WHO Releases Consolidated HIV Testing Guidelines Prior to World AIDS Day 2019

With a commitment to reducing HIV mortality and introducing treatment to all, international organizations across the globe will observe World AIDS Day on December 1, 2019.

The annual commemoration was first initiated by the World Health Organization (WHO) in 1988 as a day to unite the world in the fight against HIV/AIDS. More than 30 years later it is an opportunity to reflect on scientific advances in the field, evaluate the quality of life of people living with HIV throughout the world, and assess the progress towards ending the epidemic.

Between 2000 and 2018, the rate of new HIV infections fell by 37% and HIV-related mortality declined by 45%.

The theme for this year’s observance is “Ending the HIV/AIDS Epidemic: Community by Community.”

At the end of 2018, there were approximately 37.9 million individuals living with HIV across the world, according to the WHO. Thanks to international efforts to bolster response to the epidemic, 62% of adults and 54% of children in low- and middle-income countries received antiretroviral therapy (ART) in 2018.

The WHO notes that not everyone is able to access HIV testing, treatment, and care. In fact, the 2018 Super-Fast-Track targets to reduce new HIV infection among pediatrics patients to 40,000 was not met, which jeopardizes the status of 2020 global targets. Additionally, due to gaps in care 770,000 individuals died from HIV-related causes in 2018 and 1.7 million individuals became infected.

Furthermore, the WHO reports that at the end of 2018, 79% of people living with HIV were aware of their status. In total, 23.3 million (62% of all) people living with HIV were receiving ART and 53% had achieved viral suppression.

On November 27, ahead of World AIDS Day, the WHO released consolidated guidelines on HIV testing services, which include new approaches to respond to “contemporary needs.”

Under the new guidelines, the WHO encourages all countries to adopt a standard HIV testing strategy using 3 consecutive reactive tests to confirm a diagnosis. This is will replace the 2 consecutive test approach, which many countries rely on, and will help achieve maximum accuracy.

The new guidelines also recommend the use of self-tests. This is based on evidence that individuals who are at a higher risk for acquiring HIV who are not testing in clinical settings are more likely to undergo testing if they can self-test for HIV.

Additionally, the guidelines emphasize the importance of using social network-based HIV testing in order to reach individuals who are at high risk but do not have adequate access to HIV testing services. The WHO notes that when testing 99 contacts from social networks of 143 HIV-positive people in the Democratic Republic of Congo, 48% tested positive for HIV.

In order to build demand and increase uptake of HIV testing, digital communications including short messages and videos can be used. In Vietnam, this outreach method was used among 6500 individuals from key at-risk groups. In total, 80% were referred to testing and 95% complied. Among these at-risk individuals, 75% had never engaged in outreach services for HIV.

In relation to contemporary needs, the agency recommends using community efforts to deliver rapid testing where the laboratory-based method called “western blotting” is still in use. This is based off of evidence from Kyrgyzstan where HIV testing using the method typically took 4-6 weeks, but following policy changes, only takes 1-2 weeks and is more affordable.

Finally, the WHO recommends using HIV/syphilis dual rapid tests in antenatal care to eliminate mother-to-child transmission of both infections and reduce the rate of stillbirths worldwide.

“Saving lives from HIV starts with testing,” Rachel Baggaley, MD, MSc, WHO’s Team lead for HIV Testing, Prevention and Populations, said in the WHO’s statement. “These new recommendations can help countries to accelerate their progress and respond more effectively to the changing nature of their HIV epidemics.”

On Monday, December 2, 2019 at 4 p.m. EST, Contagion® will be co-hosting a World AIDS Day TweetChat with the National Hispanic Medical Association. The topic will be Tackling the HIV Epidemic in Our Communities. Follow us @Contagion_Live.