Via Eurosurveillance: HIV testing in Europe: Evaluating the impact, added value, relevance and usability of the European Centre for Disease Prevention and Control (ECDC)’s 2010 HIV testing guidance. Excerpt from the discussion section:
This study attempted to assess the impact of the ECDC HIV testing guidance 5 years after its release, using a multidisciplinary approach. The findings indicate there is a high level of awareness of the guidance, that it has reached a wider audience than the intended audience, that it is perceived to be relevant and useful, and that it adds value by providing an EU/EEA-wide perspective.
The guidance has been widely used to develop and revise national policies, guidelines, programmes and strategies as well as to support monitoring and evaluation and advocacy, and has contributed to changes in HIV testing strategies in a number of EU/EEA countries.
There is, however, a lack of data on HIV testing coverage and uptake, and of standardised data in particular. This makes it difficult to accurately measure changes in testing across the EU/EEA over time but the limited improvements described in testing rates and in the number of late presenters suggest that testing policies and guidelines are not being implemented effectively. For example, the ECDC 2010 guidance emphasises the need for scaling up indicator condition guided HIV testing and community-based testing, which are the focus of a number of recent initiatives and projects in Europe, including the EU funded OptTEST, Euro HIV EDAT and COBATEST projects.
Despite this, recent data show that indicator condition guided HIV testing is not being widely implemented in Europe. The OptTEST project has reviewed national HIV testing guidelines and audited implementation of indicator condition guided HIV testing in seven pilot countries. The results show low rates of HIV testing in patients presenting with indicator conditions as well as sub-optimal inclusion of indicator condition guided testing recommendations both in national HIV testing guidelines and relevant specialty guidelines.
Community-based testing has been expanded in the EU/EEA since 2010 through a variety of service delivery models. However, limited funding, poor integration with national HIV programmes and regulatory barriers in some cases (for example, restricting testing to trained health professionals), have hindered further scale up.
These findings reinforce the need for guidance to clearly address these implementation challenges, including through direct guidance in relation to engagement with the broader target audience. There is a need to assist countries to a greater extent in the development of national policies, their implementation and evaluation and to support them when undertaking future revisions. The focus group discussions confirmed this need.
This assessment has shown that the guidance has successfully reached a wider audience than the intended one. This observation may reflect the broadening range of stakeholders involved in health policy and decision making at least in some countries, as well as of healthcare workers involved in delivery of HIV testing services. The lessons learned from this evaluation should be used to inform future evaluations as well as the development of potential new guidance.
