HCT becomes HTS

In guidance issued by the Department of Health, HIV counselling and testing (HCT) will now be referred to as HIV testing services (HTS) to embrace the full range of services that should be provided together with HIV testing. The main entry point for the HIV continuum of care is through testing services, making this a central component of strategies to accelerate universal access to services for people living with HIV and AIDS.

An introduction to the guidelines provides a useful summary of the changes:

HIV represents the primary burden of disease in South Africa, with an estimated national prevalence of 12.2% in 2012. The HIV incidence among individuals aged 15 to 49 years is estimated at 1.9%, and 2.3% among youth aged 15 to 24 years.

The country has a generalised and a maturing HIV epidemic, with the highest number of people (6.4 million) living with HIV in the world. Although the prevalence of HIV in South Africa remains high, it has been stable over the last decade, which can be attributed to the rapid scale-up and success of the antiretroviral treatment (ART) programme. It is estimated that approximately three million people are on ART, making it the largest programme in the world.

HIV counselling and testing (HCT) is now referred to as HIV testing services (HTS) to embrace the full range of services that should be provided together with HIV testing. These services include:

• counselling (pre-test information and post-test counselling)
• linkage to appropriate HIV prevention, treatment and care services and other clinical support services
• coordination with laboratory services to support quality assurance and the delivery of correct results.

The South African government has embarked on a deliberate effort to scale up HTS and strengthen its quality at all health facilities and non-health sites. With increasing availability of quality HTS and its uptake in all public health facilities in South Africa, the proportion of people who have ever had an HIV test and are aware of their status has increased from 50% in 2008 to 66.5% in 2014. In addition, 92.3% South Africans are aware of HTS services and 66.2% had actually utilised them in the past year, according to 2014 data.

The goals of the National Strategic Plan on HIV, STIs and TB, 2012-2016 (NSP) include the reduction of new HIV infections by at least 50% using combination prevention approaches and initiation of at least 80% of eligible patients on ART, with 70% retained on treatment. Knowledge of HIV status is critical to achieve prevention and treatment goals and HTS is the key entry point to a comprehensive continuum of HIV care.