Universal Access to HIV Testing in Africa: WHO Frameworks, Innovations, and Progress Toward Early Diagnosis

Authors

  • Emmanuel Ifeanyi Obeagu Department of Biomedical and Laboratory Science, Africa University, Mutare, Zimbabwe https://orcid.org/0000-0002-4538-0161
  • Akash John Lecturer, Department of Allied Health Sciences, The University of Chenab, Gujrat, Pakistan

DOI:

https://doi.org/10.22270/ijmspr.v12i2.191

Keywords:

HIV testing, universal access, early diagnosis, World Health Organization, Africa

Abstract

Universal access to HIV testing is fundamental to effective HIV prevention, timely treatment initiation, and epidemic control. Africa continues to shoulder the highest global burden of HIV, where delayed diagnosis remains a major driver of morbidity, mortality, and ongoing transmission. The World Health Organization (WHO) has provided sustained normative leadership through evidence-based frameworks, rights-centered policies, and programmatic innovations designed to expand HIV testing coverage and promote early diagnosis across diverse African settings. This narrative review synthesizes WHO guidance on provider-initiated and community-based testing, differentiated service delivery, and ethical standards, alongside key innovations such as HIV self-testing, integrated and dual rapid diagnostics, and mobile outreach models. Progress toward early diagnosis and the first UNAIDS targets is examined, highlighting gains in antenatal testing, male and adolescent engagement, and test-and-treat implementation. Persistent gaps—including late presentation, stigma, health system constraints, and sustainability challenges—are also discussed. The review concludes by outlining strategic priorities for strengthening equitable, data-driven, and resilient HIV testing services. Sustained implementation of WHO-led frameworks remains central to achieving universal access and ending AIDS as a public health threat in Africa.

Keywords: HIV testing, universal access, early diagnosis, World Health Organization, Africa

Author Biographies

Emmanuel Ifeanyi Obeagu, Department of Biomedical and Laboratory Science, Africa University, Mutare, Zimbabwe

Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Akash John, Lecturer, Department of Allied Health Sciences, The University of Chenab, Gujrat, Pakistan

Research officer, Lahore Medical Research Center, Lahore, Pakistan

References

Ripamonti D, Leon SR. World AIDS Day 2022: putting ourselves to the test: achieving equity to end HIV. Frontiers Media SA; 2024. p. 1478645. https://doi.org/10.3389/978-2-8325-5615-3

Balogun K, Slev PR. Towards achieving the end of the HIV epidemic: advances, challenges and scaling-up strategies. Clinical biochemistry. 2023;117:53-9. https://doi.org/10.1016/j.clinbiochem.2022.05.006 PMid:35640680

Mwende Wairimu G. The global burden of HIV and progress toward the 2030 UNAIDS targets: A comprehensive review. Res Output J Public Health Med. 2024;3(3):46-51. https://doi.org/10.59298/ROJPHM/2024/334651

Bekker L-G, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, et al. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission. The Lancet. 2018;392(10144):312-58. https://doi.org/10.1016/S0140-6736(18)31070-5 PMid:30032975 PMCid:PMC6323648

Easterbrook P, Johnson C, Figueroa C, Baggaley R. HIV and hepatitis testing: global progress, challenges, and future directions. AIDS Rev. 2016;18(1):3-14.

Organization WH. Consolidated guidelines on HIV testing services. Consolidated guidelines on HIV testing services2015.

Qin Y, Han L, Babbitt A, Walker JS, Liu F, Thirumurthy H, et al. Experiences using and organizing HIV self-testing. Aids. 2018;32(3):371-81. https://doi.org/10.1097/QAD.0000000000001705 PMid:29194120 PMCid:PMC5758403

Vrazo AC, Golin R, Fernando NB, Killam WP, Sharifi S, Phelps BR, et al. Adapting HIV services for pregnant and breastfeeding women, infants, children, adolescents and families in resource‐constrained settings during the COVID‐19 pandemic. Journal of the International AIDS Society. 2020;23(9):e25622. https://doi.org/10.1002/jia2.25622 PMid:32996705 PMCid:PMC7525801

Ford N, Vitoria M, Doherty M. World Health Organization guidance to support human immunodeficiency virus care models during the coronavirus disease 2019 era. Clinical Infectious Diseases. 2022;74(9):1708-10. https://doi.org/10.1093/cid/ciab855 PMid:34558608 PMCid:PMC8500102

Akintunde TY, Akintunde OD, Musa TH, Sayibu M, Tassang AE, Reed LM, et al. Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-coronavirus disease 2019 (COVID-19) pandemic reformation. Global Health Journal. 2021;5(3):128-34. https://doi.org/10.1016/j.glohj.2021.07.006 PMid:36338822 PMCid:PMC9625850

Organization WH. Guidance for national strategic planning (NSP): health sector response to HIV, viral hepatitis and sexually transmitted infections: World Health Organization; 2023.

