HIV testing volume and positivity

Export Indicator

The number of HIV tests conducted (testing volume) and the percentage of HIV-positive results returned to people (positivity) in the calendar year
What it measures

Trends in the uptake of HIV testing services, including through different modalities, and their effectiveness at identifying people living with HIV.

Rationale

Testing volume and data on positivity are useful for programme monitoring. Knowing the numbers of people tested annually and the modality of testing or uptake of self-tests is critical to commodity forecasting and staff resource planning. Positivity data among those tested who have received a result can also help to validate the number of people reported as newly diagnosed through routine reporting systems and estimates of HIV prevalence from survey data. Finally, when disaggregated by age, sex, testing modality, and HIV status, these data are useful in assessing the effectiveness of delivering HIV testing services and addressing gaps in various settings, contexts and populations.

In addition to programme monitoring activities, annual testing volumes and positivity rates are inputs into the UNAIDS model that estimates progress towards the first 95 (95% of people living with HIV know their HIV status) target. This model is used primarily in countries that have national surveys to measure the population's historic testing coverage by HIV serostatus, but weak HIV case reporting systems (see Indicator 2.1).

Numerator

Number of tests conducted where an HIV-positive result was returned to the person (positivity)

Denominator

Number of tests performed where results were received by the person (testing volume)

Calculation

Numerator/denominator

Method of measurement

The numerator and denominator should be collected from HIV testing services programme registers, log books and reporting forms on a quarterly or annual basis. Reported data should be a count of the number of tests conducted where results were returned to a person and not the number of unique persons who tested at least once during the calendar year. For example, if a person who is HIV-positive tests once at a mobile testing van and then again at a clinic during the same calendar year, they should be counted twice in the numerator and twice in the denominator. In an alternative scenario, if a person tests negative at a voluntary counselling and testing (VCT) centre and then positive through provider-initiated testing, they should be reported once in the numerator and twice in the denominator.

Please note that only tests conducted where the results are returned to the person should be counted. Also, a person should only be counted as testing once in the numerator and the denominator, even if up to three different assays are performed to confirm an HIV-positive diagnosis according to the national testing algorithm.

Please separately report numbers of self-test kits procured and distributed in the calendar year (where available). Procured self-test kits refers to the total number of self-test kits purchased (not distributed or used) in a year by the national government, including (but not limited to) donors. Test kits procured via other channels, such as the private sector, should not be counted; rather, they should be detailed in the comments. Self-test kits distributed refers to the total number of individual self-test kits that were distributed in a year; it is not the total number of people self-tested, nor is it the total number of people who received a self-test (as individuals may obtain more than one kit within a year). No sex- or age-disaggregation or information on positivity is required for self-test procurement or distribution data.

Measurement frequency

Annually

Disaggregation
  • 0โ€“14 years for children and 15 years and older by sex (men and women) for adults.
  • Testing modality (for all populations including Key population services).
โ€“ Community-level HTS reporting:
  • Mobile testing (e.g., through vans or temporary testing facilities)
  • VCT centres (not within a health facility setting).
  • Other community-based testing.
โ€“ Facility-level testing:
  • Provider-initiated testing in clinics or emergency facilities.
  • Antenatal care clinics (including labour and delivery).
  • VCT (within a health facility setting).
  • TB clinic (if available)
  • Family planning clinic.
  • Other facility-level testing.
Note: If testing volume and positivity cannot be disaggregated by modality, please report overall numbers.
Additional information requested

Please provide information in the comments box about any national testing campaigns or shifts in testing strategies or practices that might explain changes to testing volumes when compared to previous years. If data on retesting among HIV-positive or HIV-negative individuals (volumes or rates/proportions) are available, please also provide this in the comments box.

Strengths and weaknesses

Not all countries have unique identifiers or underlying systems to deduplicate first and repeat testing among individuals, nor to differentiate by HIV status of the person re-testing. People who test positive may seek additional confirmatory testing and people who are HIV-negative may test repeatedly during the year. As a result, this indicator is not directly comparable to knowledge of status (as measured in Indicator 2.1).

As HIV information systems evolve, it will be important to be able to disaggregate tests by previous testing history (e.g., people who have never been tested, people who were HIV-negative at their last test, and people who already know their HIV-positive status and are seeking or otherwise requiring confirmatory testing) as well as by the year of previous testing. In future years, this indicator could be extended to request this information so as to better understand testing patterns and capture the valid numbers of new diagnoses to better assess the effectiveness of HIV testing services.

Further information

Consolidated strategic information guidelines for HIV in the health sector. Geneva: World Health Organization; 2015 (https://apps.who.int/iris/bitstream/10665/164716/1/9789241508759_eng.pdf?ua=1).

Related Indicators

TL.2 HTS testing volume and positivity, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).

HTS_TST, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf).