Objectives

In 2015 and 2016, the World Health Organization (WHO) issued guidelines on HIV testing services (HTS) highlighting recommendations for a strategic mix of differentiated HTS approaches. The Policy review examines the uptake of differentiated HIV Testing service (HTS) approaches recommendations.

Methods

Data were extracted from all available national policies published between January 2015 and June 2019 and stored in WHO’s national policy repository. WHO recommended as HTS approaches facility-based testing, community-based testing, HIV self-testing and provider-assisted referral (or assisted partner notification); in terms of testing components: pre-test information, lay provider testing and rapid testing. Descriptive analyses were conducted to examine availability of policies and adherence to WHO-differentiated HTS recommendations.

Results

Of 194 countries worldwide, 65 published policies were identified in the review period. 24 were from the African region (51% of African countries, 24/47), six from the Eastern Mediterranean region (29%, 6/21), 21 from the European region (40%, 21/53), five from the American region (14%, 5/35), four from the South East Asia region (36%, 4/11) and five from the Western Pacific Region (19%, 5/27). Only five countries were compliant with recommendations and 63 included at least one. 85% (n=55) included facility-based testing for pregnant women, 75% (n=49) facility-based testing for key populations, 74% (n=48) community-based testing for key populations, 38% (n=25) HIV self-testing, 25% (n=16) provider-assisted referral, 69% (n=45) rapid testing, 57% (n=37) post-test counselling, 45% (n=29) lay provider testing and 29% (n=19) pre-test information. The highest uptake of WHO recommendations was seen in countries from the African and Eastern Mediterranean region.

Conclusions

There was substantial variability in the uptake of WHO HTS recommendations, ranging from 25% to 85%. Uptake was above 50% for facility-based testing for pregnant women and key populations, community-based testing, rapid diagnostic testing and post-test counselling; uptake was between 25% and 45% for all the other recommendations.