The following documents are acceptable as per the LOA Protocol:
The following are unacceptable forms of identification:
NB. In cases where a minor (under 18 years old) is unable to supply an identity document (due to age), the identity document of the legal guardian is required. The legal guardian must sign the consent to testing.
NB. The above identification requirements apply to all insurance pathology tests and not only HIV testing.
Venesection (Blood Collection)
Substitutions for insurance HIV tests have reached alarming proportions in South Africa. In order to restrict the possibility of substitution and sample swopping, the LOA strongly recommends that venesections only be performed by a Medical Officer of the insurance company concerned or the staff of the laboratory performing the tests.
In terms of this Protocol, the following options exist:
The service may be delivered by medical practitioners as in paragraph 3.1 above, or registered persons entitled to perform venesections as in 3.2 above.
The persons who are in the salaried employment of the Life Office and also qualified in terms of paragraph 3 above.
Third party providers ie registered persons entitled to perform venesections, who have an independent contract or relationship with each specific company. It is the responsibility of the company to manage the risks associated with this service.
Loa Hiv Testing Information Sheet (Printable PDF)
If you have any problem understanding this document, ask the nurse or laboratory assistant or doctor to explain to you.
What are my rights? You have the following rights:
Why do Life Insurance companies test for the AIDS virus? Underwriting is the basis of assurance to ensure that each applicant pays a premium that is appropriate to the risk.
The insurance company requires information from the applicant to help it assess the risk of granting the Insurance and to establish an appropriate premium. Insurance companies screen applicants for serious diseases or habits that may affect their state of health. This may be done through questionnaires, medical examinations and other tests, including a test for the AIDS virus.
Is the test always correct? Can there be mistakes? Even though the tests are very accurate, and are performed by registered laboratories, they must be regarded as screening tests only and not diagnostic. If your test result shows that you may be infected with the AIDS virus, you can have this confirmed by having further tests done.
As with any biological test, false positive results may occur in a small number of cases, i.e. the test shows positive when the person is not infected with the virus. This is not the fault of the laboratory or the insurance company, but the true HIV status of the person can be ascertained by doing further tests. The insurance company and laboratories follow a strict protocol to eliminate potential mistakes. In order to minimize false positives results, three different tests are performed.
What does it mean if the test is negative? If your test result is negative, it means that you are not currently infected, but it does not mean that you may not become infected in the future. There is a period of about six weeks after the infection before an HIV test will be positive.
Your risk of becoming infected is increased if you have more than one sexual partner or if you engage in unprotected sex. It is also important to get prompt treatment for other sexually transmitted diseases, e.g. syphilis and gonorrhea that make you more susceptible to the AIDS virus.
What does it mean if the test is positive? If your test result is positive, it means that you may be infected with the AIDS virus and your application for insurance will be declined. All existing cover will remain valid unless periodical retesting for the AIDS virus is required. As from 1 January 2005, Insurance Companies may no longer have AIDS exclusion clauses on new business. Some insurance policies that were taken out before 1 January 2005 may have an AIDS exclusion clause. This means that if you develop any AIDS related illness, a claim will not be paid. Existing policies that do not have an AIDS exclusion clause will not be invalidated as a result of the test results being positive. The implications of a positive test should be discussed with your doctor. If it is shown that there was a false positive result, the company will reconsider a further application for insurance.
Notification of test results If your test result is negative: Cover will be granted if all other requirements have been met. If your test result is positive:
A trained person should discuss the information with you so that you can understand clearly what the test result means. Consequently, it is of the utmost importance that you think carefully about the doctor who should receive the results. You will be advised to contact this doctor. Please note that if you receive a letter to contact the nominated doctor, that this does not automatically mean that the AIDS test result is positive, as many other medical impairments may lead to the refusal of the insurance application. The doctor will be fully informed and will inform you accordingly.
For any further assistance on this matter, call the AIDS helpline: 0800 012 322
The HIV testing information sheet is also available in the other 10 official languages. Visit the LOA Website (http://www.loa.co.za) to download these.
