Globally, HIV testing services (HTS) have scaled substantially over the last twenty years. For example, in 2005, an estimated 12 percent of people who wanted to test for HIV had access to testing services, whereas in 2022, 86 percent of people with HIV knew their status through testing.  However, despite the tremendous progress in HTS availability and uptake, there remain significant gaps in certain population groups, such as key populations (KPs), adolescents and children, and adult men, knowing their HIV status. To address these testing gaps, EpiC offers differentiated testing models. Between October 2020 and September 2024, EpiC tested more than 4.7 million people in 30 countries, resulting in 263,456 newly diagnosed people living with HIV (PLHIV), representing a 5.6 percent case-finding rate. Of those 4.7 million, 1.9 million were KPs and their sexual partners and children; among these, 127,541 were newly diagnosed, representing a 6.5 percent case-finding rate.  

The PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project implemented a variety of testing approaches such as index testing and risk network referral (RNR), an enhanced peer outreach (EPO) approach, and HIV self-testing (HIVST) to increase the number of individuals who knew their HIV status.   

Index testing—also called provider-assisted partner services—involves systematically identifying current and former sexual and drug-injecting partners of individuals newly or previously diagnosed with HIV and then engaging them in HTS. Index testing is also utilized to elicit and test children of individuals who are diagnosed with HIV. This approach can improve testing coverage and efficiency while also identifying people with undiagnosed HIV infection. Testing can be done in a health facility or in the community. RNR can be offered at the same time as index testing and extends to the social contacts of PLHIV. RNR is an additional and self-guided option to informally extend links to HIV testing and other services to a broader set of social and risk network members who have an elevated risk of HIV infection. When index testing is combined with community-based outreach and RNR services, it serves as part of a comprehensive case-finding model. Over the life of the EpiC project, 550,099 individuals were offered index testing. Of those, 280,421 accepted (1.84 percent), and 410,541 (84.6 percent) contacts were tested, resulting in 69,390 newly diagnosed PLHIV, representing a 16.9 percent case-finding rate. RNR resulted in the testing of 45,825 individuals, of whom 3,647 were newly diagnosed, representing an 8 percent case-finding rate. 

The EPO approach engages KPs and priority population individuals in HIV prevention and testing who are not currently engaged in HIV services and would benefit from them. EPO is led by peer outreach workers, who engage contacts to encourage peers in their own social and sexual networks to be tested for HIV or other health outcomes. EPO can be used for a variety of objectives, including an increase in new HIV and sexually transmitted infection diagnoses, improved treatment, and stronger linkage from an HIV-negative test to pre-exposure prophylaxis (PrEP) initiation. Over the life of the EpiC project, EPO resulted in the testing of 113,434 individuals, of whom 9,596 were newly diagnosed, representing an 8.5 percent case-finding rate. 

HIVST is a process in which a person collects their own specimen (oral fluid or blood) and then performs a test and interprets the result, often in a private setting, either alone or with someone they trust. HIVST kits can be distributed and used in a variety of settings such as community- or facility-based settings and can also be distributed through index testing, EPO, and PrEP services. Over the life of the EpiC project, 1,541,599 HIVST kits were distributed, of which 75 percent (1,156,051) were used.   

EpiC also offered differentiated testing services through community- and facility-based testing, mobile testing services, and online options for ordering HIV self-test kits and scheduling HTS appointments. Following testing, appropriate service pathways, such as prevention or treatment, are offered to reduce HIV transmission, as well as curtail ongoing infections and improve health outcomes among PLHIV.  

Key resources 

This blog is part of a series highlighting EpiC’s technical approaches, key results, tools, and strategies that have driven positive change in HIV outcomes.