5.1 HIV testing and counselling
Consolidated ARV guidelines, June 2013
People access HIV treatment, care and prevention through the gateway of HIV testing and counselling. It is currently estimated globally that about half of the people living with HIV do not know their HIV status. The people who do know often test late, and poor linkages from HIV testing and counselling to care – including failure to assess rapidly for ART eligibility – mean that many people start treatment when they are already significantly immunocompromised, resulting in poor health outcomes and ongoing HIV transmission.
The overall HIV testing and counselling goal for a national HIV programme should be to identify as many people living with HIV as early as possible after acquiring HIV infection, and link them appropriately and in a timely manner to prevention, care and treatment services. The people tested who are not infected should be linked to appropriate prevention services, such as voluntary male medical circumcision in the priority countries in sub-Saharan Africa, or harm reduction services for those who use drugs, and encouraged to retest at a later time.
Diverse models of HIV testing and counselling services are available to increase access to HIV diagnosis, including testing services in health care facilities, freestanding sites and a wide range of community-based approaches. These are described in detail in the WHO 2012 strategic HIV testing and counselling framework (1) .
The use of rapid HIV diagnostic tests that can be used at point of care has become an important strategy to expand access, increase the return of same-day results and enable appropriate referral and follow-up. Countries should choose a strategic mix of service delivery models to achieve equitable access to HIV testing and counselling, based on the local context, the nature of the epidemic, cost–effectiveness and available resources. The mix should facilitate diagnosing as many people living with HIV as early as possible to enable timely linkage to ART. Strategies should be able to reach the people who are most vulnerable, most-at-risk and marginalized (Box 5.1).
The use of a single HIV test to diagnose HIV infection is not sufficient; it must be confirmed by following the steps outlined in the updated WHO 2012 HIV testing strategies (algorithms) (1) . Quality assurance systems should be put in place to minimize false-positive and false-negative results. Failure to do this will lead to people being given incorrect test results, with potential serious adverse long-term consequences. Quality assurance and quality improvement measures are also important for the counselling process to ensure that HIV testing and counselling is always conducted in an acceptable and effective manner.