Laurent, C. Journal of Public Health Policy (December 2012), pp. 1-5, e-publication ahead of print.
The author provides commentary on the status of HIV testing in low- and middle-income countries, which remains critically low among countries where HIV prevalence is high. Only 20 percent of adults and 28 percent of infants born to an HIV-positive mother are tested promptly. HIV testing, combined with adequate counseling, is beneficial to persons who test positive (e.g., facilitating assessment of eligibility for antiretroviral therapy or ART, psychosocial support, and other services), persons who test negative (allowing for risk reduction counseling), and at the population level. HIV testing approaches include facility-based, community-based, couple- or partner-based, and self-testing. Earlier HIV diagnosis is critical for improved health outcomes and aligns with the World Health Organization's (WHO) recommendation for earlier initiation of ART. Expanding HIV testing supports the WHO's objective of universal access to HIV prevention, treatment, and care and support, as well as the United Nations' Millennium Development Goals related to HIV. However, various barriers to HIV testing remain at the individual (e.g., lack of awareness and fear of stigma) and structural levels (e.g., limited laboratory equipment and negative health care workers' attitudes). The author highlights a successful scale-up of early infant HIV testing in facilities in Rwanda. This was a comprehensive program, supported with national leadership, that can serve as a model for other countries.