Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Regulation and Prequalification, World Health Organization, Geneve, GE, Switzerland.
BMJ Glob Health. 2020 May;5(5). doi: 10.1136/bmjgh-2019-001939.
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.
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.
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.
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.
确保正确和及时的 HIV 诊断至关重要。世界卫生组织发布了 HIV 检测策略指南，最大限度地提高了正确确定 HIV 状况的可能性。2014 年对各国 HIV 检测政策的审查发现，对世卫组织指南的遵循率较低。我们更新了这项审查，以确定对当前建议的遵循情况。
我们在 2018 年 4 月前进行了一项全面的政策审查。我们提取了 HIV 检测策略、在开始抗逆转录病毒治疗 (ART) 前 HIV 重新检测的建议以及与暴露前预防 (PrEP) 相关的 HIV 检测信息的数据。通过按区域进行描述性分析，确定了对建议的遵守情况，并描述了检测策略的特点。
在所纳入的 91 项政策中，26%（n=24/91）遵循了世卫组织的建议。采用两剂检测策略来确定 HIV 感染，而不是推荐的三剂检测策略，是不遵守建议的主要原因。在提供了足够信息的 72 个国家政策中，31%（n=22）建议在开始 ART 前对 HIV 进行重新检测。在报告了与 PrEP 相关的 HIV 检测指南的 25 个国家和两个地区中，几乎所有国家都建议在开始 PrEP 前进行检测，并且在使用 PrEP 期间每 3 个月进行一次检测。
自 2014 年以来，全球对 HIV 检测策略的世卫组织建议的遵循率有所提高，但仍然很低。我们发现，这种遵循情况是连续的。这样的系统提供了一些见解，说明各国如何通过对检测策略进行相对较小的更改来逐步达到遵循的要求。世卫组织关于新的 HIV 检测技术在检测算法中的作用的指导以及确定简化检测指导的方法是有必要的。