Loa Sponsored Personal Pre-Test Councelling (PDF)
Kindly note that PPTC will only be provided during office hours and by appointment.
Read the entire LOA protocol, including more information about PPTC by visiting the LOA Website (requires internet access).
PPTC will initially only be offered at the following venues in major urban centres:
7th Floor Southern Life Centre Riebeek Street Tel: 021 425 5984 Fax: 021 421 0630
Bellville Medical Centre Blanckenberg Street Bellville Tel: 021 946 2105/6 Fax: 021 949 8095
Mediclinic Hospital Ground Floor Kellner Street Westdene Tel: 051 401 4600 Fax: 051 401 4613
St George's Medical Centre Ground Floor 40A Park Drive Central Tel: 041 373 6422 Fax: 041 373 6424
Mercantile Hospital 2nd Floor Room 240 Korsten Tel: 041 451 4423 Fax: 041 451 4999
PathCare 45 St Marks Road Southernwood Tel: 043 701 5900 Fax: 043 701 5950
Insurance Test Information (PDF)
Anaemia (Hb / Haemoglobin)
Anaemia is said to be present when the haemoglobin (Hb) concentration is below the normal range for the age and sex of that individual. The function of Hb is to carry oxygen from the lungs to the tissues.Mechanisms of Anaemia
In healthy adults there is a steady state between the bone marrow production of young red cells and destruction of senescent red cells from the circulation.
Red cell life span is roughly 100 days resulting in 1% new cells (reticulocytes) being produced daily to maintain a steady state.
The reticulocyte count is hence an indication of the bone marrow response to anaemia.
This substance is a metabolite of nicotine that was previously measured in urine but presently it can also be determined on a blood specimen. The idea is that this stable metabolite can tell the insurers that an applicant has recently been smoking (or taking in / absorbing nicotine / tobacco) and that not all the relevant information has been divulged on the application form.
A positive Cotinine test can be due to the client absorbing tobacco / nicotine by:
There is some suspicion that certain slimming products eg.Nobese, contain a substance that can result in a positive Cotinine test, but this has not been confirmed.Special requirements to perfom the test None.
Specimen required A clotted specimen is required for this test.
ESR (Erythrocyte Sedimentation Rate) If an anticoagulant is added to blood and the mixture set up in a vertical tube, the red cells gradually fall, and the plasma is displaced upward.
The rate of this action is constant in health and is known as the sedimentation rate.
Although the ESR is a non-specific phenomenon, its measurement is clinically useful in disorders associated with an increased production of acute-phase proteins.
In rheumatoid arthritis or tuberculosis it provides an index of progress of the disease, and it is also useful as a screening test in the routine examination of patients.
Although a normal ESR cannot be taken to exclude the presence of organic disease, the fact remains that the vast majority of acute or chronic infections and most neoplastic and degenerative diseases are associated with changes in the plasma proteins which lead to an acceleration of sedimentation.
Full Blood Count The full blood count is one of the most commonly carried out blood tests and is useful for screening as well as aiding in the diagnosis of disease.
It is used to reflect the ability of the body to fight disease and can be an indicator of progress in certain disease states such as infection or anaemia.
Glucose Metabolism Glucose metabolism is amongst other things dependent on insulin levels. There can either be an absolute deficiency of insulin such as in insulin dependent. Diabetes (juvenile diabetics) or there may be a relative insulin deficiency or insulin resistance (adult onset diabetes). When serum glucose levels exceed 11.1 mmol/l it will spill over into the urine as it exceeds the renal threshold - this is called glycosuria.
There are various ways of diagnosing diabetes. If the fasting glucose level exceeds certain cut-off levels on two occasions and the client also has signs and symptoms of:
Then it may be indicative of diabetes mellitus.When it is unclear if a patient has diabetes or not, a glucose tolerance test (GTT) is performed.
Glucose Tolerance Test This requires the client to be fasting for 10-12 hours after 3 days of having a normal diet which includes at least 150gm of carbohydrates. Should the patient go on a strict diet prior to the GTT, a false positive test can be recorded. The client must come to the depot having fasted.
