Indicator 5.1: "Population requesting an HIV test, receiving a test and receiving test results"
The percent of respondents who have ever voluntarily requested an HIV test, received the test and received their results.
UNAIDS general population survey; DHS AIDS module; FHI BSS; MICS (UNICEF).
What It Measures
The coverage of quality VCT services will go a long way towards determining whether those services achieve their threefold aims of providing an entry point for care and support, promoting safe behaviour and breaking the vicious circle of silence and stigma.
This indicator aims to give an idea of the reach of HIV testing services in the general population and of the percentage of people who now know their HIV status. It can also be constructed for specific sub-populations with high-risk behaviour among whom counselling and testing services are being promoted. When calculated for sub-populations with high-risk behaviour, the numerator should include only those who requested a test and received their results in the last 12 months.
A breakdown of the indicator into its components parts (looking, for example, at people who requested and received a test but never received their results) can point to gaps in programme service provision and quality of care. Data on those who do not return for results or know their results may offer insight, for example, into levels of stigma and/or reluctance to learn their HIV status based on lack of available options for care.
How to Measure It
In a general population or sub-population survey, respondents are asked whether they have ever requested an HIV test, whether they were tested and if so whether they have received the results. Those having ever requested a test and received the results form the numerator, while the denominator is all respondents in the survey.
The questionnaire prefaces the questions by saying, " I do not want to know the results of the test". As for most indicators, results should be presented by component and separately for men and women. In addition to having information on the broad reach of VCT services over time, it will be useful also to know the percentage of the population surveyed who have been tested and have received the results in the last 12 months, a more time-sensitive measure.
Strengths and Limitations
The survey question specifies that the test must have been requested by the respondent. In many situations, people may assume that their blood has been tested for HIV at some time, for example when giving a blood donation, when applying for insurance, or for surveillance purposes when attending antenatal services. These involuntary tests, whether real or perceived, are excluded in the calculation of this indicator. So are tests made for diagnostic purposes without the consent of the client, even if the client was then told of the results. Such tests do not reflect either the coverage of or the demand for testing services; nor do they take into account that the measure emphasises the "voluntary" element desired for HIV tests. For that reason, survey questions must specify that the person requested a test.
In many countries, many people will have been offered and accepted an HIV test in a health care setting. To get an idea of the proportion of people who may be aware of their sero-status (regardless of who initiated the request for a test), data should also be collected on people having been offered a test, accepted it and received their results.
This indicator gives some idea of the increasing coverage of services that meet people's demand for testing. It is not, however, limited to voluntary testing and counselling services staffed by trained counsellors. It may therefore include tests requested from private doctors who do not necessarily provide any counselling.
In areas where HIV is highly stigmatised, respondents may be unwilling even to admit to having taken an HIV test, since it may be counted an admission that they fear they may be infected. This is all the more true when the question is posed in the context of a questionnaire about risk behaviour. On the other hand, in countries where testing has been heavily promoted as a "responsible" thing to do, some people may say they have been tested when in fact they have not. Despite these potential biases, the indicator is useful for getting a rough idea of the proportion of people likely to know their HIV status at all.
If the indicator is adapted to reflect the percentage of respondents requesting, receiving an HIV test and receiving results in the last 12 months, the measure will reflect recent changes in testing services, knowledge about testing among the population surveyed and desire for testing. Those people exposed to HIV more than once in a lifetime should be targeted for repeat testing. Note, however, that in high-prevalence populations with good coverage of testing services, trends in the time-bound indicator can be expected to be affected by the fact that people who have tested HIV positive will not return for further testing in future years.
The "ever tested" measure is less sensitive to recent trends in test-seeking behaviour than a time-bound measure such as "tested in the last 12 months", but it will provide an idea of the overall reach of testing services.
In low-level and concentrated epidemics, the indicator is likely to yield extremely low percentages if measured in the general population. However it can be used effectively in surveys of behaviour in sub-populations at higher risk of infection.