Abstract Body

Strengthening HIV testing services (HTS) and linkage to antiretroviral therapy (ART) is critical to reaching the UNAIDS 1st 95 and 2nd 95 targets (95% of people living with HIV (PLHIV) know their status, 95% are on ART). In support of these goals, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) updated its technical guidance in 2019 to promote efficient HIV testing strategies to reduce unnecessary tests and improve HIV case finding. Facilitated linkage services and differentiated service delivery were implemented to expand access to and uptake of ART.

We analyzed HIV testing and treatment outcomes reported quarterly to PEPFAR from 41 countries between 2016-2021. A descriptive trend analysis of testing and treatment outcomes from (January–March) 2016 through (April–June) 2021 was conducted for persons aged ? 15 years with complete HIV data. Trends analyzed include the number of HIV tests conducted, HIV positive tests, percent positivity (HIV positive tests divided by total tests), number of PLHIV newly initiated on ART, and the proxy patient linkage rate (individuals newly initiated on ART divided by HIV-positive tests).

From January 2016 to June 2021, the 41 countries reported conducting 443 million (M) tests, including 17.5M positive tests. The number of tests conducted increased by 42% from 19M in March 2016 to a peak of 27M in September 2018, before decreasing by 45% to 15M in June 2021 (figure 1). HIV-positive tests increased by 11% from 0.9M in March 2016 to a peak of 1M in September 2017, before decreasing by 40% to 0.6M in June 2021. Percent positivity was stable at approximately 5% from March 2016 to September 2017, decreased to 3% in March 2018, and then increased to 4% in June 2021. PLHIV newly initiated on ART increased by 60% from 0.5M in March 2016 to 0.8M in September 2017, before decreasing by 25% to 0.6M in June 2021.The proxy linkage to treatment rate increased from a low of 60% in March 2016 to approximately 90% in June 2021.

Countries substantially reduced the number of HIV tests conducted over the past three years, resulting in fewer HIV diagnoses but a stable percent positivity. Countries have also become more efficient in linking PLHIV identified to HIV treatment. To ensure continued progress towards 95-95-95 goals, HTS programs need to balance efforts to make testing more efficient (represented by percent positivity) without compromising the number of PLHIV diagnosed.