HIV testing services
HIV testing services (HTS) include 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.
The development and use of HIV rapid diagnostic tests in the late 1990s have facilitated expansion of HIV testing services. These rapid diagnostic tests can be performed with a finger-prick blood sample collected and processed by a trained community worker and can be conducted outside of health facilities and traditional testing sites. Use of more than one rapid diagnostic test, within either a low prevalence or a high prevalence testing strategy and using a nationally validated testing algorithm, can provide immediate, on-site HIV diagnosis.
WHO has issued guidance on HTS soon after first HIV tests were developed in 1985. Since that time, WHO has issued guidance on all forms of HIV testing and approaches to HIV testing service delivery.
Innovative and creative approaches to service delivery have been implemented in numerous countries, including facility-based and community-based HIV testing services. Services range from provider-initiated testing and counselling, standalone voluntary testing and counselling, to home, mobile and outreach testing in the community, “moonlight” testing during evening hours in high-risk settings, and in 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. In this approach a trained lay provider uses a single rapid diagnostic test and refers and links all people with a reactive test result to HIV prevention, care and treatment services in a timely manner.
All HIV testing services should be performed using a WHO recommended testing strategy for a high or low HIV prevalence setting and using a nationally validated testing algorithm.
WHO has defined five key components—the “5 Cs”—that must be respected and adhered to by all HTC services. These components are:
- Correct test results
- Connection/linkage to prevention, care and treatment.
More information on standard testing approaches is available in the 2015 WHO Consolidated Guidelines on HIV testing services.
Mandatory, compulsory or coercive HIV testing is never appropriate and should always be provided in a respectful, non-discriminatory and ethical manner, reflecting the professional integrity of the provider and respecting the human rights of the person being tested.
Recognizing the importance of disclosure to family members and sexual partners, many countries have also introduced “couples testing and counselling” where couples can learn their results together, with the assistance of a trained counsellor or health worker. Sharing serostatus allows couples to plan, make important life decisions, including making HIV prevention choices, and to seek care and support together. Services targeting other groups have also been introduced, including for adolescents and people from key populations, such as services for sex workers, injecting drug users, and men who have sex with men and transgender people. It is imperative that these services are provided within a context of respect, non-discrimination, and protection of privacy and confidentiality.