HIV Testing Strategies in Health Care Settings

HIV testing in health care settings has evolved from risk-based approaches towards more inclusive models that aim to normalise screening and reduce undiagnosed infection. Routine opt-out testing—where patients are informed that HIV screening will be performed unless they decline—has been recommended to increase uptake and minimise stigma. Rapid point-of-care tests deliver results within minutes, facilitating immediate counselling and linkage to care, especially in emergency departments, community clinics and antenatal services. Fourth-generation laboratory assays, which detect both p24 antigen and antibodies, have shortened the diagnostic window and improved early detection. Integration of electronic health-record prompts, standing orders and clinical decision support tools has streamlined offering of tests at outpatient visits, inpatient admissions and visits for other sexually transmitted infections. Self-sampling and digital self-testing programmes have extended reach beyond traditional facilities, engaging key populations reluctant to seek facility-based care. Effective linkage to care and referral pathways remain critical to ensure that newly diagnosed individuals initiate antiretroviral therapy without delay. Globally, combination strategies that blend routine screening, targeted testing of high-risk groups and community-based approaches underpin efforts to achieve universal knowledge of status and to curb onward transmission.

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HIV Testing Strategies in Health Care Settings publication trend

The graph below shows the total number of articles in hiv testing strategies in health care settings across all publications each year (not limited to Nature Index journals).

Technical terms

Opt-out testing: A screening approach in which HIV tests are routinely performed unless the patient expressly declines.

Point-of-care testing (POC testing): Diagnostic tests conducted at the site of patient care, providing rapid results and enabling immediate clinical decisions.

Fourth-generation assay: A laboratory test that detects both HIV-1/2 antibodies and p24 antigen, reducing the window period for diagnosis.

Linkage to care: The process of connecting an individual with a confirmed HIV diagnosis to specialised treatment and support services.

References

1. HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016–2017. MMWR Morbidity and Mortality Weekly Report (2019).
2. HIV Testing Trends at Visits to Physician Offices, Community Health Centers, and Emergency Departments — United States, 2009–2017. MMWR Morbidity and Mortality Weekly Report (2020).
3. Implementation of Targeted Point of Care HIV Testing in a Pediatric Emergency Department. Pediatric Quality and Safety (2020).
4. A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results. JMIR Research Protocols (2014).