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. 2023 Dec 28;13(12):e071198.
doi: 10.1136/bmjopen-2022-071198.

Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region

Emmanuel Fajardo  1 , Céline Lastrucci  1 , Nayé Bah  2 , Casimir Manzengo Mingiedi  3 , Ndoungou Salla Ba  4 , Fausta Mosha  5 , Frank John Lule  6 , Margaret Alia Samson Paul  6 , Lago Hughes  6 , Magdalena Barr-DiChiara  1 , Muhammad S Jamil  1 , Anita Sands  7 , Rachel Baggaley  1 , Cheryl Johnson  8
Affiliations

Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region

Emmanuel Fajardo et al. BMJ Open. .

Abstract

Objectives: In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.

Design: Policy review.

Setting: 47 countries within the WHO African region.

Participants: National HTS policies from the WHO African region as of December 2021.

Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.

Results: National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies.

Conclusions: Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.

Keywords: Diagnostic microbiology; HIV & AIDS; Health policy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Countries from the WHO African Region with HIV testing policies identified (in blue) and included in the analysis (n=45/47). The two countries not included in the review are indicated in the map.
Figure 2
Figure 2
Overall adoption of 2019 WHO HIV testing strategies in Africa by subregion in 2021.
Figure 3
Figure 3
Policy adoption in 2021 of six specific WHO HIV testing recommendations in the WHO African Region. ANC, antenatal care; ART, antiretroviral treatment.
See this image and copyright information in PMC

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