WHO releases “Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples”

WHO has developed this guidance to encourage the provision of couples HIV testing and counselling (CHTC) to support increased testing and earlier access to treatment and prevention. The guideline also considers the benefits of offering antiretroviral therapy (ART) for HIV prevention for serodiscordant couples, irrespective of his/her own immune status (CD4 count). The guideline makes five main recommendations and discusses the range of opportunities, challenges and operational issues associated with providing CHTC.

This document relies heavily on data and experience in low-income and middle-income countries and particularly in sub-Saharan Africa. It therefore focuses in particular on operational approaches and options for serodiscordant couples in such countries. Countries with concentrated or low-prevalence epidemics are encouraged to adapt this guidance to suit national policies and programmes.

The five recommendations are:

  1. Couples and partners should be offered voluntary HIV testing and counselling with support for mutual disclosure.
  2. Couples and partners in antenatal care settings should be offered voluntary HIV testing and counselling with support for mutual disclosure.
  3. Couples and partner voluntary HIV testing and counselling with support for mutual disclosure should be offered to individuals with known HIV status and their partners.
  4. People living with HIV who are in a serodiscordant couple and who are on ART for their own health should be advised that ART is also recommended to reduce HIV transmission to the uninfected partner.
  5. HIV-positive partners with CD4 counts above 350 cells/µL in serodiscordant couples should be offered ART to reduce HIV transmission to uninfected partners.

The revised WHO/Europe clinical protocol Patient evaluation and antiretroviral treatment for adults and adolescents, released in January 2012, suggests considering ART as prevention of HIV transmission in serodiscordant couples in settings where resources allow this and is in line with the global recommendations.