Consolidated guidelines on differentiated HIV testing services
Key points
- WHO's 2024 consolidated guidelines bring together existing and new guidance on HIV testing services (HTS) across settings and populations, to support the 95-95-95 targets and ending HIV as a public health threat by 2030.
- New: HIV self-testing may be offered as an additional option for testing at facilities and may be used to deliver pre-exposure prophylaxis (PrEP), including initiation, re-initiation and continuation (conditional recommendations, low-certainty evidence).
- New: syphilis self-testing is suggested as an additional approach, and STI partner services should be offered to people with STIs (strong recommendation, low-certainty evidence).
- Updated: social network testing services may be offered as an additional HIV testing approach within a comprehensive package of care and prevention.
- New: HIV recency testing is not recommended as part of routine HIV testing services (conditional recommendation, low-certainty evidence).
Overview
These guidelines update WHO guidance on HIV testing services, first consolidated in 2015, with new recommendations on self-testing and network-based testing and a recommendation against routine recency testing. HTS covers the full range of services provided with an HIV test: brief pre-test information and post-test counselling, linkage to prevention, care and treatment, and coordination with laboratory services for quality assurance. All approaches should follow the WHO 5 Cs: Consent, Confidentiality, Counselling, Correct results and Connection. This overview is based on the executive summary and part of the summary table of recommendations.
Self-testing
HIV self-testing does not replace provider-administered testing: anyone with a reactive self-test should receive further testing from a trained provider using the full national testing algorithm. At facilities, self-testing can replace risk screening tools; WHO does not recommend tools used to screen people out of testing. Self-testing can support PrEP and post-exposure prophylaxis (PEP), and dual HIV/syphilis self-tests can be used. Syphilis self-tests can be reactive with any current or prior treponemal infection, including yaws, bejel or pinta, so self-testers need clear guidance on interpreting results and on further testing.
Pre-test and post-test services
Pre-test counselling is often not needed; information on testing and linkage can be given in other ways, including virtual platforms. Post-test services must include linkage to treatment and to prevention options such as PEP and PrEP, and messages for people testing HIV-positive should explain that undetectable equals untransmittable (U=U). Post-test counselling alone does not improve linkage or lead to sustained behaviour change.
Diagnostics and quality
Programmes should use the serial three-test HIV testing strategy, retest before starting antiretroviral therapy (ART) and select products to reach an overall positive predictive value of 99% or higher. Inconclusive results should be retested after two weeks. Dual HIV/syphilis rapid diagnostic tests are most relevant for key populations and for pregnant women and their male partners. All HIV tests must meet regulatory standards and be quality-assured.
FAQ
Can an HIV self-test confirm a diagnosis?
No. A reactive self-test must be followed by further testing from a trained provider using the full national testing algorithm.
Is HIV recency testing recommended?
No. The guideline recommends against HIV recency testing as part of routine HIV testing services (conditional recommendation, low-certainty evidence).
What should happen after an inconclusive HIV test result?
Retesting after two weeks is recommended.
Source
World Health Organization. Consolidated guidelines on differentiated HIV testing services. Geneva: World Health Organization; 2024. ISBN: 978-92-4-009639-4. Open access under CC BY-NC-SA 3.0 IGO. Summary prepared by Medpresso from the original publication; it is not a substitute for the full text or for medical advice.