Has WHO and UNAIDS issued technical recommendations on the application of HIV recency testing?

The Global HIV Strategic Information Working Group (co-coordinated by WHO and UNAIDS) first issued guidance in 2011 on the use of recency assays at the population level (e.g. for epidemiologic or surveillance monitoring) (1). This guidance focused on purposes such as population surveillance and evaluation of the impact of preventive interventions. With support from the WHO HIV Incidence Assay Technical Working Group, regular technical updates are provided to supplement the 2011 guidance. The most recent technical updated was published in March 2018 (2).

This update briefly identifies the emerging areas of interest in the use of recency testing for programmatic and/or individual patient management application; however, it states that a recommendation for the use of rapid diagnostic tests used at point-of-care tests as an aid for diagnosis or aid for staging, can only be made once one or more products have been brought to market and data to support the manufacturer’s claims are available. The update also summarizes two recent publications of interest that lay out possible new applications for RITA for program monitoring and individual patient management use (3,4).

With regards to technical guidelines, the use-cases cited above under “What is the overall goal of this strategic approach?” are potentially relevant to the 2015 WHO consolidated guidelines on HIV Testing Services. In the 2015 guideline, the application of HIV recency testing outside use for research purposes and population-level surveillance was not considered due to lack of evidence. WHO is currently updating its guidelines on HIV testing services for publication in 2019. The guidelines development group which is convened by WHO on HIV testing normative guidelines development has reviewed available published literature on recency testing; currently there is insufficient evidence on the use of recency assays for individual patient management to enable recommendations to be made. When results are available from ongoing operational research (including the implementation being proposed/conducted by PEPFAR), recommendations about their use at the individual patient management will be considered by WHO for inclusion in future testing guidelines based on the level of evidence.

1. When and how to use assays for recent infection to estimate HIV incidence at a population level. 2011. Geneva: UNAIDS and World Health Organization, 2011.
2. Recent infection testing algorithm technical update: Applications for HIV surveillance and programme monitoring http://www.unaids.org/en/resources/documents/2018/infection_ testing_algorithm. Geneva: Global HIV Strategic Information Working Group, 2018.
3. Target product profile for tests for recent HIV infection. Geneva: Foundation for Innovative Diagnostics (FIND); 2017.
4. Morrison CS, Homan R, Mack N, et al. Assays for estimating HIV incidence: updated global market assessment and estimated economic value. J Int AIDS Soc. 2017;20(3):n.p.