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 number of HIV tests conducted and the effectiveness of HIV testing services (HTS) in reaching people who are HIV- positive.

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 also can 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 HTS 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 to monitor progress towards the first 90 (percentage of people living with HIV who know their HIV status). This model is used primarily in countries with weak case reporting systems that also have national population-based HIV surveys (see Indicator 1.1).
Numerator

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

Denominator

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

Calculation

Numerator/denominator

Method of measurement
The numerator and denominator should be collected from HTS 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, she should be counted twice in the numerator and twice in the denominator. In an alternative scenario, if a person tests negative at a VCT centre and then positive through provider-initiated testing, she 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. Testkits 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). No sex or age disaggregation or information on positivity are required for self-test procurement or distribution data.
Measurement frequency

Annually

Disaggregation
  • 0–14 years for children and 15 years and older by sex (men and women) for adults.
  • Testing modality.
– Community-level HTS reporting:
  • Mobile mobile testing (e.g., through vans or temporary testing facilities);
  • VCT centres (not within a health facility setting); and
  • Other other community-based testing.
– Facility-level testing:
  • provider-initiated testing in clinics or emergency facilities;
  • ANC clinics (including labour and deliver);
  • VCT (within a health facility setting); and
  • Other 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 that might explain any changes to testing volumes when compared to previous years. If data on retesting rates among HIV -positive or HIV-negative individuals are available, please also provide this in the comments box.
Strengths and weaknesses
Not all countries have unique identifiers or underlying systems to deduplicate retesting among individuals. As a result, this indicator is not directly comparable to knowledge of status (as measured in Indicator 1.1). People who test positive may seek additional confirmatory testing and people who are HIV-negative may test repeatedly during the year.
 
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 or who were HIV- negative at their last test and people who already know their HIV-positive status to be positive and are seeking or otherwise requiring confirmatory testing). In future years, this indicator could be extended to request this information so as to better understand testing patterns and the efficiency of HTS.
Further information

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

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