New HIV Testing Strategies in PEPFAR COP19: Rollout and Human Rights Concerns

Introduction

Between 2016 and 2018, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supported more than 252 million HIV tests in the 35 countries and regions in which it implements programs. HIV testing is the most crucial component of HIV programs as it is the gateway by which people who are positive are able to know their status and be linked immediately to treatment and care services to protect their own health and prevent transmission of HIV to their partners. It also allows HIV-negative individuals to be linked to HIV prevention interventions and provides them with the knowledge they need to remain negative. Despite the very low individual cost of testing, the aggregate cost can be substantial. Between 2015 and 2018, PEPFAR spending on HIV testing services grew from $141 million to $436 million per year. This has raised concerns about the sustainability and feasibility of the existing testing campaigns.

To improve testing efficiency and uptake among harder-to-reach populations such as youth and younger men, PEPFAR is revising or introducing testing interventions including provider-initiated testing and counseling (PITC) optimization, HIV recency testing, HIV self-testing, and index testing and/or partner notification services. It is important to understand that PEPFAR’s approach to testing is almost exclusively focused on initiating people on treatment, not on aiding downstream prevention activities or simply enabling people—especially HIV-negative people—to know their status. The implementation of these strategies, the complexity of their rollout, and their implications are issues for civil society organizations in each PEPFAR country to engage with, monitor, and improve both during the upcoming country operational plan (COP) reviews in Johannesburg, South Africa, and going forward.

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