Each year, over a million people acquire preventable HIV infections, and many others with HIV remain undiagnosed and untreated. Quality testing services are crucial for reaching, treating, and preventing HIV, yet current efforts are falling short of the 2030 goal to end HIV as a public health threat.
Recent reports indicate that new syphilis cases in adults rose by over 1 million in 2022, reaching 8 million. Deaths from viral hepatitis also increased, with 1.3 million lives lost in 2022. To address these challenges, integrated testing services are vital for achieving the WHO’s global health strategy and maximizing the impact of limited resources.
Ahead of the International AIDS Conference in Munich (21–26 July 2024), the WHO released updated consolidated guidelines on differentiated HIV testing services. Additional guidance includes:
- Updated recommendations for treating Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis);
- New syphilis testing and partner services recommendations;
- Guidelines for HIV post-exposure prophylaxis (PEP);
- A WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV, including provider modules for oral and long-acting PrEP.
The updated guidelines emphasize expanding the integration of services through network-based testing to reach partners and social contacts of those affected by HIV and STIs. They also recommend expanding self-testing to include syphilis and dual HIV/syphilis tests. Additionally, WHO has prequalified the first hepatitis C self-test, enhancing access to self-testing and improving comorbidity testing for people living with HIV. The new STI guidelines also detail simplified syphilis diagnosis with treponemal and non-treponemal dual rapid tests for settings with limited laboratory capacity.
HIV self-testing is now recommended for the initiation, re-initiation, and continuation of PrEP and PEP, facilitating access to PrEP through various person-centered service models and helping prevent new HIV infections. WHO is also reviewing the potential use of self-testing with long-acting injectable PrEP.
The guidance advises against routine HIV recency testing, noting that its clinical benefits are not well-established. Instead, resources should be focused on essential testing services. WHO and UNAIDS’ previous 2022 guidance on recency assays, used for surveillance and strategic targeting of testing and prevention efforts, remains unchanged.
