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Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

DEPARTMENT ORDER
No. 2018 - ___________

SUBJECT: Operational Guidelines on Community Based HIV Screening (CBS)

I. BACKGROUND

The epidemic of Human Immunodeficiency Virus (HIV) in the Philippines is concentrated


in key populations particularly, among men who have sex with men (MSM) community where
80% of all new HIV cases in 2013 were occurring. This group requires a targeted intervention to
improve uptake of testing and linkage to care. The result of the 2015 Integrated Behavioral and
Serologic Surveillance (IHBSS) showed that only 14% of MSM were tested and knew their status,
2% were tested but did not know the result, and 78% reported that they never had an HIV test in
the last 12 months.

Community Based HIV Screening (CBS) is a screening model recommended by WHO to


improve the uptake of HIV testing and to link reactive clients to the continuum of care by
maximizing the engagement of trained and supervised lay providers. This is neither meant to
replace diagnostic testing options currently available in the country nor shall be considered as the
first test in the diagnostic algorithm.

As indicated in the Administrative Order 2017-0019 or Policies and Guidelines in the


Conduct of Human Immunodeficiency Virus (HIV) Testing Services (HTS) in Health
Facilities, CBS is an additional HIV risk assessment tool independently performed by trained and
supervised lay providers or individuals using rapid diagnostic kits. This shall be offered to HIV
key populations such as males having sex with males (MSM) and transgender (TG) women.

In 2016, the Global Fund HIV Project, through Save the Children, with support from the
National HIV, AIDS and STI Prevention and Control Program (NASPCP) of the Department of
Health, commissioned the HIV AIDS Support House (HASH) for the pilot implementation of
CBS in the National Capital Region (NCR), and in the cities of Cebu and Davao. This pilot
implementation resulted to a total of 1,363 clients screened for HIV of which, 78% were reactive,
and 74% of screening reactive clients were successfully linked to HIV testing facilities and
received HIV testing services.

II. OBJECTIVES

This Order provides specific operational guidelines for the conduct of Community Based
HIV Screening as prescribed in the AO No. 2017-0019 or Policies and Guidelines in the Conduct
of Human Immunodeficiency Virus (HIV) Testing Services (HTS) in Health Facilities.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ● URL: http://www.doh.gov.ph; e-mail: ftduque@doh.gov.ph
III. SCOPE

This Order applies to all Social Hygiene Clinics and partner community-based
organizations that will implement Community Based HIV Screening.

IV. DEFINITION OF TERMS

1. Client - a person who is a member of the key population who may or may not live in
the same geographic area availing HIV related services from a CBS-trained peer.
2. Community Based HIV Screening – a non-laboratory rapid HIV screening procedure
done outside a health facility by a trained member of a community-based
organizations or groups.
3. Community-based organization - a group of people organized for a particular purpose;
may or may not have a formal organizational structure but has a clearly identified
leader.
4. Confidentiality - an ethical duty that maintains the privacy of any personal information
revealed during the entire process of HIV testing services, including community-based
HIV screening.
5. Finger prick –pricking the fingertip with a lancet to extract blood for HIV screening
done in an aseptic manner.
6. HIV Screening - a procedure using DOH Food and Drug Administration (FDA)-
registered HIV test kits performed through finger-pricking by a trained and supervised
healthcare worker or lay person/HIV Screening Agent (HSA).
7. HIV Screening Agent (HSA) – an individual who is certified by the Social Hygiene
Clinic to conduct and perform rapid HIV screening.
8. HIV Testing - refers to initial serological test to determine the presence of antigens
and/or antibodies against HIV, performed by an HIV proficient medical technologist.
9. Male having sex with male – a person who is born male and who reported ever having
sex with a male.
10. Quality assurance – supportive supervision and random check of skills in pricking,
among others, done by an HIV proficient medical technologist.
11. Reactive result - an HIV testing or screening procedure that indicates the presence of
HIV antibodies and/or antigens.
12. Social Hygiene Clinics - health facilities managed by the local government units
(LGU) that specialize in management of Sexually Transmitted Infections.
13. Transgender woman – a person who is assigned male at birth but who self-identifies
as a female.

