The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

Abstract

Scale-up of HIV testing services (HTS), primarily through routine offer of HIV testing in health services, has led to an increase in the proportion of people with HIV who know their status and are accessing HIV treatment.

Risk Screening Tools Could Potentially Miss HIV-Positive Individuals Who Seek Testing Services: A Secondary Program Data Analysis on the Performance Characteristics of an Adolescent and Adult HIV Risk Screening Tool in Uganda

“…In 2018, 8,473,627 were tested versus 280,767 identified; in 2019, 6,384,317 were tested versus 199,743 identified; and in 2020, 6,355,186 were tested versus 164,804 identified. Whereas the country has not performed statistical analysis to correlate the reduction in HIV testing volumes with the number of HIV-positive clients that could be potentially missed, our data analysis, plus the published literature suggests the potential of missing HIV-positive people through the use of risk screen-out tools [ 14 ].…”

“…Of these, HIV self-testing would be the ideal option for people who are categorized as ineligible for testing because being an antibody-based test, it is more sensitive and specific than risk-based screening tools. In their paper entitled, “The future of HIV testing in Eastern and Southern Africa: Broader scope, targeted services”, Anna Grimsrud et al recommend a shift away from yield/positivity and case identification as the sole or primary indicators of HTS program success, and instead focus on maximizing the absolute number of HIV diagnoses [ 14 ] and linking high-risk individuals to combination prevention services to minimize their chances of acquiring HIV. This contributes to the status-neutral HIV testing approach where PLHIV have undetectable viral loads and negligible chances of transmitting HIV, while the high-risk negative have negligible chances of acquiring HIV.…”

Temporal Trends and Determinants of HIV Testing at Antenatal Care in Sub-Saharan Africa: A Pooled Analysis of Population-Based Surveys (2005–2021)

“…These services allow those at ongoing HIV acquisition risk to be linked to appropriate combination prevention interventions, such as preexposure prophylaxis, voluntary medical male circumcision, and condoms, among others. 6,7 Expanding HTS through various modalities—voluntary counselling and testing, provider-initiated testing and counselling, home-based testing—increased HIV diagnosis coverage from an estimated 6% of people living with HIV aware of their status in SSA in 2000 to 84% in 2020. 8…”

“…To achieve UNAIDS’ ambitious diagnostic target of 95% people living with HIV aware of their status, countries' focus and mix of testing approaches need to be adapted to their local epidemics. 7 At this critical time for national HIV testing strategies, we analyzed historical and comparative perspective of the role of ANC among women's access to and uptake of HIV testing. Specifically, we synthesized data from 41 SSA countries on recent HIV testing (in the past 24 months), estimated the proportion of these recent tests that were performed during ANC visits, and examined regional, country, and sociodemographic factors associated with HIV testing at ANC.…”

Determinants and acceptability of HIV self-testing among vulnerable groups in sub-Saharan Africa: A scoping review protocol

“… 38 Alternatively, follow-up services linked to HIVST, such as counselling or confirmatory testing, also present opportunities for data collection. 30 These mechanisms, although reliant on individual willingness and therefore potentially subject to underreporting, could contribute to establishing a statistical benchmark for HIV incidence and prevalence in the target population. 39 However, it is crucial to acknowledge the potential limitations in data completeness and representativeness due to the private and voluntary nature of HIVST.…”