A fasting blood glucose level is taken followed by the ingestion of 75gm of glucose dissolved in 250ml of water, over a 5 minute period. Then glucose levels are taken 2 hours after the ingestion of the glucose.
Should a client be confirmed a diabetic, it is essential that the client be under proper dietary control. In addition insulin or oral medication may be required. To ascertain whether the diabetes is properly controlled, a random blood glucose can be measured, however, this only reflects the control at that instant. To determine the control over a longer period of time, a haemoglobin A1c (HbA1c) level can be done.
Special requirements to perform the test: An appointment needs to be made at the depot where the test is going to be done. The client also needs to fast for 10-12 hours before the test is done. The test takes two hours to perform and the client needs to stay at the depot (under observation) for this time.
After the test, the client may feel very tired and should have something to eat and drink. If the client's initial fasting glucose is above 9mmol/l, the test will be discontinued & the glucose not given. This will be repeated to the Insurance Company Underwriter's, who may call for additional tests (e.g. HbA1C) after re-assessment of the case.
NB!.: Please note that the test cannot be done if the client has fasted for more than 14 hours (as having this much glucose after this long a fast is dangerous and the client could go into a coma).
The GTT is also not done in the afternoons, as there are physiological (cortisol) changes and the results will therefore not be accurate.
Specimens required: Two glucose (grey top tubes) specimens are required
The HbA1c is formed when ordinary Hb has reacted with the glucose in the blood. The higher the glucose has been over the past 40-60days, the higher the HbA1c levels. It is therefore a reflection of the control over a longer period of time.
Diabetes, if not well controlled, can have serious if not fatal implications. It is vitally important to ascertain if the diabetes has affected any organs. One method of doing this is to check the renal function of the patient on a regular basis.
This can be done by doing urea and electrolyte levels. This is however a less refined way of picking up early damage.
In the very early stages of renal involvement, the kidney starts to leak albumin. It is possible to detect these low levels of albumin in the urine as microalbuminuria. Only at a late stage does frank proteinuria occur.
Special requirements to perform the test None
Specimens Required Edta (purple top tube)
Haematocrit When anticoagulated whole blood is centrifuged, the space occupied by the packed red cells is termed the haematocrit reading and is measured as the percentage of red cells in a volume of whole blood.
In healthy individuals there is a strong correlation between the haemoglobin, red cell count and the haematocrit (HCT).
HIV Tests for HIV infection fall into 2 groups, screening and confirmatory tests:
Screening Test: Only the HIV ELISA should be used for screening. This assay tests for the presence of antibodies to HIV 1 and HIV 2.
As with all serology tests, there is a delay between exposure and the formation of antibodies, the window period, of between 3-6 weeks.Most patients seroconvert at 3-4 weeks after exposure.
After the window period the test has a sensitivity of 100% and a specificity of 99.7 %.
This implies that all HIV infected patients past the window period will be detected. However, 3 out of every 1000 patients will have a false positive result. Therefore all positive HIV ELISA results need to be confirmed by a confirmatory test.
Confirmatory Tests: These include the triple HIV ELISA, Western blot, P24 antigen and HIV PCR (quantitative or qualitative). Confirmatory tests require a new specimen, not only to confirm the diagnosis, but also to reconfirm the patient identity.
Triple Elisa Each ELISA test uses 6 antigens to detect antibodies to the HI 1 & HI 2 viruses. The three ELISA tests therefore use 18 antigens. Each test is 100% sensitive after the window period and therefore all 3 tests need to be positive to confirm the diagnosis. The problem with this approach is that neither the doctor nor the patient is comfortable with discrepant results and therefore ask for further tests in any case. The ELISA tests only confirm the diagnosis and do not help with the decision whether to treat a patient or not. A HIV viral load still needs to be performed to assist in making this decision
Western Blot This test also only tests for the presence of antibodies. However, the binding of antigen to antibody can be seen and this test excludes the non-specific binding of other antibodies. An HIV PCR baseline viral load will still need to be done to assist in the management of the patient.
