Couples HIV testing and counseling (CHTC): A review of national policies, programs and practices in 22 high-priority countries of sub-Saharan Africa since the 2012 publication of WHO's CHTC guidance

We conducted a narrative review of policies, programs and practices relevant to couples HIV testing and counseling (CHTC) and partner testing in the 21 Elimination of Mother-to-Child HIV Transmission (EMTCT) priority countries of sub-Saharan Africa , plus Rwanda. In the 22 countries, national HIV testing and counseling (HTC) guidance published subsequent to WHO’s 2012 CHTC recommendations align with WHO guidance fairly well. It is a much more mixed scenario in regard to national HTC guidance published before 2012, as well as with other current and available country HIV guidelines. In examining new studies aiming to increase or optimize CHTC uptake and implementation we found that in no case did investigators fail to follow country recommendations. In several studies, however, investigators made innovative efforts to expand the contexts of specific policy areas. In such cases, ongoing research in a given country may be aligned more closely with WHO policy and international standards than national guidance meant to underpin research in that country. We suggest that WHO work closely with all countries in the region to harmonize national HTC and CHTC guidance with WHO recommendations, to the extent that this is feasible in the respective settings. Along with other innovative, multifaceted approaches, we also suggest that structural interventions to change social norms regarding male participation in their partners’ pregnancies and antenatal care may be a promising avenue of investigation.