Overview

MEASURE DHS has conducted population-based HIV testing since 2001. The MEASURE DHS testing protocol provides for anonymous, informed, and voluntary testing of women and men. All respondents receive referrals for free testing, counseling, and educational materials.

The linkage of DHS HIV test results to the full DHS survey record (without personal identifiers) allows for an in-depth analysis of the sociodemographic and behavioral factors associated with HIV infection. Datasets showing test results and variables to link them to other findings from the DHS or AIS are available for research and study.

HIV Prevalence Testing in Population-Based Surveys

Traditionally, HIV prevalence estimates have been derived from data from sentinel surveillance systems that monitored HIV rates among pregnant women and high-risk populations using statistical systems. By collecting blood for HIV testing from representative samples of the population of men and women in a country, MEASURE DHS can provide nationally representative estimates of HIV rates.

Both sentinel surveillance and population-based data sources of prevalence data can and should be used to track HIV epidemics. Population-based testing can only be undertaken every 3 to 5 years in most countries, because of the size and expense of the surveys. Sentinel surveillance testing is often reported annually, and provides a good benchmark for measuring progress over short time periods.

In addition, population-based testing is dependent on the population’s willingness to be voluntarily tested for HIV. In cases where the characteristics of those who agreed to be tested are different than those who refused testing, bias may result. The current DHS reports with HIV testing include analysis of non-response bias.

Testing Protocol

The DHS HIV testing protocol provides for informed, anonymous, and voluntary testing of women and men in the reproductive ages. The testing protocol undergoes a host country ethical review. The testing is simple; blood spots are collected on filter paper from a finger prick and transported to a laboratory for testing. The laboratory protocol includes an initial ELISA test, and then retesting of all positive tests and 10 percent of the negative tests with a second ELISA. For those tests with discordant results on the two ELISA tests, a Western blot test is performed.

Since the testing is anonymous, survey respondents cannot be provided with their results. However, all respondents are offered referrals for free voluntary counseling and testing (VCT) and AIDS educational materials. In some countries, mobile VCT teams follow-up after interviewers to counsel and test willing DHS respondents.