The ECDC Guidance advocates for a concerted effort to scale up integrated testing strategies or programmes for hepatitis B (HBV), hepatitis C (HCV) and HIV to try to reduce the large number of those that are currently infected but undiagnosed.
Such integrated testing strategies or programmes should apply the six core testing principles and respect the individual needs of those tested:
- Testing should be accessible, voluntary, confidential and contingent on informed consent.
- Appropriate information should be available before and after testing.
- Linkage to care is a critical part of an effective testing programme.
- Normalising HBV, HCV and HIV testing in all healthcare settings; and
- Those carrying out HIV, HBV and/or HCV testing should receive appropriate training and education.
- An effective national testing strategy, including a monitoring and evaluation framework, is critical in responding to HBV, HCV and HIV infection.
Success in increasing the testing uptake should contribute considerably to the elimination of HIV and to combat viral hepatitis as public health threat by 2030 as outlined in the Sustainable Development Goals.
The ECDC Guidance outlines whom, where, how and when to test for viral hepatitis and HIV and offers options for testing strategies that are applicable to all healthcare settings and beyond (e.g. self-sampling and self-testing). Due to higher risk of infection, population groups suitable for targeted HBV, HCV and/or HIV testing include, amongst others, men who have sex with men, homeless people, sex workers, people who inject drugs, pregnant women or haemodialysis patients. Best practice examples in the Guidance provide approaches for primary healthcare settings, hospitals, STI clinics, pharmacies, prisons as well as for community settings, including drug and harm reduction services.
Integrated testing: health benefits and synergies in times of resource constraints
"If we want to maximise the benefits of treatment for HIV or viral hepatitis, it is critical to test and diagnose people as soon as possible in the course of the infection. This is challenging, as all three infections can typically be asymptomatic for years. According to ECDC estimates, it currently takes on average three years from the time of HIV infection until diagnosis. That's way too long", notes ECDC Director Andrea Ammon. "Our new testing Guidance offers a range of evidence-based options for the design of national or local testing interventions for different settings and populations at risk. One of the key elements is to diversify and integrate testing services as this allows synergies in times of resource constraints."
Early diagnosis and linkage to care bring strong individual and public health benefits: effective HIV or viral hepatitis treatment either eliminates or suppresses the viruses significantly which in turn means that those on treatment interrupt existing transmission chains, preventing further infections.
Yet, too many people living with HIV or chronic hepatitis B or C in the EU/EEA are not aware of their infection - and consequently do not receive treatment.
Vytenis Andriukaitis, the European Commissioner for Health and Food Safety, said: "Advances in antiretroviral therapy have changed the nature of the HIV epidemic in Europe - HIV is no longer a fatal disease. For people who have been diagnosed early and have received effective treatment, HIV has become a chronic condition. Despite all the progress in intensive testing efforts over the last decade, estimates show that one in seven of those living with HIV in the EU/EEA are still undiagnosed. We must focus our efforts on reaching these individuals, and in particular the most vulnerable in society. We must also intensify our efforts in testing for hepatitis B and C; a disease estimated to affect 9 million people in the EU. We need to address these three diseases together, if we are to meet our Sustainable Development target. This is why I and the European Commission are strong supporters of the European Testing Week."
European Testing Week starts today with more than 700 organisations across Europe and Central Asia promoting dialogue among those who might benefit from being tested and those who offer tests - because early diagnosis of HIV and viral hepatitis benefits everyone.