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