June 24, 2024

WHO recommends optimizing HIV testing services

At the 12th IAS International Conference on HIV Science, the WHO calls on countries expand the use of HIV self-testing (HIVST).to Offer HIVST for initiation, continuation and resumption of pre-exposure prophylaxis (PrEP) and that promote testing through sexual and social networks increase testing coverage and strengthen uptake of HIV prevention and treatment services for the general public in high-burden settings and in populations and regions with the largest gaps in testing coverage. These recommendations are issued at a time of unique opportunity, when self-care and self-testing are increasingly recognized as ways to increase access, efficiency, effectiveness and acceptability of health care across many different disease areas, including HIV.

New suggestion

HIV self-testing may be offered as an additional option for testing at facilities (conditional recommendation, low certainty evidence).

Although HIV testing is routinely offered in some clinical settings such as antenatal services, there are many missed testing opportunities among people who present at health facilities, including men who are not often offered testing even in high-burden settings. As of 2022, an estimated 5.5 million people still did not know their HIV status.

Providing HIV self-testing at facilities can select the number of tests and improve the efficiency of service delivery, particularly in settings where there is a shortage of health workers and HIV testing is not readily available in any other way.

Evidence from a systematic review showed that facility-based HIV self-testing may lead to uptake of HIV testing comparable to or higher than standard facility-based testing. Another finding from the review was that having access to HIVST at facilities reduces barriers to testing and increases the number of people tested who are found to be HIV positive. In Zimbabwe, offering testing coverage increased from 0.5% to 64% within 3 months of implementation of HIVST in family planning clinics where HIV testing was not routinely offered. (1).

New suggestion

HIV self-testing may be used to deliver pre-exposure prophylaxis, including for initiation, re-initiation and continuation. (conditional recommendation, low certainty evidence).

Access to PrEP, which has been shown to be highly effective in reducing HIV infections, has yet to increase. The WHO now promotes a global scale-up of simplified delivery of PrEP, with a focus on reducing the need for frequent facility visits, including by streamlining HIV testing requirements. Offering HIVST as an alternative strategy is an innovative way to increase access and effective use of PrEP in many programs. HIVST can also be used to reassure people without HIV that their prevention practices are effective.

There are a range of PrEP options in which the use of HIVST could be considered, including oral PrEP (daily or on demand) and the dapivirine vaginal ring. HIVST can also be considered as part of the implementation of post-exposure prophylaxis (PEP). Further research is needed on the role of HIVST in the implementation of long-acting injectable prevention options, such as cabotegravir.

New suggestion

A social network testing approach may be offered as an additional approach to HIV testing as part of a comprehensive care and prevention package (conditional recommendation, low certainty evidence).

The guidelines also recommend that countries expand the offer of social network testing (SNA) approaches as a way to increase access to and uptake of HIV testing. Social network-based HIV testing is an approach to recruit sexual and injecting drug partners and social contacts of people with HIV and those who are HIV-negative and at persistent risk into voluntary testing services. This approach includes providing contacts with information about testing services or providing contacts with self-tests.

WHO previously recommended this approach for people in key population groups, but now extends this recommendation to anyone in high-burden settings.

Results from a systematic review showed that CRS could increase uptake of HIV testing – either through HIV self-testing or standard facility-based testing – among sexual partners and social contacts of test initiators. Social network approaches may also increase the number of first-time testers, demonstrating the value of these types of approaches in closing gaps in testing coverage and increasing the number of infections diagnosed.

“Offering a range of HIV testing approaches is an effective way for programs to meet HIV testing, prevention and treatment goals and to achieve and maintain low HIV incidence,” said Dr Meg Doherty, Director, WHO’s Global HIV, Hepatitis and STI Programmes.

The updated recommendations will be presented and discussed at the following sessions of the 12th IAS Conference on HIV Science:


References

1. Integration of HIV testing and connectivity in family planning and contraceptive services: an implementation brief. Geneva: World Health Organization; 2021

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