This is a departure from the past whereby doctors in the country referred patients to laboratories or Voluntary Counseling and Testing centres whenever they suspected they were infected with HIV.

According to Dr David Bukusi, the manager of KNH VCT and Comprehensive Care Centres, what the hospital is doing is a move designed to improve the management of HIV positive patients.

But even in the current practice, known as Diagnostic Testing and Counseling, the patient is provided with information on why the test is important and asked to give a verbal consent.

A form is then filled to indicate that the person has agreed to be tested. The patient is at liberty to refuse the test to be conducted. This is however rare as most patients would want to do what the doctor is advising.

For those who agree, a rapid HIV test is done at no cost. It is after the results of the test are out that intensive counseling is done to the patient and other family members.

In the current practice, staffs knowledgeable in HIV matters have been posted to hospitals medical wards on the 7th and 8th floors, and children wards for purposes of undertaking rapid HIV tests on patients doctors suspect to have the virus.

In the children wards, besides giving consent for their children to be tested, parents too are requested to undertake similar tests.

But before the tests are done in these wards, a list of patients needing such tests is drawn following doctors request.

The new practice has seen the hospital test over 4,500 patients since it was introduced late last year on a pilot basis, according to Dr Bukusi.

Of those tested, 40 percent have turned out to be HIV positive.

“We have just managed to test 4 out of the every 10 people we would like to reach due to shortage of staff,” says Dr Bukusi.

He adds that the whole idea behind the Diagnostic Testing and Counseling is to assist the doctors manage the patient better and save lives.

“This strategy helps as identify HIV patients and put them on a comprehensive care that includes among other things drugs, care, and counseling,” says Bukusi.

With over 50 per cent of its bed with HIV positive patients, the new cases are now putting more pressure on the hospitals support and treatment programme.

The flipside of it is that the diagnostic approach has helped doctors to decide from the onset on how to treat the patient; unlike in the past when patient’s management changed mid-stream on realizing the person is HIV positive.

The strategy also intents to remove the stigma around the disease by treating HIV like any other test a patient is required to do whenever he or she presents with an ailment.

National Aids and STD Control Programme, which is in the process of coming up with a policy to guide hospitals on how to implement the practice, is encouraging them to start embracing the practice.

KNH is now exploring the idea of expanding the practice to test every patient who consults it, once enough staff has been trained in HIV testing and management.

Dr Bukusi says even in this instance, the test will not be compulsory, but it would be beneficial to the patients to know their HIV status.

“If someone is positive, then they will be advised on how to get treatment and manage their condition. And if negative, will be advised on how to prevent themselves from infections.

If this happens, then the hospital will be doing what is done in the antenatal clinics, where women have to routinely undergo an HIV test unless they decline.

The mass testing of patients consulting hospitals is an issue on the minds of many health workers and doctors who want anybody seeking treatment in a health centre or hospital to do an HIV test.

Their argument is that HIV should be considered just like any other disease for which tests are done as a standard practice.

This is called opt-out model where HIV testing is done routinely to anybody who consults a health care centre or hospital when they are ill. If the patient declines to have the test done, he or she can be required to provide some explanation for that.

Under the model, a person’s results are not necessarily confidential since the disease is treated like any other. The model is practiced especially in antenatal clinics.

The methods as been found to be less costly as Joia Mukherjee of Department of Social Medicine at the Harvard Medical School observes, under routine testing, the infrastructure and resources spend to counsel a person before being given results will not be needed, releasing more time to health workers to engage in other activities.

Further, routine testing will make more people accept to carry out HIV tests and a higher proportion of them to go back for their results. In 2004, a study done in Botswana’s prenatal clinics to test the opt-out modal showed that 75 percent of the clients went back to get the HIV results under routine testing while 74 percent returned after voluntary testing.

But in the past, World Health Organization and UNAIDS has been uncomfortable with an opt-out model claiming it might violate the human rights of individuals such as the right to health, privacy and informed consent.

The two organizations insist those to be tested have to be provided with pre- and post-test counseling before they decide whether or not to do the testing.

There are also other problems in the simplicity of the opt-out model. The proponents of the model seem to lack the answers on how to convince patients who test negative to come back for confirmatory test after the three months widow period.

In the prenatal clinics where the model is a success, it easier to track down expectant women who are more likely to come back to the clinics for check-ups.

There are also no clear answers to what happens when a huge number of people are tested and have to be put on antiretroviral therapy.

At the moment, less than half of the 200,000 HIV positive people who need ARV treatment have access to the drugs, despite the government’s promise to put half of the number on treatment by the end of last year.

KNH and other hospitals are also likely to be confronted with the issues of capacity - personnel and facilities - when they decide to test every patient who visits the hospital.