Provider-initiated HIV testing and counselling in health facilities
The WHO/UNAIDS guidance advises that health care providers globally should recommend HIV testing and counselling to all patients who present with conditions that might suggest underlying HIV disease.
Additional guidance is tailored to local circumstances. In generalized HIV epidemics1, HIV testing and counselling should be recommended to all patients attending all health facilities, whether or not the patient has symptoms of HIV disease and regardless of the patient's reason for attending the health facility. In concentrated2 and low-level3 HIV epidemics, depending on the epidemiological and social context, countries should consider recommending HIV testing and counselling to all patients in selected health facilities (e.g. antenatal, tuberculosis, sexual health, and health services for most-at-risk populations) as well as adolescents and children.
The recommendations build on previous policy positions of WHO and UNAIDS and responds to a growing demand from countries for more detailed policy and operational advice in this area. This guidance was developed following a review of available evidence and a broad consultative process with experts and implementers, including submissions received from over 150 organizations and individuals.
WHO and UNAIDS recognize that resource and other constraints may prevent immediate implementation of the guidance. The document therefore provides advice about how to prioritize implementation in different types of health facilities.
Other key recommendations
Other key WHO/UNAIDS recommendations for provider-initiated HIV testing and counselling in health facilities include:
- All HIV testing must be voluntary, confidential, and undertaken with the patient's consent.
- Patients have the right to decline the test. They should not be tested for HIV against their will, without their knowledge, without adequate information or without receiving their test results.
- Pre-test information and post-test counselling remain integral components of the HIV testing process.
- Patients should receive support to avoid potential negative consequences of knowing and disclosing their HIV status, such as discrimination or violence.
- Testing must be linked to appropriate HIV prevention, treatment, care and support services.
- Decisions about HIV testing in health facilities should always be guided by what is in the best interests of the individual patient.
- Provider-initiated HIV testing and counselling is not, and should not be construed as, an endorsement of coercive or mandatory HIV testing.
- Implementation of provider-initiated HIV testing and counselling should be undertaken in consultation with key stakeholders, including civil society groups, acknowledging that what works and is ethical will inevitably differ across countries.
- When implementing provider-initiated HIIV testing and counselling, equal efforts must be made to ensure that a supportive social, policy and legal framework is in place to maximize positive outcomes and minimize potential harms to patients.
- A system that monitors and evaluates the implementation and scale-up of provider-initiated testing and counselling should be developed and implemented concurrently.
As countries work towards universal access to HIV prevention, treatment, care and support, the new guidance on provider-initiated HIV testing and counselling offers an important opportunity to introduce new approaches and improve the standards of HIV testing and counselling in both public and private health facilities. Together with their partners, WHO and UNAIDS will continue to help countries expand access to the full range of HIV testing and counselling services, as well as to other needed health sector interventions against HIV/AIDS.
1 HIV is firmly established in the general population. Numerical proxy: HIV prevalence consistently over 1% in pregnant women.
2 HIV has spread rapidly in a defined sub-population, but is not well-established in the general population. Numerical proxy: HIV prevalence is consistently over 5% in at least one defined sub-population, but is below 1% in pregnant women in urban areas.
3 HIV has never spread to significant levels in any sub-population. Numerical proxy: HIV has not consistently exceeded 5% in any sub-population.