RT Journal Article SR Electronic T1 Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e001939 DO 10.1136/bmjgh-2019-001939 VO 5 IS 5 A1 Virginia A Fonner A1 Anita Sands A1 Carmen Figueroa A1 Rachel Baggaley A1 Caitlin Quinn A1 Muhammad S Jamil A1 Cheryl Johnson YR 2020 UL http://gh.bmj.com/content/5/5/e001939.abstract AB 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.