The World Health Organisation (WHO) has released new guidelines for HIV testing in an effort to reach the 90-90-90 targets proposed by UNAids, which call for a scale-up of HIV testing so that 90 percent of people with HIV are aware of their infection, 90 percent of people diagnosed with HIV are linked to antiretroviral treatment (ART) and 90 percent of those on ART adhere and have undetectable levels of HIV in their blood.
To reach the first 90—diagnosing 90 percent of people with HIV who do not know their HIV status—countries need to improve the effectiveness of their HIV testing services and reach people with HIV who are undiagnosed so they can be linked to HIV prevention, care and treatment.
Counselling is still seen as a key component but providers need to do more than counsel and test. Hence the shift in terminology from voluntary testing and counselling (VTC) and HIV testing and counselling (HTC) to the current preferred term: HIV Testing Services (HTS). HTS captures the full range of services that should be provided together with HIV testing.
All HIV testing services should continue to be provided within WHO’s essential 5Cs: Consent, Confidentiality, Counselling, Correct test results and Connection (linkage to prevention, care and treatment). This includes pre-test information, post-test counselling, linkage to appropriate HIV prevention, care and treatment services and other clinical and support services, quality HIV testing, accurate test results and diagnosis, and coordination with laboratory services to support quality assurance.
Recent estimates report that only 51 percent of people with HIV know their HIV status. In order to reach the UN 90–90–90 goals, it is critical that HIV testing services be strategically expanded to diagnose as many people with HIV as early as possible. New consolidated guidelines on HIV testing services from the WHO recommend that lay providers who are trained can, using rapid diagnostic tests, independently conduct safe and effective HIV testing services
The guidance reviews a range of ways of providing HIV testing. This includes testing in health facilities as well as a range of community-based HIV testing services. WHO coins a new term, ‘test for triage’ to describe community-testing services which will systematically refer to other services for confirmation of what appear to be HIV-positive results. Another important component of the guidelines is testing men, as currently majority of people who get tested are women.
The guidelines stress that “countries will need to assess their specific situations and take into account their epidemiological context and the populations most in need in their settings”. So, for Malawi what are our peculiarities?
(adapted from who.org and aidsmap.com)