Gilks CF, Alemu YA. A WHO Public Health Approach to Ending AIDS in the Global South: Lessons for NCD Control and Universal Health Coverage: Taylor & Francis; 2024. https://doi.org/10.4324/9781003505693

Organization WH. Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Policy brief on integrating and strengthening monitoring of differentiated ART service delivery: World Health Organization; 2023.

Organization WH. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030: World Health Organization; 2022.

Boakye DS, Adjorlolo S. Achieving the UNAIDS 95-95-95 treatment target by 2025 in Ghana: a myth or a reality? Global health action. 2023;16(1):2271708. https://doi.org/10.1080/16549716.2023.2271708 PMid:37921654 PMCid:PMC10627043

Mugo Moses H. Comprehensive Review of HIV Testing Strategies and Practices in Uganda.

Simwinga M, Gwanu L, Hensen B, Sigande L, Mainga M, Phiri T, et al. Lessons learned from implementation of four HIV self-testing (HIVST) distribution models in Zambia: applying the Consolidated Framework for Implementation Research to understand impact of contextual factors on implementation. BMC infectious diseases. 2022;22(Suppl 1):977. https://doi.org/10.1186/s12879-024-09168-5 PMid:38448832 PMCid:PMC10916003

Mannoh I, Amundsen D, Turpin G, Lyons CE, Viswasam N, Hahn E, et al. A systematic review of HIV testing implementation strategies in sub-Saharan African countries. AIDS and behavior. 2022:1-12.

Barker JL. Effective Public Health Strategies to Optimize HIV Testing Services Among Men Ages 15 Years and Older in Kenya: The University of North Carolina at Chapel Hill; 2023.

Mwisongo A, Nabyonga-Orem J, Yao T, Dovlo D. The role of power in health policy dialogues: lessons from African countries. BMC Health Services Research. 2016;16:337-46. https://doi.org/10.1186/s12913-016-1456-9 PMid:27454227 PMCid:PMC4959373

Ford N, Vitoria M, Doherty M. Providing antiretroviral therapy to all who are HIV positive: the clinical, public health and programmatic benefits of Treat All. Journal of the International AIDS Society. 2018;21(2):e25078. https://doi.org/10.1002/jia2.25078 PMid:29436776 PMCid:PMC5810349

Kadye T, Jamil MS, Johnson C, Baggaley R, Barr-DiChiara M, Cambiano V. Country uptake of WHO recommendations on differentiated HIV testing services approaches: a global policy review. BMJ open. 2024;14(3):e058098. https://doi.org/10.1136/bmjopen-2021-058098 PMid:38485173 PMCid:PMC10941124

Long L, Kuchukhidze S, Pascoe S, Nichols BE, Fox MP, Cele R, et al. Retention in care and viral suppression in differentiated service delivery models for HIV treatment delivery in sub‐Saharan Africa: a rapid systematic review. Journal of the International AIDS Society. 2020;23(11):e25640. https://doi.org/10.1002/jia2.25640 PMid:33247517 PMCid:PMC7696000

Plan A. Global action plan on HIV drug resistance 2017-2021. WHO, Geneva, Switzerland. 2017.

Organization WH. Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact: World Health Organization; 2022.

Organization WH. Framework for implementing the "End TB Strategy" in the African Region 2016-2020. Framework for implementing the "End TB Strategy" in the African Region 2016-20202017.

Pai NP, Pai M. Point-of-care diagnostics for HIV and tuberculosis: landscape, pipeline, and unmet needs. Discovery medicine. 2012;13(68):35-45.

Tonen-Wolyec S, Djang'eing'a RM, Batina-Agasa S, Kayembe Tshilumba C, Muwonga Masidi J, Hayette M-P, et al. Self-testing for HIV, HBV, and HCV using finger-stick whole-blood multiplex immunochromatographic rapid test: A pilot feasibility study in sub-Saharan Africa. PLoS One. 2021;16(4):e0249701. https://doi.org/10.1371/journal.pone.0249701 PMid:33836036 PMCid:PMC8034751

Toskin I, Blondeel K, Peeling RW, Deal C, Kiarie J. Advancing point of care diagnostics for the control and prevention of STIs: the way forward. Sexually transmitted infections. 2017;93(S4):S81-S8. https://doi.org/10.1136/sextrans-2016-053073 PMid:29223966

