{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:58:10Z","timestamp":1788562690087,"version":"build-2803163510"},"reference-count":27,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T00:00:00Z","timestamp":1703721600000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-024432"],"award-info":[{"award-number":["INV-024432"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,8]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Policy review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>47 countries within the WHO African region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>National HTS policies from the WHO African region as of December 2021.<\/jats:p>\n                    <jats:p>Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV\/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>National policies were reviewed for 96% (n=45\/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21\/47); of which 31% and 22% were in low-prevalence (&lt;5%) and high-prevalence (\u22655%) countries, respectively. Ten policies (21%) recommended the use of WB and 49% (n=23) recommended retesting before ART initiation. Dual HIV\/syphilis RDTs were recommended in 45% (n=21\/47) of policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Many countries in the African region have adopted WHO-recommended HIV testing strategies; however, efforts are still needed to fully adopt WHO guidance. Countries should accelerate their efforts to adopt and implement a three-test strategy, retesting prior to ART initiation and the use of dual HIV\/syphilis RDTs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-071198","type":"journal-article","created":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T12:15:26Z","timestamp":1703765726000},"page":"e071198","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Country adoption of WHO 2019 guidance on HIV testing strategies and algorithms: a policy review across the WHO African region"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7561-3368","authenticated-orcid":false,"given":"Emmanuel","family":"Fajardo","sequence":"first","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Lastrucci","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nay\u00e9","family":"Bah","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casimir Manzengo","family":"Mingiedi","sequence":"additional","affiliation":[{"name":"Inter-country support team for Central Africa, World Health Organization Regional Office for Africa, Libreville, Gabon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ndoungou Salla","family":"Ba","sequence":"additional","affiliation":[{"name":"Inter-country support team for Western and Central Africa, World Health Organization Regional Office for Africa, Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausta","family":"Mosha","sequence":"additional","affiliation":[{"name":"Inter-country support team for Eastern and Southern Africa, World Health Organization Regional Office for Africa, Harare, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank John","family":"Lule","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret Alia Samson","family":"Paul","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lago","family":"Hughes","sequence":"additional","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Barr-DiChiara","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad S","family":"Jamil","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Sands","sequence":"additional","affiliation":[{"name":"Regulation and Prequalification, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Baggaley","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Johnson","sequence":"additional","affiliation":[{"name":"Global HIV, Hepatitis, and STI Programmes, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,28]]},"reference":[{"key":"2025121602595443000_13.12.e071198.1","unstructured":"Consolidated guidelines on HIV testing services, 2015. 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