Started in 2005, the HPTN 052 trial followed serodiscordant couples in Botswana, Brazil, India, Malawi, South Africa, Thailand and Zimbabwe (39). The study had two arms – one in which the partner living with HIV in a serodiscordant couple received antiretroviral therapy immediately if his or her CD4 cell count fell below 550 cells/mm3 and the other, the delayed arm, in which partners did not receive antiretroviral therapy until they met the prevailing eligibility criteria of having CD4 cell counts at or below 250 cells/mm3. All participants received ongoing couples counselling and condoms.
The study found that providing immediate antiretroviral therapy to the partner living with HIV was associated with a 96% reduction in the likelihood of HIV transmission among serodiscordant couples. As of 21 February 2011, HIV-1 had been transmitted to 39 partners. Of these, 28 were virologically linked to the partner living with HIV, and only one occurred in the group getting early antiretroviral therapy. Although the probability of death did not differ signifi cantly between the two arms, HIV-related clinical events declined by 41% in the subgroup that received immediate antiretroviral therapy.
prophylaxis and antiretroviral therapy, the economic costs and benefi ts of the various strategies and the effectiveness of various models of providing testing and counselling. As more scientifi c evidence becomes available, WHO will assess its implications for the strategic use of antiretroviral drugs in HIV prevention and its repercussions for the development of technical guidelines for countries.
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KEY FINDINGS
The number of facilities providing HIV testing and counselling continued to increase. The reported number of health facilities providing HIV testing and counselling services reached 131 000 in 2010 (119 countries), from 107 000 in 2009 (118 countries), 78 000 in 2008 (111 countries) and 30 300 in 2007 (78 countries). In a subset of 104 countries reporting data in both 2009 and in 2010, the median number of facilities per 100 000 population increased from 5.7 to 8.2 (44%).
The number of HIV tests increased globally. In a subset of 87 countries providing data in both 2009 and 2010, about 72 million HIV tests were performed, an increase from the 64 million tests performed in 2009; the median number of tests per 1000 adult population rose from 47 to 55, a 17% gain.
Population-based surveys conducted in selected low-income countries in sub-Saharan Africa show that 1) the proportion of people who report having ever had an HIV test is higher among women than men and 2) knowledge of HIV status, although increasing, remains broadly inadequate. In six countries with results from population-based surveys conducted in 2007–2009, a large proportion of respondents was not aware of their HIV seropositivity before the survey, from about 30% in Kenya to close to 70% in the Congo.
Available data indicate that extensive attrition exists between HIV testing and counselling and treatment, care and support services. Greater attention is needed to implement service delivery models that refl ect local needs and can strengthen links between HIV testing and counselling and other services, including prevention, treatment, care and support interventions.