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About the Authors:
Shona Dalal
* E-mail: [email protected]
Affiliations Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Chung-won Lee
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Thato Farirai
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Pretoria, South Africa
Allison Schilsky
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Thurma Goldman
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Pretoria, South Africa
Janet Moore
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Naomi N. Bock
Affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Introduction
Well into the third decade of the worldwide human immunodeficiency virus (HIV) epidemic, less than one-third of people in countries with generalized or emerging HIV epidemics know their HIV serostatus [1]. Access to HIV counseling and testing, an essential first step for prevention and HIV care and treatment service access, was constrained by a model for HIV testing developed decades ago in response to different circumstances: a disease with no treatment, lack of rapid testing to provide same day results, and concentration among persons already marginalized by illicit or stigmatized behaviors [2]. Most voluntary counseling and testing (VCT) sites were located in the community, not in health facilities, and any utilization was self-initiated. HIV testing was introduced into sub-Saharan African countries using this same VCT model [3]–[6].
The revised Policy Statement on HIV Testing published by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in 2004 emphasized the importance of knowledge of HIV status for expanding access to prevention, treatment, and care, and the importance of a serostatus-based approach to prevention has been further delineated [7], [8]. The recent results of a large multinational clinical trial indicating that earlier initiation of antiretroviral therapy among men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners imparts even more urgency to the need for more widespread uptake of HIV testing and...