Guidance on provider-initiated HIV testing and counselling in health facilities
ISBN: 978 92 4 159556 8
Until recently, the primary model for providing HIV testing and counselling has been client-initiated HIV testing and counselling - also known as voluntary counselling and testing (VCT) - in which individuals must actively seek an HIV test at a health or community-based facility. But uptake of client-initiated HIV testing and counselling has been limited by low coverage of services, fear of stigma and discrimination, and the perception by many people - even in high prevalence areas - that they are not at risk.
Current evidence also suggests many opportunities to diagnose HIV in clinical settings are being missed, even in places with serious HIV epidemics. While, therefore, expanded access to client-initiated HIV testing and counselling is still necessary, other approaches are also required if coverage of HIV testing and counselling is to increase and, ultimately, universal access to HIV prevention, treatment, care and support is to be achieved.
The new WHO/UNAIDS guidance was prepared in light of increasing evidence that provider-initiated testing and counselling can increase uptake of HIV testing, improve access to health services for people living with HIV, and may create new opportunities for HIV prevention. Provider-initiated HIV testing and counselling involves the health care provider specifically recommending an HIV test to patients attending health facilities. In these circumstances, once specific pre-test information has been provided, the HIV test would ordinarily be performed unless the patient declines.
Provider-initiated HIV testing and counselling has already been implemented in a range of clinical settings in several low- and middle-income countries, including Botswana, Kenya, Malawi, Uganda and Zambia, as well as in pre-natal settings in parts of Canada, Thailand, the United Kingdom, and the United States.