“What Took You So Long?” The Impact of PEPFAR on the Expansion of HIV Testing and Counseling Services in Africa

Abstract

HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status.

Poor Performance of the Determine HIV-1/2 Ag/Ab Combo Fourth-Generation Rapid Test for Detection of Acute Infections in a National Household Survey in Swaziland

“…T he development of HIV rapid tests (RTs) has facilitated the massive scale-up of HIV testing and counseling at thousands of testing venues, especially in sub-Saharan Africa, allowing millions of individuals to receive their HIV diagnosis outside a primary care facility (1). HIV RTs have relied on the detection of HIV antibodies (Ab) after seroconversion, and the sensitivities of various RTs have approached nearly 100% (2,3).…”

Trends in between-country health equity in Sub-Saharan Africa from 1990 to 2011: improvement, convergence and reversal

“…One encouraging sign for HIV/AIDS control, however, is that those countries with substantial DAH tend to be those who enjoyed accelerated improvement, a preliminary and macro-level signal that supports the effectiveness of DAH programs such as the Global Fund to Fight AIDS, Tuberculosis and Malaria [31] and President's Emergency Plan for AIDS relief [32]. Those countries that now fell behind the average thus need more evidence-based investment in HIV/AIDS prevention and control, with resources both from outside and from within the Sub-Saharan region [33].…”

The Centrality of Laboratory Services in the HIV Treatment and Prevention Cascade: The Need for Effective Linkages and Referrals in Resource-Limited Settings

“…For example, in Mozambique, after introducing point of careCD4 for same day results, the proportion of patients lost to follow-up before completion of CD4 staging dropped from 57% to 21%. 3 A holistic approach to improving access to various laboratory services to support HIV treatment is necessary.…”

“…New HIV infections, morbidity, and mortality have decreased, and the proportions of people who know their HIV status and are enrolled into antiretroviral treatment (ART) programs have increased significantly. 1–3 Sustaining and maximizing these gains is critical but there are many challenges. While ART efforts are being scaled up globally, patient attrition remains high between HIV diagnosis, enrollment, and retention in care.…”