Differentiated HIV Testing and Linkage
HIV testing and linkage to post-test services are central to epidemic control and ending HIV as a public health threat.
Enabling and empowering people at high risk of HIV to know their status and access appropriate post-test services is essential for both individual health and HIV epidemic control. Status neutral HIV testing and linkage services are designed to support those at high risk of HIV to access testing and then to link to treatment services if they are positive or prevention services if they are negative. This requires a differentiated approach that tailors testing strategies to meet the needs and expectations of different groups of people.
ICAP’s CQUIN team is collaborating with diverse global stakeholders, including WHO, PEPFAR, CHAI, ITPC, the South-to-South Learning Network, key population-led organizations, and Ministries of Health from the 21 countries in the CQUIN Network, to co-create tools and share resources to address gaps in national HIV testing programs.
One key tool developed from this collaboration is the Differentiated HIV Testing Services Capability Maturity Model (dHTS CMM) that country teams use to self-assess their national testing programs.
Meetings and Satellites
Differentiated Service Delivery Across the HIV Testing Cascade Meeting
March 2023, Nairobi Kenya
Following successful country self-assessments of testing services at the health system level, using CQUIN’s dHTS capability maturity model, CQUIN hosted a meeting in Nairobi, Kenya, to share knowledge, best practices, and innovations in delivering person-centered HIV testing and linkage services.
The three-day meeting included over 200 participants from over 20 countries and was structured to address the key elements of the HIV Testing Services cascade: Mobilizing (day 1), Testing (day 2), and Linkage (day 3). Framing remarks and summary staging results are available here.
The meeting was a success, with a total of 403 action points generated by country teams. Countries will use these action points to address key gaps and challenges in their national dHTS programs, as identified during self-assessments. Cross-cutting gaps include (but are not limited to) a lack of monitoring and evaluation systems to track status-neutral testing, the absence of dHTS implementation and scale-up plans, gaps in HTS quality management, and limited involvement of the private sector in country HTS programs.
Country participants will cascade the learning and key messages from the meeting to country leadership and other country stakeholders. Participants from each country will also present their action plans to wider national stakeholder teams for validation, prioritization, and approval. Country teams will then negotiate for funding of priority activities in ongoing COP23 and NFM4 discussions, and ICAP will work closely with other stakeholders to link Ministries of Health to appropriate technical assistance when needed.
At the 24th International AIDS Conference (AIDS 2022), which took place from July 29 to August 2, 2022, in Montreal, Canada, CQUIN hosted a satellite session exploring the use of a DSD approach in designing high-impact HIV testing services. Discussions explored strategies for scaling up evidence-based targeted HIV testing, including discussions around the sustainability of HIV testing through engaging the private sector to subsidize the cost of HIV self-testing kits, making them affordable for the public.
Presentations:
- Gertrude Ncube, MOH Zimbabwe: Testing for prevention in Zimbabwe
- Raymond Kwesiga: National Forum of PLHIV Networks in Uganda Community engagement in dHTS
- Geoffrey Taasi, MOH Uganda: Targeting facility-based testing using HIVST in Uganda
- Jeffrey Walimbwa, Kenya: Differentiated testing services for MSM in Kenya
Key take-home points
- Testing for prevention augments efforts to end AIDS by 2030
- Adoption of a mix of evidence-based HTS models is necessary to maximize HIV case identification and prevention
- A sole focus on HIV-positive yield is no longer the optimal strategy for epidemic control: the status-neutral testing approach is now preferred.
