http://www.who.int/hiv/who_pitc_guidelines.pdf
New recommendations aim for wider knowledge of HIV status and greatly
increased access to HIV treatment and prevention
30 MAY 2007 | LONDON -- WHO and UNAIDS today issued new guidance on
informed, voluntary HIV testing and counselling in the world's health
facilities, with a view to significantly increasing access to needed
HIV treatment, care, support and prevention services. The new
guidance focuses on provider-initiated HIV testing and counselling
(recommended by health care providers in health facilities).
Today, approximately 80% of people living with HIV in low- and middle-
income countries do not know that they are HIV-positive. Recent
surveys in sub-Saharan
10% of women have been tested for HIV and received their test results.
Increased access to HIV testing and counselling is essential to
promoting earlier diagnosis of HIV infection, which in turn can
maximize the potential benefits of life-extending treatment and care,
and allow people with HIV to receive information and tools to prevent
HIV transmission to others.
"Scaling up access to HIV testing and counselling is both a public
health and a human rights imperative," said WHO HIV/AIDS Director Dr
Kevin De Cock. "We hope that the new guidance will provide an impetus
to countries to greatly increase availability of HIV testing services
in health care settings, through realistic approaches that both
improve access to services and, at the same time, protect the rights
of individuals. Without a major increase in HIV testing and
counselling in health facilities, universal access to HIV prevention,
treatment and care will remain just a noble goal."
Additional approaches needed to expand access
Until recently, the primary model for providing HIV testing and
counselling has been client-initiated HIV testing and counselling -
also known as voluntary counselling and testing (VCT) - in which
individuals must actively seek an HIV test at a health or community-
based facility. But uptake of client-initiated HIV testing and
counselling has been limited by low coverage of services, fear of
stigma and discrimination, and the perception by many people - even
in high prevalence areas - that they are not at risk.
Current evidence also suggests many opportunities to diagnose HIV in
clinical settings are being missed, even in places with serious HIV
epidemics. While, therefore, expanded access to client-initiated HIV
testing and counselling is still necessary, other approaches are also
required if coverage of HIV testing and counselling is to increase
and, ultimately, universal access to HIV prevention, treatment, care
and support is to be achieved.
The new WHO/UNAIDS guidance was prepared in light of increasing
evidence that provider-initiated testing and counselling can increase
uptake of HIV testing, improve access to health services for people
living with HIV, and may create new opportunities for HIV prevention.
Provider-initiated HIV testing and counselling involves the health
care provider specifically recommending an HIV test to patients
attending health facilities. In these circumstances, once specific
pre-test information has been provided, the HIV test would ordinarily
be performed unless the patient declines.
Provider-initiated HIV testing and counselling has already been
implemented in a range of clinical settings in several low- and
middle-income countries, including
and
"If we are going to get ahead of this epidemic, rapidly scaled up HIV
treatment and prevention efforts are critical - and increased uptake
of HIV testing will be fundamental to making this a reality," said Dr
Paul De Lay, Director of Monitoring and Evaluation, UNAIDS. "At the
same time, and in all cases of HIV testing and counselling, the 3 Cs -
that is consent, confidentiality and counselling - must be
respected," he added.
Guidance tailored to different types of epidemics and health
facilities
The new WHO/UNAIDS guidance advises that health care providers
globally should recommend HIV testing and counselling to all patients
who present with conditions that might suggest underlying HIV disease.
Additional guidance is tailored to local circumstances. In
generalized HIV epidemics1, HIV testing and counselling should be
recommended to all patients attending all health facilities, whether
or not the patient has symptoms of HIV disease and regardless of the
patient's reason for attending the health facility. In concentrated2
and low-level3 HIV epidemics, depending on the epidemiological and
social context, countries should consider recommending HIV testing
and counselling to all patients in selected health facilities (e.g.
antenatal, tuberculosis, sexual health, and health services for most-
at-risk populations). The guidance also includes special
considerations for HIV testing and counselling for adolescents and
children.
WHO and UNAIDS recognize that resource and other constraints may
prevent immediate implementation of the guidance. The document
therefore provides advice about how to prioritize implementation in
different types of health facilities.
The new guidance builds on previous policy positions of WHO and
UNAIDS and responds to a growing demand from countries for more
detailed policy and operational advice in this area. Its
recommendations were developed following a review of available
evidence and a broad consultative process with experts and
implementers, including submissions received from over 150
organizations and individuals.
Other key recommendations
Other key WHO/UNAIDS recommendations for provider-initiated HIV
testing and counselling in health facilities include:
- All HIV testing must be voluntary, confidential, and undertaken with the patient's consent.
- Patients have the right to decline the test. They should not be tested for HIV against their will, without their knowledge,without adequate information or without receiving their test results.
- Pre-test information and post-test counselling remain integral components of the HIV testing process.
- Patients should receive support to avoid potential negative consequences of knowing and disclosing their HIV status, such as discrimination or violence.
- Testing must be linked to appropriate HIV prevention, treatment, care and support services.
- Decisions about HIV testing in health facilities should always be guided by what is in the best interests of the individual patient.
- Provider-initiated HIV testing and counselling is not, and should not be construed as, an endorsement of coercive or mandatory HIV testing.
- Implementation of provider-initiated HIV testing and counselling should be undertaken in consultation with key stakeholders, including civil society groups, acknowledging that what works and is ethical will inevitably differ across countries.
- When implementing provider-initiated HIIV testing and counselling, equal efforts must be made to ensure that a supportive social, policy and legal framework is in place to maximize positive outcomes and minimize potential harms to patients.
- A system that monitors and evaluates the implementation and scale-up of provider-initiated testing and counselling should be developed and implemented concurrently.
As countries work towards universal access to HIV prevention,
treatment, care and support, the new guidance on provider-initiated
HIV testing and counselling offers an important opportunity to
introduce new approaches and improve the standards of HIV testing and
counselling in both public and private health facilities. Together
with their partners, WHO and UNAIDS will continue to help countries
expand access to the full range of HIV testing and counselling
services, as well as to other needed health sector interventions
against HIV/AIDS.
- HIV is firmly established in the general population. Numerical proxy: HIV prevalence consistently over 1% in pregnant women.
- HIV has spread rapidly in a defined sub-population, but is not well-established in the general population. Numerical proxy: HIV prevalence is consistently over 5% in at least one defined sub-population, but is below 1% in pregnant women in urban areas.
- HIV has never spread to significant levels in any sub-population. Numerical proxy: HIV has not consistently exceeded 5% in any sub-population.
[WHO (2007) GUIDANCE ON PROVIDER-INITIATED HIV TESTING AND COUNSELLING IN HEALTH FACILITIES is available on the following url http://www.who.int/hiv/who_pitc_guidelines.pdf
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