Responding to HIV and AIDS is one of the most important tasks in South Africa, which is why the prevention of new HIV infections and treatment and care of HIV-infected people are the South African government’s top priorities.
Recent new South African and international guidelines and recommendations prompted the review of South Africa’s HIV counselling and testing (HCT) guidelines, which resulted in this newly revised document, the South AfricanNational HIV Testing Services: Policy and Guidelines, 2015. TheNational Strategic Plan for HIV, STIs and TB 2012-2016 (NSP)guides this response, while theHealth Sector HIV Prevention Strategy and Guidelines, 2014 -2016,which focuses on the implementation of combination prevention, contributes to the operationalisation of the NSP. The policy is also aligned with theNational Development Plan, 2030andtheambitious90-90-90targets expounded by UNAIDS.
The NSP outlines four strategic objectives that shape the HIV, STI and TB responses in South Africa. These include:
•addressing the social and structural drivers ofHIV, STI and TB infectons
•preventng new HIV, STI and TB infectonsthrough combinaton interventons
•sustaining the health and wellness of peoplethrough improved access to high quality
treatment, care and support services
•protectng the human rights of and improvingaccess to justce for people living with HIV.
Overaperiodofﬁveyears,theNSPaimsto reach the following goals:
•reduce new HIV infectons by at least 50%using combinaton preventon approaches
•initate at least 80% of eligible patents onantretroviral treatment, ensuring that 70%
of patents are stll alive and on treatment
ﬁve years afer initaton
•reduce the number of new TB infectons anddeaths from TB by 50%
•ensure an enabling and accessible legalframework that protects and promotes the
rights of those living with HIV
•reduce stgma and discriminaton related toHIV and TB by at least 50%.
Knowing one’s HIV status is critical to the achievement of these prevention and treatment goals, making HTS the gateway to a complete continuum of care. A comprehensive approach,known as HIV testing services (HTS) is central to every single HIV intervention and among all target populations, and requires close collaboration with other health services.Through linkages with care, treatment and support programmes, HTS is an effective package of services that diminishes the impact of the HIV epidemic in our country. The South African Government has embarked on a deliberate effort to scale up and strengthen the quality of HTS at all public health facilities and non-health sites offering this service, and over the years, testing and counselling has improved and has progressively become more available and acceptable to our people.
The Department of Health acknowledges international trends and recommendations as described in the revised World Health Organization’s (WHO) guidelines. All forms of HTS adhere to the 5Cs:Conﬁdentiality,
Counselling,Consent,Correct results and Connection, or linkage to care, with all based within a human rights context. In addition to
the 5Cs, however, the Department accentuates the use of a variety of approaches to HTS that will reduce the number of missed opportunities.These include provider-initiated counselling and testing, couple counselling and testing, home-to-home and infant and children counselling and testing in alignment to the revised WHO guidelines.
Effective combination of prevention interventions require strengthened biomedical interventions like the familiar prevention of mother to child transmission or medical male circumcision.
It also demands that we engage fully with changing the attitudes, beliefs, cultural practices and other barriers that thwart individual, couple,family, and community access to HTS and other prevention interventions. We recognise that prevention remains the cornerstone of our entire response to this epidemic. The programme seeks to ensure that people who test HIV-negative are encouraged and motivated to maintain their negative status, and those who test positive are supported in living long, healthy lives through positive health-seeking behaviour and the provision of appropriate services.The National HTS programme will continue to provide an integrated service at all levels of the public health service delivery system. We encourage and support formal collaboration among public, private and non-governmental sectors.
The revision of our National HTS policy is important to keep abreast of international guidance and recommendations. More importantly,Iamconﬁdentthatimplementation of these revised guidelines will be important in achieving epidemic control in South Africa.I strongly urge all HTS service providers to do all that is necessary to adhere to the recommendations outlined herein.