%0 Journal Article
%T Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region.
%A Fajardo E
%A Lastrucci C
%A Bah N
%A Mingiedi CM
%A Ba NS
%A Mosha F
%A Lule FJ
%A Paul MAS
%A Hughes L
%A Barr-DiChiara M
%A Jamil MS
%A Sands A
%A Baggaley R
%A Johnson C
%J BMJ Open
%V 13
%N 12
%D 2023 12 28
%M 38154882
%F 3.006
%R 10.1136/bmjopen-2022-071198
%X 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.<BR>Policy review.<BR>47 countries within the WHO African region.<BR>National HTS policies from the WHO African region as of December 2021.<BR>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.<BR>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.<BR>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.