HIV testing and counselling

HIV testing and counselling (HTC) services have helped millions of people learn their HIV status and for those testing positive, learn about options for long term care and treatment. In 2012, WHO estimated that 118 million people in 124 low- and middle-income countries received HIV testing and counselling in the past 12 months and learned their test result

The development and use of rapid, point-of-care HIV tests in the late 1990s have facilitated expansion of HIV testing services. These rapid 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 test can provide immediate, on-site confirmation of test results.

Innovative and creative approaches to service delivery have been implemented in numerous countries, including testing in the 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.

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.

Home-based testing is also expanding in many countries. Home testing may be used to offer testing to the family members of patients enrolled in care and treatment or may be offered on a door-to-door basis for all members of a community. Such door-to-door testing has now been implemented in many countries with generalized epidemics, including Uganda, Kenya, Lesotho, Zambia, and others.

WHO has issued guidance on HTC soon after first HIV tests were developed in 1985. Since that time, WHO has issued guidance on all forms of HIV testing.

WHO has defined five key components—the “5 Cs”—that must be respected and adhered to by all HTC services. These components are:

  • Consent
  • Confidentiality
  • Counselling
  • Correct test results
  • Connection/linkage to prevention, care and treatment.

More information on standard testing strategies is available in the 2012 WHO document: Service Delivery Approaches to HIV Testing and Counselling (HTC): A Strategic HTC Programme Framework.