P24 Antigen The current P24 test has a poor sensitivity and is only reliable as a confirmatory test in patients that have a very high viral load. The use of this test is therefore limited to patients during seroconversion as the viral loads tend to be high during this phase of the infection. This phase is part of the window period of the ELISA test when the ELISA test is still negative. We recommend that this test only be used with the ELISA test in cases such as needlestick injuries where the source patient may be in the seroconversion / window period.
HIV PCR The diagnostic or qualitative PCR detects integrated HIV DNA in host cells. The viral load PCR detects HIV RNA from free viruses in the circulation. HIV RNA can be detected as early as 16 days after exposure to the HIV virus.
A recent small study has shown that the DNA or diagnostic PCR detected the DNA at age 2 weeks in only 50% of babies infected via vertical transmission. 98% of infections were detected at 6 weeks.
Free HIV RNA as detected by the viral load PCR detected 98% of infections at 2 weeks.
It therefore seems that the RNA is a better test to detect early infection. The RNA assay however is twice as expensive as the diagnostic DNA assay.Comments for HIV serology Our laboratories use the AXCYM assay for screening purposes. The cutoff value for a positive result on this assay is 1. This result may however be false positive (3/1000 cases) Experience has shown us that most false positive results fall between the values of 1-2. No value above 10 has ever been documented as being false positive by confirmatory test in our laboratory.
Conclusion We recommend the following approach (this approach does not apply to insurance investigations):
Liver functions Liver Function Tests include amongst other things the following parameters: alanine amino transferase (ALT) aspartate amino transferase (AST) gamma-glutamyltransferase (GGT) alkaline phosphatase (ALP) which are all enzymes involved in liver metabolism. With liver disease these enzymes can leak into the bloodstream and depending on the characteristic pattern detected, deductions can be made as for the type of liver pathology involved.
ALT is a specific liver enzyme, whereas AST can be found in tissues other than the liver, like muscle or red blood cells. These enzymes normally reflect liver cell damage.
On the other hand GGT and ALP enzymes reflect more activity of the cells lining the bile ducts.
ALP is not confined to the liver but can be traced to tissues like bone, the gastrointestinal tract and placenta.
GGT can also be found in small quantities in other tissue such as the prostate.
The other interesting characteristic about these latter two enzymes is that their levels in the blood can be affected by the ingestion of substances such as ethanol, anti-epileptic drugs, as well as many other medications.
Bilirubin is a breakdown product of haemoglobin, and it is metabolised by the liver after which it is excreted in the bile and/or the kidney, depending on the solubility of the metabolised bilirubin.
These parameters are used to ascertain whether the patient has a haemolytic disease, whether there is some form of obstruction in the liver, hepatitis or a chronic liver disease like cirrhosis.
Special requirements to perform the test None
Specimen required Clotted blood
Lipogram The lipogram is a combination of tests, which reflect the ability of the body to metabolise lipids.
Depending on the levels of each of these parameters, certain deductions can be made as far as hypercholesterolaemia is concerned and also on the protective role of some of the subfractions.
The tests included in a lipogram are:
Total Cholesterol Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL) Triglycerides (TG) Apolipoprotein (a)[Lipo(a)].
Total cholesterol is a screen for the risk of myocardial infarction. Very high levels are found in familial hypercholesterolaemia that can lead to premature death due to a myocardial infarction. Other diseases associated with a high cholesterol, include renal disease (nephrotic syndrome), an underactive thyroid gland, liver pathology and diabetes mellitus.Low density lipoprotein (bad cholesterol) (LDL) carries cholesterol in the blood from the liver, where it is synthesises, to the rest of the body, while high density lipoprotein carries cholesterol from the peripheral tissue to the liver. A high level of LDL is therefore detrimental to the body whereas a high, HDL level acts as a protective mechanism and hence a high level is advantageous.
High density lipoprotein (good cholesterol) (HDL) moves easily through the blood. They are stable and do not stick to artery walls. They help to prevent heart disease by carrying cholesterol away from the arteries, back to the liver and out of the body. HDL levels should be 40 or above.
