On 17 July 2015, the World Health Organization (WHO) released Consolidated Guidelines on HIV Testing Services (HTS).

Background Information:

HIV testing services (HTS): refers to 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.

Why is this document important?

This guidance brings together existing guidance relevant to the provision of HTS and addresses issues and elements for effective delivery of HTS that are common in a variety of settings, contexts and diverse populations.

In addition, this document provides a new recommendation to support HTS by trained lay providers. It also considers the potential of HIV self-testing to increase access to and coverage of HIV testing.

This guidance will assist national programme managers and service providers, including those from community-based programmes, in planning for and implementing HTS.

Key Messages:

5Cs: Consent, Confidentiality, Counselling, Correct results and Connection

The guidelines discuss issues relating to HTS and highlight the need for tailored HTS approaches to the following population groups:

• key populations
• infants
• children
• adolescents (10–19 years old)
• pregnant and postpartum women
• couples and partners.

Lay providers who are trained and supervised can independently conduct safe and effective HIV testing using RDTs (strong recommendation, moderate quality of evidence).

Initiatives should be put in place to enforce privacy protection and institute policy, laws and norms that prevent discrimination and promote tolerance and acceptance of people living with HIV.

Retesting

All settings

It is recommended to offer retesting at least annually to people from key populations and to HIV-negative partners in serodiscordant couples. Depending on client risk behaviours, more frequent voluntary retesting should be offered and available.

Generalized HIV epidemic

Retest all HIV-negative pregnant women in the 3rd trimester, postpartum or during labour because of the high risk of acquiring HIV infection during pregnancy.

Concentrated HIV epidemic

Retest HIV-negative pregnant women who are in serodiscordant couples or are from a key population group.

Retesting before initiating ART

National programmes should retest all people newly and previously diagnosed with HIV before they enrol in care and initiate ART.

Provider-Initiated Testing and Counselling (PITC)

Regardless of epidemic type

PITC should be considered for

• malnutrition clinics,
• STI, hepatitis and TB services,
• ANC settings and
• health services for key populations.

For TB settings:

Routine HIV testing should be offered to all clients with presumptive and diagnosed TB; partners of known HIV-positive TB patients should be offered HTS with mutual disclosure.

Community-based HIV testing services:

WHO recommends community-based HIV testing services, with linkage to prevention, treatment and care, in addition to PITC, in all settings.

Priority Populations:

Infants and children

HIV-exposed infants and children younger than 18 months with unknown or uncertain HIV exposure should be tested (with a virological assay) within 4–6 weeks of birth so that those presumptively diagnosed with HIV can start ART.

Pregnant and Postpartum women

High prevalence settings

PITC for women should be considered a routine component of the package of care in all antenatal, childbirth, postpartum and paediatric care settings.

In such settings, where breastfeeding is the norm, lactating mothers who are HIV-negative should be retested periodically throughout the period of breastfeeding.

Low prevalence settings

PITC can be considered for pregnant women in antenatal care as a key component of the effort to:

• eliminate mother-to-child transmission of HIV
• integrate HIV testing with testing for syphilis and viral or other key tests as relevant to the setting
• strengthen the underlying maternal and child health systems.

Testing Strategies

 

High Prevalence (>5%)

If two sequential HIV tests are reactive (positive) (A1+, A2+), diagnose as HIV+ve.

If A1+, A2-, A3+, report as inconclusive and advise retesting after 14 days.

If A1+, A2-, A3-, report as HIV-ve.

 

Low Prevalence (<5%)

If three sequential HIV tests are reactive (positive) (A1+, A2+, A3+), diagnose as HIV+ve

If A1+, A2-, report as HIV-ve.

However, if A1 is an Antibody/Antigen assay, and A2 is an Antibody only assay, declare as inconclusive and advise retesting after 14 days.

If A1+, A2+, A3-, report as inconclusive and advise retesting after 14 days.

Useful Links:

Link to the Consolidated Guidelines on HIV Testing:

http://apps.who.int/iris/bitstream/10665/179870/1/9789241508926_eng.pdf?ua=1

Link to the Fact sheet to the WHO Consolidated Guidelines on HIV Testing:

http://apps.who.int/iris/bitstream/10665/179931/1/WHO_HIV_2015.20_eng.pdf?ua=1&ua=1