HIV Testing Services (HTS)

Our Approach and Results

Since 2004, access to HTS has dramatically increased – often identifying individuals earlier in their infection. As countries achieve higher levels of ART coverage, HIV testing approaches have evolved accordingly to include innovations in modalities which USAID has been at the forefront of implementing. HIV rapid testing, with same-day results, is a critical tool in the global HIV response — expanding HIV testing to areas with limited laboratory facilities and increasing the number of people who learn about their HIV status at the testing site. 

USAID ensures that HTS and linkage to care, treatment, and prevention efforts are undertaken in both facility and community settings by health professionals, community health workers, and trained volunteers. Settings where USAID provides HTS include:

• antenatal care

• inpatient and outpatient departments

• tuberculosis clinics

• sexually transmitted infection and reproductive health clinics

• mobile clinics

• index testing and voluntary counseling testing sites at the community and facility levels

• pediatric clinics

• emergency clinics

• voluntary medical male circumcision clinics

• malnutrition clinics

• provider-initiated testing and counseling

The World Health Organization (WHO) identified the following services that encompass the full range of HTS:

• Counseling (brief pre-test information and post-test counseling)

• Linkage to appropriate HIV prevention, care and treatment services, and other clinical and support services

• Coordination with laboratory services to support quality assurance and delivery of correct results

HIV Testing Strategies

HIV Self-Testing

HIV self-testing (HIVST) refers to when a person collects their own specimen (oral fluid or blood) and performs an HIV screening test and interprets the results, either alone or with a trusted person. HIVST is a test-for-triage and should not be used to provide a definitive diagnosis of HIV; a reactive, or “positive” self-test result warrants further and confirmatory testing from a trained tester using a national testing algorithm. HIVST can be delivered through various modalities and can increase and encourage the uptake of HIV testing, especially among high-risk groups and populations with lower testing coverage. The privacy, convenience, and immediate results of HIVST have made it a viable option for many users. HIVST is prioritized in areas and populations with the greatest needs and gaps in testing coverage. Facility and community sites, online platforms, and pharmacies serve as some of the priority settings for HIVST.

Index Testing

Index testing, also known as assisted partner notification services, is the process in which sexual partners, drug injecting partners, or biological children of PLHIV are offered HTS in a safe and ethical manner. It is critical that all people with HIV are informed that assisted partner notification services are voluntary, and that partners or contacts identified through index testing are also made aware that HIV testing is voluntary, not mandatory.

Social Network-Based HIV Testing

Social network-based HIV testing approaches broaden the reach of partner services to include both HIV-seropositive and HIV-seronegative members of key populations, as well as their social contacts and networks. By addressing confidentiality concerns and expanding the reach of services, social network approaches can reach more people who may not otherwise test for HIV.

USAID is a key implementing partner of PEPFAR, expanding HTS in countries across the globe and contributing to global policy. Our work includes implementation of a range of HTS approaches, including targeted community-based and facility-based testing, index testing, self-testing, social network strategies, and support of HTS approaches that reach specific priority and key populations. These populations include pregnant mothers, couples, men, children, adolescents, and key populations at higher risk of infection. Additional efforts help to inform expanded approaches to accelerating entry into HIV care and treatment, as well as prevention services, after individuals learn their HIV serostatus.

Through HTS, USAID works to ensure that counselors, community health workers, and clinical professionals provide clients with accurate information, tools, and access to prevention, care and treatment interventions, which allow protection from acquiring or transmitting the virus.

• USAID investments strengthen partner country systems that drive responsive, resilient, and enduring health care through more than 10,000 HIV testing sites, more than 9,000 HIV treatment sites, and more than 3,000 sites that provide lab-based or point-of-care testing, making critical services accessible in more than 50 countries.

• In 2023, USAID provided HIV testing services to nearly 28 million —almost six million more than in 2022—which enabled nearly 760,000 people to learn of their HIV-positive status. Furthermore, USAID has procured roughly 53.8 million rapid HIV test kits for use across PEPFAR programs. 

• USAID distributed more than 3.4 million HIV self-test kits in 2023, over 800,000 more than in 2022, which enabled individuals to take control of their healthcare and choose where, when, and with whom they want to test.