test counseling procedures

The guide in counseling on the VCT test is a trained counselor who will first ask about your reasons for taking the test.

You will be asked to speak as honestly as possible about your fears and worries. Relax, everything you say is confidential and will not be leaked out of the counseling room.

Next, the counselor will explain to you what HIV is, how it is transmitted and how much you are at risk of getting infected.

Information on examination procedures will be explained in full along with guidelines for treatment and prevention of HIV transmission. The counselor will also correct any misconceptions you may have about HIV, explaining the importance of knowing your HIV status.

From this counseling session, you will better understand how to reduce the risk of mother-to-child transmission of HIV (if the patient is pregnant) and prevent sexually transmitted diseases.

Finally, the counselor will also give you the opportunity to ask questions about HIV or the tests you will be undergoing.

However, it should be noted that people who do not want counseling before the test will not be forced to undergo it. The counseling phase of the VCT test is voluntary and requires the consent of the patient himself.

VCT test procedure

At the HIV test stage, there are three types of serological tests that are commonly performed, namely the Elisa test or EIA, the Western Blot test, and rapid test.

The HIV serology test in the VCT series of tests aims to detect antibodies to the HIV-1 or HIV-2 virus after the body has produced an adequate number of antibodies.

Elisa test and Western Blot

On Elisa's test (enzyme-linked immunisorbent assay) and Western blot, the examination is done by taking a blood sample. Your blood sample will be sent to a laboratory for testing for HIV-1 and HIV-2 antibodies.

The Elisa test or EIA is more commonly used in VCT examinations. The Western Blot test is more reliable when it is difficult to detect HIV antibodies in certain cases. Both of these tests have a higher level of sensitivity than the HIV rapid test.

Rapid test HIV

While on rapid test a blood sample will be taken by the officer through the finger. This blood sample will be placed on a slide where a special chemical is dropped.

Results of rapid test HIV will be available in 20 minutes. If the test result is reactive, then the same test will be done again to really confirm the diagnosis.

Each antibody test in the VCT examination (Elisa test, Western Blot test and rapid test) have different levels of sensitivity. This affects the level of accuracy of the test results. Therefore, serologic tests may need to be done several times to give a correct diagnosis.

Post-test counseling

After undergoing the test and getting the results, the counselor will explain what the test means simply and clearly in the post-test counseling session. The counselor will give you time to understand the explanation and ask further questions.

HIV post-test counseling procedures

If the VCT test result is negative, counselors still advise patients to reduce their risk of contracting HIV / AIDS. For example, educating about having safe sex using a condom.

The counselor will also help you understand the possibility of having to be retested, given the possibility of errors due to the accuracy and sensitivity of the test.

When the test results show that you have been infected with HIV, the counselor will provide assistance and moral support to strengthen the mentality of a patient who has just been diagnosed with HIV.

In mentoring, the counselor will discuss the next steps you need to take to get HIV treatment. The counselor will refer you to a health facility so that you can be handled by a doctor immediately. Handling from the doctor will also monitor the treatment carried out regularly.

In addition, the counselor will remind and give tips to always live a healthy lifestyle for HIV. People who are HIV positive will also be guided to prevent HIV transmission to those closest to them or to avoid other sexually transmitted infections (STIs).

VCT examination results

There are 3 diagnostic criteria in the VCT examination, namely positive, negative, and HIV test results indeterminate (can not be determined). A positive result refers to three serological tests that show reactive results.

Meanwhile, negative results were obtained when the first serologic test results were negative, the non-reactive isolation test, or one of the reactive repeat tests was not included in the risk group.

Indeterminate indicates if 2 out of 3 tests are reactive or 1 result is reactive in a patient who has an infected partner.

It is important to know that doing the test during the window period in which antibodies cannot be detected can lead to false HIV test results. The results can show you are HIV negative, but the HIV virus is actually in your body.

In these cases, you will usually need to have a second VCT test within 3 months to confirm a negative result of the first test.

VCT examination is a test that can be used as an effective HIV prevention and reduces the risk of other sexually transmitted diseases.