High triglyceride levels are sometimes found in obese people, alcohol abusers and shortly after a fatty meal. Very high levels may lead to pancreatitis. The opposite is also true, i.e. that pancreatitis may lead to a high triglyceride levels. Normally it is said that a cholesterol level must be taken fasting, but this is not entirely true. Fasting or non-fasting has little influence on the total cholesterol level. It has however an influence on the triglyceride level and therefore it is said that cholesterol must be measured fasting.
The only advantage would be if one would subsequently like to do a lipogram. This can be done on the same specimen. Another important aspect as far as cholesterol is concerned, is that cholesterol levels can vary in an individual by approximately 10% on a day to day basis. It is therefore recommended that one should do at least 3 determinations, instead of one, to obtain an average level.Special requirements to perform the test Fasting Lipogram:
Fast for 10 hours before the test. A client may therefore eat his/her evening meal butshould not have any breakfast until after the blood test. Water is allowed during the fasting period.
Random Lipogram: No fasting is required.
Total Cholesterol (Fasting): Fast for 10 hours before the test. A client may therefore eat his/her evening meal but not have any breakfast until after the blood test. Water is allowed during the fasting period.
Total Cholesterol (Random): A random specimen is acceptable, although a ten hour fasting specimen can subsequently be used for a lipogram if required.
Fasting Triglyceride: Fast for 10 hours before the test. A client may therefore eat his/her evening meal but not have any breakfast until after the blood test. Water is allowed during the fasting period.
Random Triglyceride: No fasting is required.
Specimen required Clotted blood specimens are required for all the above tests.
M&C Urine With each urine analysis for Life Insurance purposes, a microscopy and biochemical evaluation is done.
Red blood cells: The presence of red cells may indicate renal pathology
White blood cells: Suggest inflammatory processes such as urinary tract infections
Red blood cell casts are considered suggestive of glomerulonephritis; white blood cell casts of pyelonephritis and fatty casts of nephrotic syndrome.
This test is performed by making use of an Automatic Scanner. This will detect the presence of glucose, blood, protein, nitrates, specific gravity and ketones in the urine, giving an indication of possible underlying pathology i.e.
Glucose: The presence of glucose is a possible indication of Diabetes Mellitus
Protein: Raised protein level may indicate infection and or renal disease
Blood: Urinary Tract Infection is the most common cause
Ketones: May indicate the presence of glucose in an uncontrolled diabetic. Also present in fasting patients. A trace of these substances may be considered normal.
Specific: Gravity: May be an indicator that this is not a urine specimen. It also indicates that the kidneys are capable of concentrating urine.
Special requirements to perform the test The biochemical tests are designed to detect certain end-products of bacterial metabolism and correlate with significant bacterial presence in urine.
They require that that urine be tested after a period of incubation in the host.
Therefore the first morning clean catch, midstream specimen is used.
Red cell counts could have increased values if urine is collected during a females menstrual period.
White cell counts could be falsely elevated due to contamination from the vagina.
A clean catch urine specimen occurs when the first part of the urine is discarded, the middle portion is collected and the remaining part is then again discarded. If urine is collected in this manner the likelihood of a specimen being contaminated by vaginal /urethral discharges is reduced. The first part of the urine expelled from the bladder is generally more concentrated and could therefore affect results with a high protein level.
Micro-Albuminuria Considerable interest is currently being expressed in the measurement of small but consistent amounts of albumin being excreted by diabetic patients.
The development of diabetic nephropathy leading to reduced glomerular filtration is a common occurrence in persons with diabetes mellitus. Onset of renal complications can fist be predicted by detection of microalbuminuria, and the progression of renal disease can be delayed through better stabilisation of blood glucose levels.
Specimen required Mid-stream urine specimen. (This requires a full bladder)
Plasma Viscocity The ESR and plasma viscosity in general increase in parallel.
Plasma viscosity is, however, primarily dependent on the concentration of plasma proteins, especially fibrinogen, and it is not affected by anaemia.
