The 5 years plan to scale up HIV Testing and Counselling Services in Malawi 2006-2010
Guidelines
HIV testing services
July 2015
Supplement
HIV testing services
December 2016
These guidelines provide a framework for effective action to facilitate access to safe and ethical
testing services for different population groups. The implementation of the a comprehensive
appro
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ach, known as HIV Testing Services (HTS) is cardinal as an effective package of services
that diminishes the impact of the HIV epidemic in our country. All forms of HTS adhere to
the 5Cs: Confidentiality, Counselling, Consent, Correct results and Connection, or linkage
to care, with all based within a human right context. In addition to the 5Cs, however, the
MOHCDGEC emphasizes the use of a variety of approaches to HTS that will reduce the
number of missed opportunities. These include Provider-Initiated Testing and Counselling
testing, Couple counselling and testing, Index testing, and infant and children counselling and
testing in alignment to the revised WHO guidelines. Furthermore, these guidelines accentuate
on the continual provision of integrated HTS service at all levels of the public and private
health service delivery system.
The HTS Providers, managers and other stakeholders
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This implementation brief addresses integration of HIV testing services into family planning (FP) services. It is intended as a practical resource
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for national health programmes seeking to introduce or scale up HIV testing and linkage to HIV prevention, sexually transmitted infection, and antiretroviral therapy services in FP.
This document highlights emerging good practices and country experiences of integrated HIV prevention and testing services within FP and advocates for increased linkage for FP clients to HIV services according to their needs. It also brings together information on models of integration of HIV testing into FP services, programme examples from east and southern Africa and guidance on the implementation monitoring process.
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These consolidated guidelines on HIV testing services (HTS) bring together existing and new guidance on HTS across different settings and populations.
The World Health Organization (WHO) first re
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leased consolidated guidelines on HTS in 2015, in response to requests from Member States, national programme managers and health workers for support to achieve the United Nations (UN) 90–90–90 global HIV targets – and specifically the first target of diagnosing 90% of all people with HIV. In 2016, based on new evidence, WHO released a supplement to address important new HIV testing approaches – HIV self-testing (HIVST) and provider-assisted referral.
Since the release of 2015 and 2016 HTS guidelines, new issues and more evidence have emerged. To address this, WHO has updated guidance on HIV testing services. In this guideline, WHO updates recommendation on HIVST and provides new recommendations on social network-based HIV testing approaches and western blotting (see box, next page). This guideline seeks to provide support to Member States, programme managers, health workers and other stakeholders seeking to achieve national and international goals to end the HIV epidemic as a public health threat by 2030.
These guidelines also provide operational guidance on HTS demand creation and messaging; implementation considerations for priority populations; HIV testing strategies for diagnosis HIV; optimizing the use of dual HIV/syphilis rapid diagnostic tests; and considerations for strategic planning and rationalizing resources such as optimal time points for maternal retesting
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October 2018
HIV testing services
In 2014, GHS/NACP, with support from UNICEF and other partners, conducted a situation analysis on paediatric HIV care and treatment in Ghana. The purpose of this analysis was to identify the gaps within the current delivery of paediatric HIV care and support system and develop a road map for effecti
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ve implementation of Early Infant Diagnosis (EID) and to increase paediatric antiretroviral therapy (ART) coverage. The analysis identified gaps such as lack of task shifting on ART services, low paediatric ART coverage, and poor linkage of ART, EID, and PMTCT services with other RCH - immunization and nutrition services.
In view of the findings of the analysis, it was recommended that an Acceleration Plan for Paediatric HIV Services be developed to address the barriers and bottlenecks identified during the assessment. At the current pace of paediatric HIV Services, it can be extrapolated that paediatric ART coverage will increase from 26% to only about 40% by 2020; Ghana will, therefore, fall short of the global target of 90-90-90 (UNAIDS concept).
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Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepat
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itis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviours and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination.
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9 March 2022, Timely and accurate diagnostic testing for SARS-CoV-2 is an essential part of a comprehensive COVID-19 response strategy. Ag-RDTs can be performed by individuals in which they collect their own specimen, perform a simple rapid test and
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interpret their test result themselves at a time and place of their choosing, termed COVID-19 self-testing. This interim guidance provides a new recommendation that COVID-19 self-testing, using SARS-CoV-2 Ag-RDTs, should be offered as part of SARS-CoV-2 testing services. It also includes implementation considerations that can guide decisions on whether, and how, to adopt self-testing in different contexts, including the populations being prioritized; the disease prevalence in that population; and the impact on accessibility of testing, health care services and result reporting.
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Eaton JW et al. Journal of the International AIDS Society 2019, 22(S1):e25237 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25237/full | https://doi.org/10.1002/jia2.25237
These guidelines provide specific recommendations and expert suggestions — for national policy-makers and programme managers and their partners and stakeholders— on prioritizing, planning and providing HIV testing, counselling, treatment and car
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e services for adolescents
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The COVID-19 pandemic arrived in an evolving epidemiological context where some countries are experiencing a progressive decrease in HIV positivity in their testing programme as they are moving closer to the first 95 target. Distinguishing changes i
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n HIV testing services due to the COVID-19 pandemic from those resulting from evolving HIV testing strategies is crucial for adapting services and helping countries define their strategic mix of testing options moving forward. There is a need to focus, prioritize and plan for strategic efforts to prevent going further off the track toward achieving global targets and goals.
To support these efforts, WHO in partnership with ministries of health conducted an in-depth analysis of HIV testing services and antiretroviral therapy (ART) initiation prior to and during reported COVID-19 disruptions. Additional publicly available Global Fund and PEPFAR data was also reviewed and analysed. This analysis, and coordination with ministries of health, identified key service delivery adaptations utilized during COVID-19-related disruptions and formed the basis of this strategic guide.
This document focuses on current country needs, as well as plans for prioritization and potential surge support needs in the event of future disruptions. Although the data and implications are specific to sub-Saharan Africa, key principles and lessons can be applied elsewhere.
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