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Review
. 2020 May;5(5):e001939.
doi: 10.1136/bmjgh-2019-001939.

Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review

Virginia A Fonner  1 , Anita Sands  2 , Carmen Figueroa  3 , Rachel Baggaley  3 , Caitlin Quinn  3 , Muhammad S Jamil  3 , Cheryl Johnson  3
Affiliations
Review

Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review

Virginia A Fonner et al. BMJ Glob Health. 2020 May.

Abstract

Introduction: Ensuring a correct and timely HIV diagnosis is critical. WHO publishes guidelines on HIV testing strategies that maximise the likelihood of correctly determining one's HIV status. A review of national HIV testing policies in 2014 found low adherence to WHO guidelines. We updated this review to determine adherence to current recommendations.

Methods: We conducted a comprehensive policy review through April 2018. We extracted data on HIV testing strategies, recommendations on HIV retesting prior to antiretroviral therapy (ART) initiation and pre-exposure prophylaxis (PrEP)-related HIV testing information. Descriptive analyses disaggregated by region were conducted to ascertain adherence to recommendations and to describe testing strategy characteristics.

Results: Of 91 policies included, 26% (n=24/91) adhered to WHO recommendations. Having a two-assay testing strategy to rule-in HIV infection as opposed to the recommended three-assay testing strategy was a major reason for non-adherence. Of 72 country policies providing sufficient information, 31% (n=22) recommended retesting for HIV prior to initiating ART. Of 25 countries and two regions reporting PrEP-related HIV testing guidelines, almost all recommended testing prior to initiating PrEP and every 3 months during PrEP use.

Conclusions: Global adherence to WHO recommendations for HIV testing strategies have improved since 2014 but remain low. We found adherence existed on a continuum. Such a system provides insights into how countries can move towards adherence by making relatively minor changes to testing strategies. Guidance from WHO on the role of new HIV testing technologies within testing algorithms and identifying ways to simplify testing guidance is warranted.

Keywords: HIV; diagnostics and tools; health policy; screening.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. The contents in this article are those of the authors and do not necessarily reflect the view of the World Health Organization.

Figures

Figure 1
Figure 1
(A) Countries with HIV testing services policies identified and included in analysis (n=91). (B) Countries with policies identified containing information on HIV testing in the context of pre-exposure prophylaxis (n=27).
Figure 2
Figure 2
Adherence to WHO recommendations for HIV testing strategy by region. Adherence to WHO testing recommendations for each WHO region. Colour shows details about compliance categorisation (full adherence=no major or minor issues; mostly adherent=one minor issues; somewhat not adherent=two or more minor issues; not adherent=one or more major issues).
See this image and copyright information in PMC

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