Change in viscosity seems to reflect the clinical severity of disease more closely than does the ESR. Also, changes in the ESR may lag behind changes in plasma viscosity by 24-48 hours.
Red Cell Indices Amongst the features that distinguish one type of anaemia from another are the average size and haemoglobin content of the red blood cells. These properties are expressed in terms of MCV (mean cell volume) MCHC (mean cell Hb conc.) and MCH (mean cell haemoglobin).
Normal values for red cell indices in adults:
Mean cell volume (MCV) 82-99 fl (Lower limit may be as low as 70-74 fl between 1 and 8 years of age, in the absence of iron deficiency.)
Mean cell haemoglobin (MCH) 27-33 pg
Mean cell haemoglobin concentration (MCHC) 32-36 g/dl
Serum Urea & Creatinine Urea and Creatinine are two substances measured in the blood, to evaluate the renal function of the patient.
Urea is formed in the liver from ammonia derived from amino acids that have been ingested as proteins.
Urea is excreted by the kidneys.
Creatinine on the other hand is produced by muscle and is also excreted by the kidney and is constant for every individual.
It is a reflection of the total body muscle mass. Hence small individuals have lower creatinine levels than big body builders.
The balance between production and excretion of these two substances can be distorted and changes when renal pathology sets in.
This test is therefore done for insurance purposes to check for renal failure.
Special requirements to perform the test Avoid having a large meal, especially one containing meat, before the test is done.
Specimen required Clotted blood.
White Cell Count
The white blood count is the number of white cells in one cubic millimeter of whole blood.
This is a useful measurement to indicate infection and may also be employed to follow the progress of certain diseases.
The differential count is the percentage of different types of white cells found on that patients blood smear.
The type of cell can give clues to the disease process involved.
Main functions of blood cells:
Neutrophil Chemotaxis, phagocytosis, killing of bacteria
Eosinophil Increased in allergy and parasitic infections
Basophil Modulate inflammatory responses
Monocytes Chemotaxis, phagocytosis, killing of some microorganisms
Platelets Adhere to subendothelial connective tissue, participate in blood clotting
Lymphocytes Involved in immune responses
Travelling Nurse (Flyer) (Service Areas PDF)
Travelling Nurse (Flyer) Click here to view Travelling Nurse Request Form
Blood sample collection will only be performed: At business premises During business hours (08h00 - 17h00) Weekdays, excluding Public Holidays
Short Medicals (PDF)
Currently, the only areas authorised to perform SME's at PathCare branches are:
Port Elizabeth East London George King Williamstown Bloemfontein Vereeniging Sasolburg
Other areas are currently under consideration.
SME/LHR's may however also be required in conjunction with the Travelling Venesection Service. In these instances (ie. on a call-out basis), the SME will be performed by the travelling sister.
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|Drs de Beer, van Zijl, Mattana & Louw (North West Province: Klerksdorp)||English||Afrikaans|
|Drs Laing, Soldin & Venter (Sothern Cape: George & Surrounds)||English||Afrikaans|
|Drs Ilse Louw (Boland: Paarl)||English||Afrikaans|
|Drs Izak Loftus, Linda Steyn (Boland: Somerset-West, Stellenbosch)||English||Afrikaans|
|Drs Dietrich, Voigt & Mia (Western Cape)||English||Afrikaans|
|Dr R P Mulligan (Eastern Cape: East London)||English||Afrikaans|
|Drs Voigt & Partners (Free state: Bloemfontein)||English||Afrikaans|
|Drs Soldin & le Roux (Vaal Triangle: Vereeniging)||English||Afrikaans|
|Dr Dotti von Ulmenstein (Kimberley)||English||Afrikaans|
|Dr M Crause (Free State: Bethlehem)||English||Afrikaans||Drs Hofmeyr, Kasongo & Patners (Eastern Cape: Port Elizabeth)||English||Afrikaans||Drs Burger, Venter, van Greunen & Partners (Namibia)||English||Afrikaans|
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