"Routinizing" HIV testing in low- and middle-income countries

This discussion paper from the Public Health Programme of the Open Society Institute (OSI) examines the issues associated with scaling up access to HIV testing. It finds that developing provider-initiated HIV testing and counselling (PITC), along with scaling up voluntary testing and counselling (VTC), improves the effectiveness of HIV treatment programmes, contributes to more effective HIV prevention and can help to reduce stigma and discrimination. The paper reviews research literature and consultations carried out with HIV service providers and policymakers across the globe.

To make it feasible for health-care providers to offer HIV testing to all patients it may be necessary to relax some current pre-testing requirements. But the paper argues that patients' human rights must be respected and their right to give fully informed consent maintained. One problem with the opt-out approach to PITC, recommended by the World Health Organisation (WHO), is that patients in some contexts may feel compelled to accept the test. The paper argues that routinely recommending HIV testing on an opt-in basis is more respectful of human rights and more effective. It also recommends that introducing PITC be carried out in conjunction with scaling up VTC services, which are more effective in reaching vulnerable and marginalised populations, such as sex workers, men who have sex with men (MSM) and drug users.