Yager P, Domingo GJ, Gerdes J. Point-of-care diagnostics for global health. Annu Rev Biomed Eng. 2008;10(1):107-44. https://doi.org/10.1146/annurev.bioeng.10.061807.160524 PMid:18358075

Bacon A, Wang W, Lee H, Umrao S, Sinawang PD, Akin D, et al. Review of HIV self testing technologies and promising approaches for the next generation. Biosensors. 2023;13(2):298. https://doi.org/10.3390/bios13020298 PMid:36832064 PMCid:PMC9954708

Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis. Journal of the International AIDS Society. 2017;20(1):21594. https://doi.org/10.7448/IAS.20.1.21594 PMid:28530049 PMCid:PMC5515051

Jafari Y, Peeling RW, Shivkumar S, Claessens C, Joseph L, Pai NP. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis. PloS one. 2013;8(2):e54695. https://doi.org/10.1371/journal.pone.0054695 PMid:23468842 PMCid:PMC3582640

Facente SN, Grebe E, Maher AD, Fox D, Scheer S, Mahy M, et al. Use of HIV recency assays for HIV incidence estimation and other surveillance use cases: systematic review. JMIR public health and surveillance. 2022;8(3):e34410. https://doi.org/10.2196/34410 PMid:35275085 PMCid:PMC8956992

Ford N, Meintjes G, Pozniak A, Bygrave H, Hill A, Peter T, et al. The future role of CD4 cell count for monitoring antiretroviral therapy. The Lancet Infectious Diseases. 2015;15(2):241-7. https://doi.org/10.1016/S1473-3099(14)70896-5 PMid:25467647

Kosack CS, Page A-L, Klatser PR. A guide to aid the selection of diagnostic tests. Bulletin of the World Health Organization. 2017;95(9):639. https://doi.org/10.2471/BLT.16.187468 PMid:28867844 PMCid:PMC5578377

Organization WH. WHO consolidated guidelines on tuberculosis. Module 4: treatment. Tuberculosis care and support: World Health Organization; 2022.

Obeagu EI, One Step at a Time: Incremental Approaches to HIV Prevention, Asian Journal of Dental and Health Sciences 2024;4(4)5-9 https://doi.org/10.22270/ajdhs.v4i4.91

NJUGUNA DK. The Role of Health Services Integration in Healthcare System Performance: A Case of Hiv/Aids and Ncd Services in Nakuru County, Kenya: KeMU; 2024.

Aantjes C, Quinlan T, Bunders J. Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment. Globalization and health. 2014;10:1-15. https://doi.org/10.1186/s12992-014-0085-5 PMid:25499098 PMCid:PMC4279695

Fatti G. An evaluation of the effectiveness of task-shifting health systems approaches, including community-based and pharmaceutical care models, for HIV treatment and prevention programs in South Africa: Stellenbosch: Stellenbosch University; 2020.

Obeagu EI, Empowering Girls and Women: Reducing HIV Risk Through Education, Asian Journal of Dental and Health Sciences 2025;5(1)45-49. https://doi.org/10.22270/ajdhs.v5i1.119

Friedland BA, Sprague L, Nyblade L, Baral SD, Pulerwitz J, Gottert A, et al. Measuring intersecting stigma among key populations living with HIV: implementing the people living with HIV Stigma Index 2.0. Journal of the International AIDS Society. 2018;21(Suppl Suppl 5):e25131. https://doi.org/10.1002/jia2.25131 PMid:30033563 PMCid:PMC6055043

Barr D, J Amon J, Clayton M. Articulating a rights-based approach to HIV treatment and prevention interventions. Current HIV research. 2011;9(6):396-404. https://doi.org/10.2174/157016211798038588 PMid:21999775 PMCid:PMC3528010

Zakhidova G, editor 12. The role of public organizations and non-governmental organizations (NGOs) in addressing and supporting people with HIV. HIV and Hepatitis C in Central Asia and China; 2024: Nomos Verlagsgesellschaft mbH & Co. KG. https://doi.org/10.5771/9783748920021-227

Kohnert D. Impact of US and European Aid Cuts on Sub-Saharan Africa. Available at SSRN 5224300. 2025. https://doi.org/10.2139/ssrn.5224300

Cairney L-IN. Global HIV/AIDS initiatives, recipient autonomy and country ownership: An analysis of the rise and decline of Global Fund and PEPFAR funding in Namibia. 2017.

Political declaration on HIV and AIDS: ending inequalities and getting on track to end AIDS by 20302021.

