Every year more than a million people acquire preventable HIV infections, in addition to the millions of people with HIV who remain unreached and undiagnosed. Quality testing services remain the critical gateway to reaching, treating and preventing HIV. The world is currently off track and greater efforts are needed to achieve 2030 goals to end HIV as a public health threat.
Recent reports have highlighted that annual new syphilis cases in adults increased by over 1 million in 2022, reaching 8 million. Deaths from viral hepatitis are also increasing, with 1.3 million lives lost in 2022. Integrated testing services are essential to achieving the WHO global health sector strategy and maximizing the public health impact of increasingly limited services.
The WHO Consolidated guidelines on differentiated HIV testing services were released ahead the International AIDS Conference, which takes place in Munich, Germany, from 21–26 July 2024. Related guidance also released during the conference, include:
- Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis);
- New recommendations on syphilis testing and partner services;
- Guidelines for HIV post-exposure prophylaxis; and
- WHO implementation tool for pre-exposure prophylaxis of HIV infection: provider module for oral and long-acting PrEP.
The WHO consolidated guidelines on HIV testing provide new recommendations to expand integration of services through the scale-up of network-based testing services designed to reach partners and social contacts of people affected by HIV and sexually transmitted infections (STIs). New recommendations also include the expansion of self-testing to include syphilis and dual HIV/syphilis. WHO also recently announced the prequalification of the first hepatitis C self-test providing another tool to support great access to both self-tests to reduce stigma but also to improve comorbidity testing for people living with HIV. Additional guidance on simplified syphilis diagnosis with treponemal and nontreponemal dual rapid tests for settings with limited laboratory capacity and populations needing same day diagnosis are detailed in the new STI guidelines.
HIV self-testing is now recommended for initiation, re-initiation and continuation of PrEP and PEP across a range of service delivery options. This is an important step to accelerate access to PrEP through a range of person-centred service delivery models and prevent new HIV infections. WHO is continuing to review evidence on the potential use of self-testing within long-acting injectable PrEP.
The guidance also recommends against the use of HIV recency testing in routine testing services – which are defined as a package of services including brief pre-test information and post-test counselling; linkage to appropriate HIV prevention, care and treatment services and other clinical and support services; and laboratory services to support quality assurance. There continues to be a lack of evidence demonstrating clinical benefits of HIV recency testing for people with HIV and it is essential to optimize limited resources for essential testing services.
WHO and UNAIDS have previously published guidance for the use of recency assays (2022) – specifically for surveillance – and this guidance remains unchanged. Recency assays have been used to estimate HIV incidence in representative cross-sectional surveys and in epidemiological studies for strategic targeting of testing and prevention interventions, optimizing allocation of resources and measuring progress in the HIV response.
