HIV testing services
The first of the United Nations’ 90-90-90 targets to end the HIV epidemic is for 90% of people living with HIV to learn their HIV status. HIV testing is therefore essential to achieving “the first 90”.
Around 30% of people with HIV are unaware of their infection. The only way to determine a person’s HIV status is for them to have an HIV test.
In many countries, critical gaps exist in HIV services, including prevention, testing and treatment. These efforts often fail to reach the people at greatest risk – namely young girls, men, and key population groups including men who have sex with men, sex workers, people who inject drugs, transgender people, and people in prison or closed settings.
WHO is supporting countries to address gaps in the cascade of prevention, testing and treatment services. There is an opportunity to prevent 1.5 million infections per year by 2020 and reach the “fast-track” goals if we can improve prevention and testing services and ensure high-quality, well-adhered-to treatment and care for all.
The past decade has seen a rapid expansion of HIV testing and treatment services. Innovative approaches have been developed and introduced to expand HIV testing services: low-cost rapid diagnostic tests have enabled testing at clinics, in communities and in homes. Additionally, more lay testers have been trained to help expand access to HIV testing in community settings.
What are HIV testing services?
HIV testing services include the full range of services that should be provided together with HIV testing:
- counselling (pre-test information and post-test counselling);
- linkage to appropriate HIV prevention, treatment and care services, and other clinical and support services; and
- coordination with laboratory services to support quality assurance and the delivery of correct results.
Innovative and creative approaches to service delivery – including facility-based and community-based HIV testing services – have been implemented in numerous countries. Services range from provider-initiated testing and counselling, and stand-alone voluntary testing and counselling, to home, mobile and outreach testing in the community, and “moonlight” testing during evening hours in high-risk settings, as well as schools, workplaces, religious facilities and transport hubs. In addition, “test for triage” can be used in community-based settings to further scale up access to HIV testing services. With this approach, a trained lay provider uses a single rapid diagnostic test, then refers and links all people with a reactive test result to HIV prevention, care and treatment services in a timely manner.
WHO recently launched new guidelines on HIV self-testing and assisted partner notification to reinvigorate the global HIV response. The new guidelines focus on HIV self-testing, where people use oral fluid or blood-finger-pricks to discover their status in a private and convenient setting. Results are ready within 20 minutes. Those with positive results are advised to seek confirmatory tests at health clinics. WHO recommends that these people receive information and links to counselling, as well as rapid referral to prevention, treatment and care services.
Partner notification, or disclosure or contact tracing, is a voluntary process where a trained provider asks people diagnosed with HIV about their sexual partners and/or drug-injecting partners and, if the HIV-positive client agrees, offers these partners HIV testing services.
HIV self-testing should be offered as an additional approach to HIV testing services, and voluntary assisted partner notification services should be offered as part of a comprehensive package of testing and care to people with HIV.
All HIV testing services should continue to be provided in line with WHO's essential 5 Cs: C onsent, Confidentiality, Counselling, Correct test results, and Connection/linkage to prevention, care and treatment.
Using evidence to drive change
WHO has been producing regular evidence-based recommendations since HIV testing services were first developed in 1985. In 2015, WHO published the “Consolidated guidelines on HIV testing services”. This document:
- addressed the testing gap
- pushed testing into communities
- supported better linkages to care
- encouraged focused and appropriate targeting
- improved quality to prevent misdiagnosis.
In 2016, WHO published a supplement to these guidelines on HIV self-testing and partner notification.
WHO will continue to intensify its support to countries to achieve the 90-90-90 targets for testing, treatment and viral suppression by 2020, and to move towards ending AIDS by 2030.