Working Towards Universal Access to
HIV Counseling and Testing

• CT in Focus: Results from the International Counseling and Testing Workshop, Zambia (en français)

Although the number of people accessing HIV counseling and testing services has quadrupled in the past five years, recent surveys in sub-Saharan Africa showed on average just 12% of men and 10% of women have been tested for HIV and received their test results. In fact, most people living with HIV are unaware of their serostatus. Twenty-five years into the HIV epidemic, over 80% of people living with HIV in low- and middle-income countries do not know that they are HIV-positive.¹

In order to address these challenges, the President’s Emergency Plan for AIDS Relief (PEPFAR) sponsored the International HIV Counseling and Testing (CT) Workshop in Lusaka, Zambia from January 21–24, 2008. The meeting was supported by Population Services International, Family Health International, and the PEPFAR CT Technical Working Group. 177 delegates from 27 countries in Africa, Asia, Latin America, and the Caribbean attended the workshop which included over 50 technical presentations, visits to 10 CT sites in Lusaka, and 5 working group sessions.

The objectives of the workshop were to:

• Disseminate state of the art CT technical updates
• Identify and share international best practices and approaches to CT delivery and reaching HIV prevention, care and treatment goals
• Develop a consensus about important research, practices, policies and guidelines that are needed to effectively scale up CT to reach universal access

Six key CT paradigm shifts recommended by workshop participants:

1. Improve counseling messages to strengthen the prevention benefits of CT and encourage disclosure
2. Identify acute HIV infection (AHI) through new testing technologies and screening tools in light of the impact of AHI on HIV transmission and re-assess how tie-breaker test results are provided to clients given the possible increased risk of AHI
3. Develop testing policies to encourage the use of finger prick, non cold-chain dependent rapid test kits in both low and high HIV prevalence settings
4. Promote and scale up targeted CT (especially for STI, TB, and ANC patients, couples and high risk negatives) while working towards universal access
5. Develop proactive policies related to age of consent and disclosure to support the expansion of testing of children, partners and families
6. Develop policies and standards to support task shifting to alleviate human resource strains