Examining the WHO guidelines on HIV testing services The consolidated World Health Organisation (WHO) guidelines on HIV testing services (HTS), published in July, recommend standardised HTS for correct diagnosis. David Rowlands examines the document, with particular regard to HIV testing in the UK.
The WHO guidance addresses the issues and elements around effective delivery of HTS that are common in a variety of settings, contexts and diverse populations. As well as supporting HTS provided by trained providers, it considers the potential of HIV self-testing.
HIV testing services are the gateway to prevention services and life-saving treatment and care Recent estimates suggest that only 54 per cent of people with HIV know their HIV status. In order to reach the UN 90-90-90 goals1 it is critical that HTS be strategically expanded to diagnose as many people with HIV as early as possible.
Total tested
Between 2010 and 2014 nearly 600 million adults (ages 15+) are reported to have received HTS in 122 low- and middleincome countries. In 2014 approximately 150 million children and adults in 129 low- and middleincome countries are reported to have received HTS. About 3 million children and adults tested HIV-positive according to 81 reporting low- and middle-income
countries in 2014. Nearly 70 per cent of adults receiving HTS are women. Much testing is occurring in antenatal care settings, even in low and concentrated epidemic settings. Across all WHO regions, more than 60 per cent of adults testing HIV-positive were women; outside the WHO African Region, however, those who tested HIVpositive were more likely to be adult men.
Enabling environment for scaling-up HTS
WHO strongly recommends communitybased HIV testing services. In 2014, 93 out of 124 (75 per cent) reporting countries had policies recommending community-based HTS. WHO’s new ‘test for triage’ approach and recommendation for lay-provider-delivered HTS can be used in settings where there are barriers to introducing or scaling-up communitybased HTS. Although many countries permit layprovider HIV testing and pre- and posttest counselling, task sharing can be expanded. In 2014, 65 out of 124 (52 per cent) reporting countries had policies recommending lay provider HIV testing using rapid diagnostic tests.
David Rowlands
WHO strongly recommends voluntary HTS for key populations
Progress continues to be made as more countries are including key populations in national guidelines. In 2014, 110 out of 129 (85 per cent) countries reported that their national HIV testing policies addressed key populations. However, translating policy into implementation lags behind.