DCP3 Major Infectious Diseases_Ch4.pdf

HIV care has evolved since the 1980s with effective antiretroviral therapy (ART) transforming lives of those living with HIV, achieving substantial drops in morbidity and mortality, and preventing transmission. However, controlling the epidemic requires virologic suppression among all HIV-infected individuals through identification, retention, and viral suppression across the care continuum. The chapter discusses the rationale, guidelines, measurements, barriers, and cost-effectiveness of interventions for each step of the continuum, focusing on low- and middle-income countries, particularly Sub-Saharan Africa. HIV testing services are essential for identifying HIV-positive persons and at-risk HIV-negative individuals, with the World Health Organization (WHO) recommending universal testing in countries with generalized HIV epidemics and provider-initiated testing and counseling for women as part of antenatal care. Despite importance, nearly half of the 36.9 million people living with HIV globally in 2014 were unaware of their infection, and only 44% of pregnant women in low- and middle-income countries accessed HIV testing. Barriers to testing include perceived low risk, fear of stigma, financial costs, and gender inequality, with system-level barriers including high patient load, test kit shortages, and poor counseling skills. Approaches to improve HIV testing services uptake include voluntary counseling and testing, provider-initiated testing and counseling, and community-based testing.