HIV testing services (HTS) are an essential component of a national response to the HIV epidemic, and in lower and middle income countries, at least 150 million persons are tested annually. HIV testing is necessary to identify persons in need of antiretroviral treatment, which has been documented to be highly effective not only for treatment but also for prevention of HIV transmission to both adults and children. An assessment of the recent literature on sustainability of health and HIV services suggests that organizational performance, flexibility, and integration with other health interventions contribute to sustainability of HIV services and programs. This article describes the experiences of two HIV testing service providers in Uganda and Zambia as well as the track record of services to prevent mother-to-child HIV transmission to illustrate the factors of performance, flexibility, adaptability, and integration which are key to the sustainability of HIV testing services.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
UNAIDS. Knowledge is power: voluntary HIV counseling and testing in Uganda. Geneva: UNAIDS Best Practices Collection; 1999.
Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: World Health Organization; 2007.
UNAIDS. World AIDS Day 2015 fact sheet. 2015.
Joint United Nations Programme on HIV/AIDS. The gap report. Geneva: UNAIDS. 2014.
UNAIDS. AIDS by the numbers: 2015. Report. 2015 2015. Report No.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
World Bank. Checklist for transition planning of national HIV responses. 2015.
Vogus A, Graff K. PEPFAR transitions to country ownership: review of past donor transitions and application of lessons learned to the eastern Caribbean. Glob Health Sci Pract. 2015;3(2):274–86.
Barnighausen T, Bloom DE, Humair S. Health systems and HIV treatment in sub-Saharan Africa: matching intervention and programme evaluation strategies. Sex Transm Infect. 2012;88(2), e2.
Oberth G, Whiteside A. What does sustainability mean in the HIV and AIDS response? Afr J AIDS Res: AJAR. 2016;1–9.
Shigayeva A, Coker RJ. Communicable disease control programmes and health systems: an analytical approach to sustainability. Health Policy Plan. 2015;30(3):368–85.
Katz I, Glandon D, Wong W, Kargbo B, Ombam R, Singh S, et al. Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes. Health Policy Plan. 2014;29(3):379–87.
Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013;10(8), e1001496.
Organization WH. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection 2015. Geneva: World Health Organization; 2015.
Coates TJ, Kulich M, Celentano DD, Zelaya CE, Chariyalertsak S, Chingono A, et al. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Glob Health. 2014;2(5):e267–77.
Fonner VA, Denison J, Kennedy CE, O’Reilly K, Sweat M. Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries. Cochrane Database Syst Rev. 2012;9. Cd001224.
HIV/AIDS JUNPo, HIV/Aids JUNPo. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS. 2014.
Downing RG, Otten RA, Marum E, Biryahwaho B, Alwano-Edyegu MG, Sempala SD, et al. Optimizing the delivery of HIV counseling and testing services: the Uganda experience using rapid HIV antibody test algorithms. J Acquir Immune Defic Syndr Human Retrovirol: Off Publ Int Retrovirol Assoc. 1998;18(4):384–8.
AIDS Information Centre. Annual report. 2015
Development Aid from People to People Zambia. TCE Project Reports. 2016.
Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet. 1999;354(9181):795–802.
Coovadia HM. Prevention and treatment of perinatal HIV-1 infection in the developing world. Curr Opin Infect Dis. 2000;13(3):247–51.
Dabis F, Newell ML, Fransen L, Saba J, Lepage P, Leroy V, et al. Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice. The Ghent International Working Group on Mother-To-Child Transmission of HIV. Health Policy Plan. 2000;15(1):34–42.
WHO outlines three-pronged attack against AIDS epidemic. AIDS Wkly. 2000:17.
Cates Jr W, Allen M. Mother-to-child HIV-1 transmission. Lancet. 2000;356(9233):945.
Clark S. Hope for prevention of mother-to-child transmission of HIV. Lancet. 2000;356(9226):316.
Hankins C. Preventing mother-to-child transmission of HIV in developing countries: recent developments and ethical implications. Reprod Health Matters. 2000;8(15):87–92.
Whiteside A, Vancouver WR. AIDS conference: special report. Rwandan refugee camps: NGOs get rough treatment from both sides. AIDS Anal Afr. 1996;6(4):1.
Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P, Fowler MG, et al. Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa. Lancet. 1999;354(9181):803–9.
Cohen J. The mother of all HIV challenges. Science. 2000;288(5474):2160–3.
Wilkinson D, McIntyre J. Preventing transmission of HIV from mother to child—is South Africa ready and willing? S Afr Med J. 1998;88(10):1304–6.
De Cock KM, Fowler MG, Mercier E, de Vincenzi I, Saba J, Hoff E, et al. Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA. 2000;283(9):1175–82.
van’t Hoog AH, Mbori-Ngacha DA, Marum LH, Otieno JA, Misore AO, Nganga LW, et al. Preventing mother-to-child transmission of HIV in Western Kenya: operational issues. J Acquir Immune Defic Syndr. 2005;40(3):344–9.
Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Mwiya M, Thea DM. Potential impact of new World Health Organization criteria for antiretroviral treatment for prevention of mother-to-child HIV transmission. AIDS (London, England). 2010;24(9):1374.
World Health Organization. PMTCT strategic vision 2010–2015: preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals: moving towards the elimination of paediatric HIV, December 2009. 2010.
World Health Organization. WHO validates elimination of mother to child transmission of HIV in Cuba (press release). Retrieved from: http://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/. 2015.
Newman Owiredu M, Newman L, Nzomo T, Conombo Kafando G, Sanni S, Shaffer N, et al. Elimination of mother-to-child transmission of HIV and syphilis: a dual approach in the African region to improve quality of antenatal care and integrated disease control. Int J Gynecol Obstet. 2015;130(Supplement 1):S27–31.
Kamb ML, Perez CS, et al. Cuba eliminates mother-to-child transmission of HIV and congenital syphilis: a call to action for the Americas Region. DST - J Bras Doencas Sex Transm. 2015;27(1–2):3–5.
Yotebieng M, Thirumurthy H, Moracco KE, Kawende B, Chalachala JL, Wenzi LK, et al. Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: a randomised controlled trial. Lancet HIV. 2016;3(2):e85–93.
Pettifor A, Rosenberg N, Bekker L-G. Can cash help eliminate mother-to-child HIV transmission? Lancet HIV. 2016;3(2):e60–2.
Stevens J, Lyall H. Mother to child transmission of HIV: what works and how much is enough? J Infect. 2014;69(Supplement 1):S56–62.
The authors acknowledge the assistance of Rosina Makhubela, Mwansa Katunga, and Elise Soerensen of the Development Aid from People to People, Zambia; Henry Leku Lulu and Moses Sembatya of the AIDS Information Centre, Uganda; and Stephanie Behel of CDC Atlanta. This report and the projects described have been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) and by the US Agency for International Development.
Conflict of Interest
Elizabeth Marum, Martha Conkling, Jabez Kanyanda, Sheila Birungi, Robert Byaruhanga, and Mary Grace Alwano declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the authors.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
This article is part of the Topical Collection on The Global Epidemic
About this article
Cite this article
Marum, E., Conkling, M., Kanyanda, J. et al. HIV Testing Services in Africa: Are They Sustainable?. Curr HIV/AIDS Rep 13, 263–268 (2016). https://doi.org/10.1007/s11904-016-0328-6
- HIV tests
- HIV testing services