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

Abstract

In this Policy Forum, Anna Grimsrud and colleagues discuss the future of HIV testing in eastern and southern Africa, using insights gleaned from a 2021 expert consultation.

Fig 1. An example of a status-neutral approach to HIV testing with linkage to PrEP [31].

Legend: HIV testing services result in an action—either the red arrows for someone who is living with HIV or the black arrows for the person who tests HIV negative. HIV testing services are therefore status-neutral, with benefits and an action regardless of the test outcomes. The person on the left receives HIV testing services. If they test positive for HIV, they follow the red arrow up and are linked to and initiated on ART. They continue to follow the red arrows and are engaged in HIV care and achieve viral suppression. They may interrupt treatment and need to be re-engaged in care. By achieving and sustaining viral suppression, they have zero risk of transmitting HIV and reduced morbidity and mortality. If the person on the left receives HIV testing services and tests negative for HIV, they will follow the black arrows along the bottom. If they are at ongoing risk of HIV exposure, they should have their risk assessed by a provider. They may need to be provided with PrEP and supported to use PrEP effectively to have negligible risk of HIV acquisition. While on PrEP, they should also be provided with frequent HIV and STI testing. If they do acquire HIV, they then follow the red arrow left and to the top to be provided with services for a person living with HIV. Both people living with HIV and those without HIV should be provided with condoms and other preventive healthcare services. ART, antiretroviral therapy; HIV+, person living with HIV who tests positive; HIV-, person who tests negative for HIV; HIV/STI, HIV and sexually transmitted infection, PrEP, pre-exposure prophylaxis.