PD04.04
Background: UNAIDS launched Treatment 2015 to accelerate treatment access through the concepts of innovation, speed and focus. In 2013,12,9 million of 35 million people living with HIV globally were receiving treatment. UNAIDS has proposed a 90-90-90 target for 2020 - 90% of people living with HIV tested, 90% of those tested on ART and 90% of those on ART virally suppressed. Ensuring treatment and viral suppression for people living with HIV will require special efforts to ensure that people living with HIV but who do not know their status - have access to HIV testing.
Methods: We reviewed the national strategies of 10 high impact countries in Africa and identified gaps and strategic opportunities for innovating HIV testing.
Results: Harnessing the therapeutic and preventive benefits of ART, will entail a massive scale up and reorientation of testing efforts in countries where HIV testing deficits limit access to ART. An estimated 55% of people living with HIV in SSA are unaware of their HIV status. Data from select countries of people ever tested in SSA, where treatment coverage is 37%, ranges from very low to moderate or high and with some countries having a significant gender gap (where the proportion of men ever tested is low but the range among women is moderate or high). Often testing coverage is mismatched with the epidemic realities of countries and testing policy is not in aligned with treatment expansion targets. This calls for revised programmatic targets for testing and treatment, high yield strategies and new benchmarks for quality HIV care, with an attention to location, gender and age.
Conclusions: HIV testing programmes in many countries are inadequate - they were conceptualized when AIDS was an emergent and frightening phenomenon - now they need to address mature epidemics, where there is approaching universal access to treatment which allows HIV infection to be non-life threatening, and where the concentrations of HIV in the most affected populations in different contexts is much more known. Key areas for innovation include self-testing, multi-disease community campaigns and PoC testing for CD4 and VL for first line service delivery.
