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Abstract：
In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.
Policy review.
47 countries within the WHO African region.
National HTS policies from the WHO African region as of December 2021.
Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.
National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies.
Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.
Policy review.
47 countries within the WHO African region.
National HTS policies from the WHO African region as of December 2021.
Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.
National policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (<5%) and high-prevalence (≥5%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV/syphilis RDTs were recommended in 45% (n=21/47) of policies.
Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV/syphilis RDTs.
摘要：
目的：2019年，WHO发布了HIV检测服务（HTS）指南。我们的目标是评估非洲国家对其中六项关于艾滋病毒检测战略的建议的采纳情况。
方法：政策审查。
方法：世卫组织非洲区域47个国家。
方法：截至2021年12月，世卫组织非洲地区的国家HTS政策。
方法：在国家HTS政策中采纳WHO建议，包括标准的三项测试策略；停止进行决胜局测试以裁定HIV感染；停止进行HIV诊断的蛋白质印迹（WB）；在开始抗逆转录病毒治疗（ART）之前进行重新测试，并使用双重HIV/梅毒是产前护理中的快速诊断测试（RDTs）。对国家政策的采纳情况进行了连续评估，基于不同程度的完全采用。
结果：对世卫组织非洲区域96%(n=45/47)的国家政策进行了审查，38%(n=18)在2019年之前发表，60%(n=28)采用世卫组织指南。在尚未完全采用世卫组织指导的国家中，尚未采用三次测试策略是错位的最常见原因(45%，21/47）；其中31％和22％在低患病率（<5％）和高患病率（≥5％）国家，分别。10项政策（21％）建议使用WB，49％（n=23）建议在开始ART之前进行重新测试。45％（n=21/47）的政策建议使用双重HIV/梅毒RDT。
结论：非洲地区的许多国家采用了世卫组织推荐的艾滋病毒检测战略；然而，仍然需要努力充分采纳世卫组织的指导意见。各国应加快采取和实施三试战略,在ART开始和使用双重HIV/梅毒RDT之前进行重新测试。
方法：政策审查。
方法：世卫组织非洲区域47个国家。
方法：截至2021年12月，世卫组织非洲地区的国家HTS政策。
方法：在国家HTS政策中采纳WHO建议，包括标准的三项测试策略；停止进行决胜局测试以裁定HIV感染；停止进行HIV诊断的蛋白质印迹（WB）；在开始抗逆转录病毒治疗（ART）之前进行重新测试，并使用双重HIV/梅毒是产前护理中的快速诊断测试（RDTs）。对国家政策的采纳情况进行了连续评估，基于不同程度的完全采用。
结果：对世卫组织非洲区域96%(n=45/47)的国家政策进行了审查，38%(n=18)在2019年之前发表，60%(n=28)采用世卫组织指南。在尚未完全采用世卫组织指导的国家中，尚未采用三次测试策略是错位的最常见原因(45%，21/47）；其中31％和22％在低患病率（<5％）和高患病率（≥5％）国家，分别。10项政策（21％）建议使用WB，49％（n=23）建议在开始ART之前进行重新测试。45％（n=21/47）的政策建议使用双重HIV/梅毒RDT。
结论：非洲地区的许多国家采用了世卫组织推荐的艾滋病毒检测战略；然而，仍然需要努力充分采纳世卫组织的指导意见。各国应加快采取和实施三试战略,在ART开始和使用双重HIV/梅毒RDT之前进行重新测试。