V. SPECIFIC GUIDELINES

1. Identification and recruitment of HIV Screening Agent

Identification and recruitment of potential HIV Screening Agent (HSA) by the


community-based organizations and/or Social Hygiene Clinics (CBO/SHC) for CBS training
shall be based on the following pre-qualification criteria:
a. A peer or person who is a part of the key population (MSM, TG, PWID, SW)
b. Must not be afraid of seeing blood

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c. Knowledgeable on basic information on HIV prevention, condom use
negotiation, and availability of STI and HIV treatment
d. At least high school graduate
e. Has undergone training on HIV Counseling and Testing within the past 5 years

Based on the local needs, the Local Government Units (LGU), through the Social Hygiene
Clinics, may require additional criteria in the recruitment of HSA. Highly recommended upgrades
to the knowledge and skills of an HSA includes among others Adolescent Sexual and
Reproductive Health (ASRH).

2. Capability-building

The Social Hygiene Clinic HIV Proficient Medical Technologist shall be primarily
responsible in providing the needle-pricking training of HIV Screening Agents.
a. Only HSA who are proficient in needle-pricking for HIV Screening and who are
able to accurately perform and read the Rapid Diagnostic Test 90% of the time
shall be engaged in CBS.

3. Coordination and Oversight

Over-all coordination and oversight of CBS shall be done by the CBS Implementation
Team. The LGU, through the Social Hygiene Clinic, shall create a CBS Implementation team
composed of the SHC physician or Nurse and medical technologist, Social Worker and an
identified leader of a community-based organization.

4. CBS in special circumstances:


a. Access of Minors to CBS. Young key populations 15 years old and above can
access CBS even without consent from parents or legal guardian.
b. Events-based activities. Beauty contest, volleyball games, and other events-based
activities can serve as venues for the conduct of CBS, provided there is proper
coordination with stakeholders such as LGU-SHC and other collaborating groups,
due diligence are observed, and CBS workflow is adhered to.

5. CBS Workflow

The HSA shall be oriented on the details of the CBS workflows. (Please see Annex 1:
Community Based Screening Workflow.) Further, standard safety precautions must be employed
in all CBS processes. (Please see Annex 2: Standard Safety Precautions.)

VI. MONITORING AND EVALUATION

1. Ownership of Data

Securing the personal data of client must adhere to the protection provision of RA No.
10173, otherwise known as the Data Privacy Act of 2012 and IRR of 2016.

All HSA, SHC, and CBO staff involved in CBS must observe proper documentation.
Annex 4 provides the CBS forms to be used by the HSA. The CBO may opt to keep copies of the
reports and forms, provided that the following are met:
a. CBO fully understands the provision of RA 11166 on confidentiality and RA 10173;
b. CBO can provide a secured storage area for files. Access to these files is limited to the
designated CBO representative and HSA.

2. Recording and Reporting

Proper recording and reporting of CBS data are necessary for monitoring and evaluation
purposes. The indicators will measure the success of CBS and reflect adherence by the
stakeholders to these operational guidelines. The following must be recorded and reported every
month to the CBS Implementation Team:

a. CBO level
i. Number of CBO member certified HSA by SHC
ii. Number of People screened (MSM, TG, PWID, SW) for HIV
iii. Number of People initially screened reactive through CBS and accompanied
to the SHC
iv. Number of clients initially reactive who were accompanied to the SHC
v. Number of test kits used and returned to the Social Hygiene Clinic
vi. Incident report, if any

b. Social Hygiene Clinic


i. Number of CBO involve in CBS implementation
ii. Number of health staff certified as HSA
iii. All the indicators mentioned above (CBO level)
iv. Number of People screened
v. Number of CBS screened that tested reactive
vi. Number of People screened reactive through CBS, and tested and given post-
HIV counseling at Social Hygiene Clinic
vii. Number of People screened reactive at CBS who are confirmed HIV-positive
viii. Percent of PLHIV on ART screened initially through CBS

VII. EFFECTIVITY

This Order shall take effect immediately.

By Authority of the Secretary of Health:

MYRNA C. CABOTAJE, MD, MPH, CESO III


Undersecretary of Health
Public Health Services Team