USA —The World Health Organization (WHO) has called on countries to embrace HIV self-testing (HIVST) and social network testing (SNA) as pivotal strategies to enhance HIV prevention and treatment services.
The recommendations were unveiled at the 12th International IAS Conference on HIV Science, emphasizing the critical need for increased testing coverage in high-burden settings and regions with significant gaps in testing accessibility.
Dr. Meg Doherty, Director of WHO Global HIV, Hepatitis, and STI Programmes, stressed the significance of these novel approaches, asserting, “Offering people a range of HIV testing approaches is an effective way for programs to reach HIV testing, prevention, and treatment goals and to achieve and maintain low HIV incidence.”
HIV self-testing as an expanded option for facility-based testing
With an estimated 5.5 million people still unaware of their HIV status, ensuring access to HIV testing remains a pressing challenge.
Routine testing in clinical settings, including antenatal services, has proven effective; however, there remain missed opportunities for testing, particularly among men, even in high-burden regions.
The WHO now recommends offering HIV self-testing as an additional option at healthcare facilities. This innovative approach can lead to increased testing uptake and more efficient service delivery, especially in areas where there is a scarcity of healthcare workers and limited access to conventional HIV testing.
A systematic review has indicated that facility-based HIV self-testing can yield testing uptake rates comparable to or even higher than standard facility-based testing.
For example, Zimbabwe saw a remarkable increase in testing coverage from 0.5% to 64% within just three months of implementing HIVST in family planning clinics where routine testing was previously unavailable.
Using HIV self-testing to facilitate pre-exposure prophylaxis (PrEP)
Scaling up access to PrEP has been a challenge despite its proven effectiveness in reducing HIV infections.
To address this issue, WHO advocates for the global expansion of simplified PrEP delivery, aiming to reduce the need for frequent facility visits and streamlining HIV testing requirements.
HIVST emerges as a potential game-changer, providing an alternative strategy to enhance PrEP access and utilization in various programs.
Moreover, it can offer reassurance to HIV-negative individuals that their prevention practices are effective.
HIVST can be considered in different PrEP options, including oral PrEP (daily or on-demand) and the dapivirine vaginal ring.
Additionally, there is potential for HIVST to be integrated into post-exposure prophylaxis (PEP) implementation.
Further research is needed to explore the role of HIVST in supporting long-acting injectable prevention options such as cabotegravir.
Social Network Testing (SNA) as an additional approach to increase testing uptake
In an effort to enhance access to HIV testing, the guidelines recommend expanding social network testing approaches (SNA) in a comprehensive package of care and prevention.
SNA involves engaging sexual and drug-injecting partners, as well as social contacts of people with HIV and those at ongoing risk of HIV, in voluntary testing services. This approach includes providing information about testing services or distributing self-tests to contacts.
While SNA was previously recommended for people in key population groups, the new guidance expands its applicability to anyone in high-burden settings.
Evidence from a systematic review indicates that SNA can significantly increase HIV testing uptake among sexual partners and social contacts, whether through HIV self-testing or standard facility-based testing.
This approach also shows promise in encouraging first-time testers, making it a valuable tool for closing the gaps in testing coverage and diagnosing more infections.
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