Kumah E, Boakye DS, Boateng R, Agyei E. Advancing the global fight against HIV/Aids: Strategies, barriers, and the road to eradication. Annals of global health. 2023;89(1):83. https://doi.org/10.5334/aogh.4277 PMid:38046536 PMCid:PMC10691281

Stackpool‐Moore L, Logie CH, Cloete A, Reygan F. What will it take to get to the heart of stigma in the context of HIV? Journal of the International AIDS Society. 2022;25(Suppl 1):e25934. https://doi.org/10.1002/jia2.25934 PMid:35818934 PMCid:PMC9274335

Oleribe OO, Oladipo OA, Ezieme IP, Crossey MME, Taylor-Robinson SD. From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria. The Pan African Medical Journal. 2016;24:266. https://doi.org/10.11604/pamj.2016.24.266.6286 PMid:28154621 PMCid:PMC5267864

Odama A. 2020 GLOBAL AIDS MONITORING REPORT.

Porter LE, Bouey PD, Curtis S, Hochgesang M, Idele P, Jefferson B, et al. Beyond indicators: advances in global HIV monitoring and evaluation during the PEPFAR era. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60:S120-S6. https://doi.org/10.1097/QAI.0b013e31825cf345 PMid:22797733

Mahy MI, Sabin KM, Feizzadeh A, Wanyeki I. Progress towards 2020 global HIV impact and treatment targets. Journal of the International AIDS Society. 2021;24:e25779. https://doi.org/10.1002/jia2.25779 PMid:34546655 PMCid:PMC8454678

Moungui HC, Nana-Djeunga HC, Nko'Ayissi GB, Sanou A, Kamgno J. Mixed-methods evaluation of acceptability of the District Health Information Software (DHIS2) for neglected tropical diseases program data in Cameroon. Journal of Global Health Reports. 2021;5:e2021071. https://doi.org/10.29392/001c.25973

Asangansi I. Understanding HMIS implementation in a developing country Ministry of Health context-An institutional logics perspective. Online journal of public health informatics. 2012;4(3):ojphi. v4i3. 4302. https://doi.org/10.5210/ojphi.v4i3.4302 PMid:23569646 PMCid:PMC3615828

Waylen KA, Blackstock KL, Van Hulst FJ, Damian C, Horváth F, Johnson RK, et al. Policy-driven monitoring and evaluation: Does it support adaptive management of socio-ecological systems? Science of the total environment. 2019;662:373-84. https://doi.org/10.1016/j.scitotenv.2018.12.462 PMid:30690371

Zhu Q, Fang P, Zhao Y, Dai D, Luo X. How about the quality and recommendation on prevention, diagnosis, and treatment of HIV/AIDS guidelines developed by who: a protocol for systematic review. Medicine. 2020;99(52):e23638. https://doi.org/10.1097/MD.0000000000023638 PMid:33350740 PMCid:PMC7769307

Birhanu S, Winterhalter FS, Stupp P, Cates M, Rottinghaus E, Yavo D, et al. Point of Care CD4 Testing in National Household Surveys-Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys. Microbiology Spectrum. 2023;11(3):e03148-22. https://doi.org/10.1128/spectrum.03148-22 PMid:37071009 PMCid:PMC10269725

Sia D, Onadja Y, Hajizadeh M, Heymann SJ, Brewer TF, Nandi A. What explains gender inequalities in HIV/AIDS prevalence in sub-Saharan Africa? Evidence from the demographic and health surveys. BMC public health. 2016;16:1-18. https://doi.org/10.1186/s12889-016-3783-5 PMid:27809824 PMCid:PMC5095963

Montana LS, Mishra V, Hong R. Comparison of HIV prevalence estimates from antenatal care surveillance and population-based surveys in sub-Saharan Africa. Sexually transmitted infections. 2008;84(Suppl 1):i78-i84. https://doi.org/10.1136/sti.2008.030106 PMid:18647871 PMCid:PMC2569136

Baptiste S, Manouan A, Garcia P, Etya'ale H, Swan T, Jallow W. Community-led monitoring: When community data drives implementation strategies. Current HIV/AIDS Reports. 2020;17:415-21. https://doi.org/10.1007/s11904-020-00521-2 PMid:32734363 PMCid:PMC7497354

Published

30-05-2026

How to Cite

Obeagu, E. I., & John, A. . (2026). Universal Access to HIV Testing in Africa: WHO Frameworks, Innovations, and Progress Toward Early Diagnosis. International Journal of Medical Sciences and Pharma Research, 12(2), 1–15. https://doi.org/10.22270/ijmspr.v12i2.191