Can Trained Lay Providers Perform HIV Testing Services? A Review of National HIV Testing Policies

March 2017 - Structural Prevention

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Flynn, D.E., Johnson, C., Sands, A., et al. BMC Research Notes (January 2017), 10(1): 20, doi:10.1186/s13104-016-2339-1.

Since 2008 the World Health Organization has recommended increasing the scope of work of trained lay providers. However, in many settings lay providers have not been used for HIV testing services (HTS). This paper analyzed national HIV testing policies from 50 countries to determine the role of lay providers in delivering HIV testing as well as pre- and post-test counseling. Of the 50 countries, 21 allowed lay providers to use rapid diagnostic tests using fingerstick blood; 15 explicitly prohibited lay providers from performing them; and 14 did not specify. Twenty-eight of the 50 countries permitted lay providers to provide pre- and post-test counseling; 12 prohibited them from performing counseling; and 10 did not specify. Overall, 42 percent of countries permitted lay providers to perform HIV testing; 56 percent permitted them to administer pre- and post-test counseling. The authors compared these findings with Global AIDS Response Progress Reporting data to understand if national HIV health policy reflects what happens in health care systems. They found that less than half of reported data from countries aligned with their national HIV testing policies regarding lay counselors. The authors said that given the low use of lay providers globally, and their proven effectiveness in increasing HIV testing, countries should consider revising policies to support lay provider testing using rapid diagnostic tests.

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