WHO has released a new toolkit to enable countries to accelerate their ongoing efforts to fully adopt WHO guidelines and transition to new HIV testing algorithms.
In 2019, in response to changing epidemiology, WHO recommended countries adopt a standard HIV testing strategy with three consecutive reactive tests for an HIV-positive diagnosis to ensure quality services as countries move toward and achieve the UNAIDS 95-95-95 targets. The guidance also highlighted the need to introduce dual HIV/syphilis rapid diagnostic tests (RDTs) and to phase out older testing technologies, including western blotting methods.
Many countries have since taken up this WHO guidance. For example, in the WHO African Region, compliance to HIV testing strategies increased from 8% in 2014 to 71% in 2021. However, gaps remain. More than a dozen countries use western blotting methods that hinder same day diagnoses and immediate access to ART and PrEP. Also, many settings have yet to fully transition to WHO’s recommended testing strategy or integrate dual HIV/syphilis RDTs into testing algorithms for pregnant women and key populations. Speaking at the African Society of Laboratory Medicine Conference, 2021, Anita Sands from WHO’s Department of Regulation and Prequalification said, “WHO encourages national programmes to use verified national algorithms with quality-assured products, including the offer of dual HIV/syphilis RDTs and efforts to phase out western blotting methods. Such shifts are feasible and will enhance HIV testing quality, enable people with HIV to start treatment quickly, and people with substantial risk to scale-up access to PrEP.”
Fifteen low- and middle-income countries have already begun using elements of the toolkit to improve testing. Dr Abderrazzack Adoum, Coordinator, Chad National HIV, Hepatitis and STI Programme, says, “Verification of HIV testing algorithms are important for identifying multiple assays that can be used to provide high quality and flexibility of testing algorithms.” The toolkit has also been helpful with bringing innovative approaches for both HIV and syphilis into national planning. “The evidence generated informed our final algorithms and plans for integrating the dual HIV/syphilis tests in antenatal care,” says Jean De Dieu Anoubissi, Chief of Research, Cameroon National AIDS Council.
Delivering correct results is one of the WHO “5Cs” and a core principle for all HIV testing services and essential to achieving global prevention and treatment goals. WHO expresses thanks to the countries and international experts who supported the development and review of this toolkit. As WHO celebrates the achievements of many countries making progress toward the 95-95-95 targets, the toolkit’s efforts to operationalize existing WHO recommendations to achieve quality HIV testing services are timely and will become increasingly important.
