Bibliographic Info
GuidelineConsolidated guidelines on HIV testing services, 2019
Year of Publication2020
Issuing InstitutionWHO
Recommendation
Status
Updated
Demand creation to increase HIV testing services (HTS) uptake and engage those in greatest need of services is a valuable tool for mitigating stigma, discrimination and criminalization. Demand creation approaches may need to be prioritized, depending on the setting, focus population and available resources, as part of a strategy to reach people with HIV who do not know their status and who have high HIV-related risk. A wide range of demand creation strategies have been rigorously tested to assess impact on HIV testing uptake and the proportion of people with HIV diagnosed, but often later outcomes related to linkage to care or prevention have not been measured. Evidence-based platforms for delivering demand creation include:
- peer-led demand creation interventions, including mobilization
- digital platforms, such as short pre-recorded videos encouraging testing.
Notes and Remarks
- 1)Approaches that have showed evidence of increasing demand include: a) advertisement of specific HTS attributes b) brief key messages and counselling by providers (less than 15 minutes) c) messages during couples counselling that encourage testing d) messages related to risk reduction and economic empowerment, particularly for people who inject drugs f)motivational messages.
- 2)Evidence suggests that the following approaches may be less effective for demand creation: a) personal invitation letters b)individualized content messaging c)counselling focused on building relationship between the client and counsellora d)general text messages, including SMS.
- 3)Some studies report increases in HTS uptake when incentives are offered, however when considering the use of incentives for demand creation, benefits and risks should be carefully weighed, such as: a)resource use and sustainability, especially for providing financial incentives, which may undermine the principles of universal health coverage b)longer-term behavioural changes associating HTS and other services with incentive, weighed against short-term increases in uptake c) negative effect on equity, due to prioritization of some populations and diseases d)potential to deprioritize systematic implementation of strategies that improve service delivery and reduce barriers and disincentives, such as patient costs associated with accessing health services more broadly.