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People reach HIV treatment, care, and the full range of prevention options through the gateway of HIV testing and counselling (HTC). Currently, most people with HIV do not know that they are infected; those who do know often test late; and poor linkages from HTC to care mean that may people start antiretroviral therapy (ART) when they are already significantly immunocompromised, resulting in poor health outcomes and ongoing transmission. A successful public health response to HIV requires robust HTC services. At the same time, HTC requires successful linkages to HIV care and treatment. The value of HTC depends on linking people to services that are acceptable, accessible, and effective.

The overall goal for HTC for a national programme should be to identify as many people as possible with HIV early in their infection and link them successfully to prevention, care, and treatment services, and to link those who test negative to prevention services. This framework has been developed to support countries to select the best combination of approaches to achieve this, identifying the models of HTC delivery that are most acceptable, most cost-effective, and best reach the communities most vulnerable to HIV. Countries should set targets for HTC to assure its role in the overall response to HIV, and they should monitor the uptake and coverage of testing for the populations they seek to serve so that they can adjust ongoing programmes appropriately.