Expansion of HIV Laboratory Diagnostic Services in Chennai, India 2001–2006: Is the Growth Commensurate with the Need? A. K. Srikrishnan 1 , Kartik K. Venkatesh2, Suniti Solomon1, Easter Thamburaj1, S. Anand 1 , K. G. Kosalaraman1, Pachamuthu Balakrishnan 1 , Kenneth H. Mayer2* 1 YRG CARE, VHS, Chennai, Tamil Nadu, India, 2 Miriam Hospital, Division of Infectious Diseases, Brown University Medical School, Providence, Rhode Island, United States of America Abstract Objective: To describe the changes in HIV services provided and the patient population utilizing voluntary counseling and testing (VCT) services at private testing laboratories in Chennai, India in 2001 and 2006. Methods: In 2001, a cross-sectional descriptive survey was conducted to assess the services provided and client population of 1,031 private laboratories. A subset of labs (9%) that had been surveyed in 2001 were also studied in 2006. Results: In 2001, significantly more high volume labs (.10 HIV tests per month) offered HIV diagnostic tests than low volume labs (,10 HIV test per month) (p,0.001). More high volume labs (20.0%) provided pre-test counseling as part of HIV testing than low volume labs (11.1%) (p = 0.003). Between 2001 and 2006, the number of labs that provided HIV diagnostic tests significantly increased, including ELISA (87.8% vs. 40.0%), Western Blot (84.4% vs. 13.3%), and Tridot (98.9% vs. 72.2%) (p,0.001). Also the number of labs that reported greater than 10 women seeking HIV testing per month significantly increased from 14.5% to 79.0% (p = 0.006). More labs provided pre-test counseling in 2006 (34.4%) than in 2001 (21.1%) (p = 0.046). Conclusions: Though HIV diagnostic testing services have increasingly become available, counseling services have not expanded commensurately. Further outreach and education is necessary to expand comprehensive HIV VCT services in both urban and rural India. Citation: Srikrishnan AK, Venkatesh KK, Solomon S, Thamburaj E, Anand S, et al. (2008) Expansion of HIV Laboratory Diagnostic Services in Chennai, India 2001– 2006: Is the Growth Commensurate with the Need? PLoS ONE 3(10): e3471. doi:10.1371/journal.pone.0003471 Editor: Srikanth Tripathy, National AIDS Research Institute, India Received June 17, 2008; Accepted September 23, 2008; Published October 21, 2008 Copyright: 2008 Srikrishnan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The authors are grateful to the research survey staff at the YRG Centre for AIDS Research and Education, VHS, Chennai, India, for their facilitation of the study. The authors would like to thank Brown University’s AIDS International Research and Training Program of the Fogarty International Center at the National Institutes of Health (NIH), USA, (grant no. D43TW00237), and the Lifespan/Tufts/Brown Center for AIDS Research (CFAR) of the NIH, USA (grant no. #P30 AI42853). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: Kenneth_Mayer@Brown.edu Introduction It is estimated that 2–3 million Indians are currently living with HIV and the overall HIV prevalence continues to rise [1]. Tamil Nadu in South India is one of the six Indian states which has been classified as high prevalence, defined as having rates in excess of 5% among high risk groups and in excess of 1% of antenatal women [1,2]. Although the epidemic in India began in high-risk populations, such as female sex workers, truck drivers, and intravenous drug users, infection has now spread into the general population, both urban and rural [3,4]. Increasingly married monogamous women have presented with a high prevalence of HIV in India, suggesting a strong risk from their spouses [5]. Voluntary Counseling and Testing (VCT) is recognized as an integral element of any effective HIV public health primary prevention and care program [6]. The process of finding out one’s HIV status, regardless of the test result, offers a critical opportunity for education and prevention aimed at reducing the risk of HIV transmission. For individuals found to be infected with HIV, VCT can provide a means to accessing further services, including counseling support, antiretroviral therapy (ART), and medical care. Studies in the developed and developing world have demonstrated that VCT can reduce high risk sexual practices [7,8,9] and can be a cost-effective intervention [10]. HIV voluntary counseling and testing (VCT) has increasingly become a central prevention strategy in the national AIDS control policies of most developing countries as it serves as an important entry point into care [9]. In India, VCT has been available in certain locations since 1986 [11], and has been widely implemented as part of the HIV prevention program of the National AIDS Control Strategy since 1999 [12]. As low-cost antiretroviral therapy has increasingly become available in India [13], VCT has become an important link connecting individuals to treatment and care. However, though VCT services have become available in India [14], accessing these services has been hampered by a lack of resources PLoS ONE | www.plosone.org 1 October 2008 | Volume 3 | Issue 10 | e3471