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Network-based testing services for HIV, viral hepatitis, and STIs
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Credits
Toolkit for planning, implementing and monitoring integrated network-based testing
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Innovative approaches are needed to identify and contact people in need of services to achieve ambitious global goals for the control of HIV, hepatitis B, hepatitis C, and other sexually transmitted infections (STIs) in the setting of funding restrictions.
Network-based testing (NBT) services include a range of service delivery modalities that broaden the reach of testing and other services by supporting individuals to disclose to, refer for testing, and/or distribute self-tests or treatment to partners, family members, and others within their social networks.
These approaches include partner services, family and household testing services and social network testing services.
NBT services can be tailored to individual contexts and settings, and can maximize impact with limited costs. For instance, secondary distribution of self-testing kits to partners and members of social networks can effectively reach populations in need of testing services, while minimizing the burden on the health-care workforce.
While NBT services are related to other contact tracing modalities such as those used for respiratory infections like COVID-19 and tuberculosis (TB), approaches differ when used for bloodborne infections and STIs. However, because populations at risk for HIV and TB often overlap, there are relevant strategies for HIV case finding in groups affected by TB.
As such, NBT strategies described in this toolkit may involve people with HIV, TB, STIs and/or hepatitis B and C, as well as testing for their sexual and/or injecting partners, family members including children and other people in their home, and social contacts. Integration of NBT services across conditions should be considered based on local epidemiology, feasibility and available resources.
Definitions of terms used throughout this toolkit
- NBT services include a broad range of services that aim to identify, reach, and offer services to individuals who may be at risk of HIV, hepatitis B, hepatitis C, or other STIs. These services are not limited to testing and may include notification of exposure, offer of testing, offer of presumptive treatment, and linkage to further prevention, diagnostics, and treatment.
- Partner services are a form of NBT in which sexual or injecting partners are contacted, notified of exposure, and offered services that may include testing, presumptive treatment, and linkage to further care. Sometimes referred to as partner notification or index testing. Partner services can be passive, in which clients notify partners themselves, or active, in which providers assist in contacting, notifying, and linking partners. Active partner services are sometimes called provider-assisted or assisted partner services.
- Social NBT services are a form of NBT in which volunteers, peers, or other members of a network offer testing to others in that network.
- Family and household testing services are a form of NBT in which family members and members of a household are contacted and offered services which may include notification of exposure (adult members), testing (HIV testing of biological children; HBV testing for all household members), and linkage to additional services including additional testing (HBV).
WHO guidance on network-based testing
WHO recommends incorporating NBT into a package of services for people diagnosed with or at increased risk of HIV, hepatitis B, hepatitis C, or other STIs.
Recommendation | Reference document |
Provider-assisted partner services should be offered for all people with HIV as part of a voluntary comprehensive package of testing, care, and prevention. | Consolidated guidelines on differentiated HIV testing services, 2024 |
STI partner services should be offered to people with STIs as part of a range of options based on their needs and preferences and within a comprehensive package of voluntary STI testing, care, and prevention. | Consolidated guidelines on differentiated HIV testing services, 2024 |
Social network testing services may be offered as an additional HIV testing approach as part of a comprehensive package of care and prevention. | Consolidated guidelines on differentiated HIV testing services, 2024 |
Provider-assisted partner services should be offered to all people with HIV-associated TB as part of a voluntary comprehensive package of HIV testing, care, and prevention services. | Consolidated guidelines on differentiated HIV testing services, 2024 |
In all settings biological children of a parent with HIV should be routinely offered HTS and, if found to have HIV or to be at high risk for infection through breastfeeding, should be linked to services for treatment or prevention within a broader package of voluntary provider-assisted partner services. | Consolidated guidelines on differentiated HIV testing services, 2024 |
In high and low HIV-burden settings, HIV testing should be offered to all key populations and their partners in all services as an efficient and effective way to identify people with HIV. | |
In all settings, it is recommended that HBsAg serological testing and linkage to care be offered to sexual partners, children and other family members, and close household contacts of those with HBV infection. | |
In settings of high HIV burden, all household members and close contacts of people with TB should be offered HIV testing services. | Operational handbook on tuberculosis: module 6 – tuberculosis and comorbidities: HIV, section 4.1 |
In settings of low HIV burden, all household members and close contacts of people with TB who have symptoms compatible with TB disease should be offered HIV testing services. | Operational handbook on tuberculosis: module 6 – tuberculosis and comorbidities: HIV, section 4.1 |
Ethics of network-based testing
NBT should be strictly voluntary: coercion, mandatory testing, or forced contact tracing are never acceptable. Privacy should be protected and guaranteed for all consenting patients, and personal information should be kept confidential. As much as possible, clients should be given NBT options as a package of care that they may choose from.