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Original research
Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review
  1. Virginia A Fonner1,
  2. Anita Sands2,
  3. Carmen Figueroa3,
  4. Rachel Baggaley3,
  5. Caitlin Quinn3,
  6. Muhammad S Jamil3,
  7. Cheryl Johnson3
  1. 1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Regulation and Prequalification, World Health Organization, Geneve, GE, Switzerland
  3. 3Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, GE, Switzerland
  1. Correspondence to Dr Virginia A Fonner; fonner{at}musc.edu

Abstract

Introduction Ensuring a correct and timely HIV diagnosis is critical. WHO publishes guidelines on HIV testing strategies that maximise the likelihood of correctly determining one’s HIV status. A review of national HIV testing policies in 2014 found low adherence to WHO guidelines. We updated this review to determine adherence to current recommendations.

Methods We conducted a comprehensive policy review through April 2018. We extracted data on HIV testing strategies, recommendations on HIV retesting prior to antiretroviral therapy (ART) initiation and pre-exposure prophylaxis (PrEP)-related HIV testing information. Descriptive analyses disaggregated by region were conducted to ascertain adherence to recommendations and to describe testing strategy characteristics.

Results Of 91 policies included, 26% (n=24/91) adhered to WHO recommendations. Having a two-assay testing strategy to rule-in HIV infection as opposed to the recommended three-assay testing strategy was a major reason for non-adherence. Of 72 country policies providing sufficient information, 31% (n=22) recommended retesting for HIV prior to initiating ART. Of 25 countries and two regions reporting PrEP-related HIV testing guidelines, almost all recommended testing prior to initiating PrEP and every 3 months during PrEP use.

Conclusions Global adherence to WHO recommendations for HIV testing strategies have improved since 2014 but remain low. We found adherence existed on a continuum. Such a system provides insights into how countries can move towards adherence by making relatively minor changes to testing strategies. Guidance from WHO on the role of new HIV testing technologies within testing algorithms and identifying ways to simplify testing guidance is warranted.

  • diagnostics and tools
  • health policy
  • screening
  • HIV
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2019-001939

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    Footnotes

    • Handling editor Soumyadeep Bhaumik

    • Twitter @ccasejohn

    • Contributors CJ and RB devised the review. VF, CQ and CJ designed the protocol. CQ conducted the search, and VF, CJ, AS and CQ conducted the screening and data extraction. CJ and RB supervised the review. VF qualitatively synthesised the findings and conducted descriptive analyses. VF drafted the manuscript with input from AS, CF, MJ, RB, CJ and CQ. All authors reviewed the draft, provided critical review, and read and approved the final manuscript.

    • Funding Funding for this review was provided by the Bill and Melinda Gates Foundation (award number OPP1177903) and by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through World Health Organization and USAID’s Consolidated WHO Grant, Agreements US-2015-0839 and US-2016-940.

    • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests The authors declare no competing interests. The contents in this article are those of the authors and do not necessarily reflect the view of the World Health Organization.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and some data are publicly available. Most policies included in this review are available through the following websites: (1) https://aidsfree.usaid.gov/resources/guidance-data/hts. (2) http://www.hivpolicywatch.org/database.html. If information on a policy cannot be found through these sources, please contact the authors of this review for additional information.