Guideline

Consolidated guidelines on differentiated HIV testing services.

Year of Publication

2024

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

38 included recommendations

High HIV burden settings. WHO recommends community-based HIV testing services, with linkage to prevention, care and treatment services, particularly for key populations, in addition to routinely offering facility-based testing (strong recommendation, low-certainty evidence).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

WHO suggests offering syphilis self-testing (SST) as an additional syphilis testing approach.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

HCV self-testing should be offered as an additional approach to HCV testing services

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

HIV self-testing (HIVST) may be offered as an additional option for testing at facilities

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

HIV self-testing (HIVST) may be used to deliver pre-exposure prophylaxis, including for initiation, re-initiation and continuation

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Differentiated HIV testing services. Network-based testing is recommended including the biological children of people with HIV, including the use of social network testing

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Differentiated HIV testing services. Network-based testing is recommended including the biological children of people with HIV, including the use of family and household testing services and partner services

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

WHO recommends that sexually transmitted infection (STI) partner services should be offered to people with STIs as part of a range of options based on their needs and preferences and within a comprehensive package of voluntary STI testing, care and prevention

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Lay providers who are trained and supervised can independently conduct safe and effective HIV testing using rapid diagnostic tests (RDTs)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Western blotting and line immunoassays should not be used in national HIV testing strategies and algorithms

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

HIV recency testing is not recommended as part of routine HIV testing services

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Rapid ART initiation should be offered to all people with HIV following a confirmed HIV diagnosis and clinical assessment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Following an HIV-positive diagnosis, a package of support interventions should be offered to ensure timely linkage to care for all people with HIV

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The following interventions have demonstrated benefit in improving linkage to care following an HIV diagnosis: • streamlined interventions to reduce time between diagnoses and engagement in care including (i) enhanced linkage with case-management; (ii) support for HIV disclosure; (iii) tracing; (iv) training staff to provide multiple services, and (v) streamlined services (moderate-certainty evidence);

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The following interventions have demonstrated benefit in improving linkage to care following an HIV diagnosis: • peer supporta & navigation approaches for linkage (moderate-certainty evidence)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The following interventions have demonstrated benefit in improving linkage to care following an HIV diagnosis: • quality improvement approaches using data to improve linkage (low-certainty evidence)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Community-based HIV testing, with linkage to prevention, treatment and care, should be offered, in addition to routinely offering testing in facilities, for key populations in all settings

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

HIV testing services, with linkages to prevention, treatment and care, are recommended for adolescents from key populations

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Adolescents should be counselled about the potential benefits and risks of disclosure of their HIV status to others and empowered and supported to determine if, when, how and to whom to disclose

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

In high HIV burden settings, HIV testing services (HTS), with linkage to prevention, treatment and care, are recommended for all adolescents

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

HIV testing services, with linkage to prevention, treatment and care, should be accessible to adolescents in low-burden settings. This is particularly important for young members of key populations.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

For children and adolescents who have been sexually abused, WHO recommends that, in addition to HIV PEP and emergency contraception (which can be offered to pre-pubertal girls), STI presumptive treatment or syndromic management is suggested in settings where laboratory testing is not feasible

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

(For children and adolescents who have been sexually abused) Adolescent girls (ages 9–14 years) should be offered HPV vaccination as per national guidance

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

All pregnant women should be tested for HIV, syphilis and hepatitis B surface antigen (HBsAg)* at least once and as early as possible

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

It is strongly recommended that all HIV-exposed infants have HIV virological testing at 4–6 weeks of age or at the earliest opportunity thereafter

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

It is strongly recommended that HIV virological testing be used to diagnose HIV infection in infants and children below 18 months of age

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Point-of-care nucleic acid testing should be used to diagnose HIV among infants and children younger than 18 months of age

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Addition of nucleic acid testing (NAT) at birth to existing early infant diagnosis (EID) testing approaches can be considered to identify HIV infection in HIV-exposed infants

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In infants with an initial positive virological test result, it is strongly recommended that ART be started without delay and, at the same time, a second specimen is collected to confirm the initial positive virological test result. Immediate initiation of ART saves lives and should not be delayed while waiting for the results of the confirmatory test

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

An indeterminate range of viral copy equivalents should be used to improve the accuracy of all nucleic acid-based infant diagnosis assays

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Rapid diagnostic tests (RDTs) for HIV serology can be used to assess HIV exposure only in infants less than 4 months of age. HIV-exposure status in infants and children 4–18 months of age should be ascertained by undertaking HIV serological testing in the mother

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

It is strongly recommended that children (18 months or older) with suspected HIV infection or HIV exposure have HIV serological testing performed according to the standard diagnostic HIV serological testing algorithm used in adults

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In high HIV burden settings, infants and children with unknown HIV status who are admitted for inpatient care or attending malnutrition clinics should be routinely tested for HIV

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In high HIV burden settings, infants and children with unknown HIV status should be offered HIV testing in outpatient or immunization clinics

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Differentiated HIV testing services. Network-based testing is recommended for couples and partners of people with HIV and those with ongoing risks including the use of social network testing

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Differentiated HIV testing services. : Network-based testing is recommended for couples and partners of people with HIV and those with ongoing risks including the use of family and household testing services and partner services

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Women who disclose any form of violence by an intimate partner (or other family member) or sexual assault by any perpetrator should be offered immediate support. Health-care providers should, as a minimum, offer firstline support when women disclose violence.If health-care providers are unable to provide firstline support, they should ensure that someone else (within their health-care setting or another that is easily accessible) is immediately available to do so

Status

Maintained

Recommended in favor

Strong

Health-care providers should ask about exposure to intimate partner violence when assessing conditions that may be caused or complicated by intimate partner violence, in order to improve diagnosis/identification and subsequent care

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low