The theme for World AIDS Day 2016 is HIV Self Testing. Accordingly, the World Health Organization (WHO) has released new guidance on HIV self-testing and partner notification.
Definitions:
HIV self-testing: a process in which a person collects his or her own specimen (oral fluid or blood) and then performs a test and interprets the result, often in a private setting, either alone or with someone he or she trusts.
Directly assisted HIV self-testing (HIVST): refers to when individuals who are self-testing for HIV receive an in-person demonstration from a trained provider or peer before or during HIVST, with instructions on how to perform a self-test and how to interpret the self-test result. This assistance is provided in addition to the manufacturer-supplied instructions for use and other materials found inside HIVST kits.
Unassisted HIV self-testing: refers to when individuals self-test for HIV using only a self-test kit that includes manufacturer-provided instructions for use. As with all self-testing, users may be provided with links or contact details to access additional support, such as telephone hotlines or instructional videos.
Point-of-sex testing: refers to when individuals use an HIV rapid diagnostic test for self-testing to screen potential sex partners and determine his or her own HIV status and their partner(s)’ HIV status.
Rapid diagnostic test: in vitro diagnostic medical device of immunochromatographic or immunofiltration format for the detection of HIV-1/2 antibodies and/or HIV p24-1 antigen in the context of HIV.
Reactive test result: a test result that shows a reaction indicating the presence of analyte, which in the context of HIV includes HIV-1 p24 antigen or HIV-1/2 antibodies.
Confirm: to issue a report on HIV status. Initially reactive test results, including reactive self-test results, need to be confirmed according to the national validated testing algorithm.
Repeat testing: a situation in which additional testing is performed for an individual immediately following a first test, during the same testing visit, due to HIV-inconclusive status or discordant test results. The same assay(s) is used and, where possible, the same specimen.
Retesting: refers to certain situations in which individuals should be retested after a defined period of time: (1) HIV-negative people with recent or ongoing risk of exposure; (2) people with an HIV-inconclusive status; and (3) HIV-positive people before they enrol in care or initiate treatment. Reasons for retesting before initiation of care or treatment include ruling out laboratory or transcription errors and ruling in or ruling out seroconversion.
Partner notification services: also known as disclosure or contact tracing; is defined as a voluntary process whereby a trained provider asks people diagnosed with HIV about their sexual partners and/or drug injecting partners, and then, if the HIV-positive client agrees, offers these partner(s) HIV Testing Services (HTS). Partner notification is provided using passive or assisted approaches.
Key Messages:
People’s knowledge of their own, and their partner’s, HIV status is essential to the success of the global HIV response.
According to recent estimates, 77% of all people diagnosed with HIV are on ART; however, 40% of all people with HIV remain undiagnosed.
Men account for only 30% of people who have tested for HIV. As a result, men with HIV are less likely to be diagnosed and put on antiretroviral treatment and are more likely to die of HIV-related causes than women.
Adolescent girls and young women in East and Southern Africa experience infection rates up to eight times higher than among their male peers. Fewer than one in every five girls (15–19 years of age) are aware of their HIV status.
Testing also remains low among “key populations” and their partners – particularly men who have sex with men, sex workers, transgender people, people who inject drugs, and people in prisons – who comprise approximately 44% of the 1.9 million new adult HIV infections that occur each year.
Up to 70 % of partners of people with HIV are also HIV positive. Many of those partners are not currently getting tested. The new WHO guidelines recommend ways to help HIV positive people notify their partners about their status, and also encourage them to get tested.
The new guidelines aim to:
Support the implementation and scale-up of ethical, effective, acceptable and evidencebased approaches to HIVST and assisted HIV partner notification.
Support the routine offer of voluntary assisted HIV partner notification services as part of a public health approach to delivering HTS.
Provide guidance on how HIVST and assisted HIV partner notification services could be integrated into both community-based and facility-based HTS approaches and be tailored to specific population groups.
Support the introduction of HIVST as a formal HTS intervention using quality-assured products that are approved by WHO and official local and international bodies.
Position HIVST and assisted HIV partner notification services as HTS approaches that will contribute to closing the testing gap and achieving the UN’s 90–90–90 and 2030 global goals.
1. HIV self-testing should be offered as an additional approach to HIV testing services (strong recommendation, moderate quality evidence).
A reactive (positive) self-test result always requires further testing and confirmation from a trained tester starting from the beginning of a validated national testing algorithm.
Interpretation of a non-reactive (negative) self-test result will depend on the ongoing risk of HIV exposure. Individuals at high ongoing risk, or who test within six weeks of possible HIV exposure, should be encouraged to retest. HIVST is not recommended for users with a known HIV status who are taking antiretroviral drugs, as this may lead to an incorrect self-test result (false non-reactive).
HIVST is acceptable to many users across different contexts and can, therefore, increase uptake and frequency of HIV testing, particularly among populations at high ongoing risk of HIV, who may be less likely to access testing or test less frequently than recommended.
HIV rapid diagnostic tests (RDTs) used by self-testers can perform as accurately as when used by a trained tester, provided the HIVST products meet quality, safety and performance standards. In-person demonstrations and other support tools, such as videos, may also enhance the performance of HIVST.
HIVST can be delivered through various approaches in the public and private sectors, including community-based, facility-based and Internet-based channels.
Coerced or mandatory testing is never appropriate, whether that coercion comes from a health-care provider or from a partner, family member, or any other person.
2. Voluntary assisted partner notification services should be offered as part of a comprehensive package of testing and care offered to people with HIV (strong recommendation, moderate quality evidence).
HIV partner notification is a voluntary process where trained health workers, including lay providers, ask people diagnosed with HIV about their sexual partners or drug injecting partners, and with the consent of the HIV-positive client, offer these partners voluntary HIV testing. Partner notification is provided using passive or assisted approaches.
Assisted partner notification services (such as provider, contract or dual referral) increase the uptake of HIV testing among partners of HIV-positive clients, and high proportions of HIV-positive people are diagnosed and linked to care and treatment.
Reports of social harm or other adverse events following voluntary HIV partner notification have been rare.
HIV-positive clients should be offered multiple options for assisted partner notification
Partner notification services should always be voluntary
Notification should only be delivered to partners of HIV-positive people, no one else
Useful Links:
Link to the WHO news release:
http://www.who.int/mediacentre/news/releases/2016/world-aids-day/en/
Link to WHO’s new Guidelines on HIV self-Testing and Partner Notification (English) [PDF]:
http://apps.who.int/iris/bitstream/10665/251655/1/9789241549868-eng.pdf?ua=1
Link to WHO page on HIV self-testing:
http://www.who.int/hiv/topics/self-testing/en/
Link to WHO fact sheet on HIV/AIDS (updated November 2016):
http://www.who.int/mediacentre/factsheets/fs360/en/
Link to WHO’s World AIDS Day Campaign page:
http://www.who.int/campaigns/aids-day/2016/en/
Link to WHO page containing infographics on HIV Self-Testing:
http://www.who.int/campaigns/aids-day/2016/infographics/en/
Links to individual infographics on HIV self-testing:
http://www.who.int/campaigns/aids-day/2016/aids2.jpg?ua=1
http://www.who.int/campaigns/aids-day/2016/aids-1.jpg?ua=1
http://www.who.int/campaigns/aids-day/2016/aids4.jpg?ua=1
Link to WHO Progress Report 2016: Prevent HIV- Test and Treat All (English) [PDF]:
http://apps.who.int/iris/bitstream/10665/251713/1/WHO-HIV-2016.24-eng.pdf?ua=1
