Spotlight Center on HIV Prevention Today


How Frequently Should People Be Tested for HIV?

February 6, 2017

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What Are the Implications of the Review for HIV Testing in Canada?

This review provides an international perspective that Canadian service providers can use alongside Canadian guidelines to inform evidence-based decisions on HIV testing frequency.

The five Canadian guidelines included shared similarities with the broader trends observed in the review. Based on how often a recommendation was made, common recommendations for specific populations from the review include:

Pregnant women

  • Testing as early as possible during pregnancy -- testing during the first prenatal visit was recommended in the Quebec, British Columbia and PHAC guidelines
  • Re-testing during the third trimester or if a women's risk of HIV is high -- recommended in the British Columbia and PHAC guidelines

Men who have sex with men

  • At least annual testing -- recommended in the Quebec, Ontario and British Columbia guidelines

General population

  • Normalized testing (for example, by including the consideration of HIV testing as part of routine care) with no specific interval given -- recommended in the PHAC guidelines
  • A specific time interval such as every five years -- recommended in the British Columbia and Saskatchewan guidelines

Other populations

  • People who use injection drugs
    • Annual testing -- recommended in the Quebec, Ontario and British Columbia guidelines
  • People with HIV-positive partners
    • Annual testing -- recommended in the Quebec, Ontario, and British Columbia guidelines
  • People with multiple sex partners
    • Annual testing -- recommended in the Ontario and British Columbia guidelines
  • Sex workers and their clients
    • Annual testing -- recommended in the British Columbia guidelines
  • Migrant people from HIV-endemic countries
    • Annual testing -- recommended in the Ontario and British Columbia guidelines
  • Indigenous people
    • Annual testing -- recommended in the Ontario and British Columbia guidelines. Quebec recommended annual risk evaluation.
  • People with a partner of unknown status
    • Annual testing -- recommended in the Ontario guidelines

Finally, the recommendation of routine testing was noted in this review. The authors describe routine testing as "not recommending a specific testing interval but rather providing a recommendation to test everyone" which can happen along with more frequent testing for people at higher risk for HIV. While routine testing as noted is not a defined frequency interval, it suggests the importance of ongoing opportunities for testing as part of medical care.

When considering these recommendations it's important to remember that:

  • Some guidelines concluded there wasn't enough evidence available to inform a defined testing interval for certain populations, including the general population. Further research is needed to help define specific HIV testing intervals for a wider range of populations.
  • The guidelines were assessed and compared based on the number of times a recommendation was made and the consensus among guidelines. The guidelines themselves may be based on different types of evidence that impact the strength of their recommendations. The review did not assess the strength or weakness of the recommendations and how they were developed.
  • The review only included guidelines available in English and French. Additional insights may be gained from recommendations developed in other languages.

What Is a Systematic Review?

Systematic reviews are important tools for informing evidence-based programming. A systematic review is a critical summary of the available evidence on a specific topic. It uses a rigorous process to identify all the studies related to a specific research question. Relevant studies can then be assessed for quality and their results summarized to identify and present key findings and limitations. If studies within a systematic review contain numerical data, this data can be combined in strategic ways to calculate pooled estimates. Combining data to produce pooled estimates can provide a better overall picture of the topic being studied.

Erica Lee is the Information and Evaluation Specialist at CATIE. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).


  1. Austin T, Traversy GP, Ha S, Timmerman K. Canadian and international recommendations on the frequency of HIV screening and testing: A systematic review. Canada Communicable Disease Report. 2016 Aug 4;42(8):161-168. Available from:
  2. Summary: Measuring Canada's progress on the 90-90-90 HIV targets. Government of Canada. 1 December 2016. Available at:
  3. Samji H, Cescon A, Hogg RS, et al. Closing the Gap: Increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013 Dec 18;8(12):e81355.
  4. The INSIGHT START Study Group. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. New England Journal of Medicine. 2015 Aug 27;373(9):795-807. Available from:
  5. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine. 2011 Aug 11;365(6):493-505.
  6. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine. 2016;375:830-9. Available from:
  7. Eshleman SH, Hudelson SE, Redd AD, et al. Treatment as Prevention: Characterization of partner infections in the HIV Prevention Trials Network 052 trial. Journal of Acquired Immune Deficieny Syndromes. 2016 Aug 16. [in press]
  8. Reynolds S, Makumbi F, Nakigozi G, et al. HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy. AIDS. 2011;25:473-477
  9. Melo MG, Santos BR, Lira RD, et al. Sexual Transmission of HIV-1 among serodiscordant couples in Porto Alegre, Southern Brazil. Sexually Transmitted Diseases. 2008;35:912-915
  10. Donnell D, Baeten J, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;6736(10):2092-2098.
  11. Rodger A et al. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study. In: Program and abstracts of the 21st Conference on Retroviruses and Opportunistic Infections, March 3 to 6th, 2014, Boston, U.S., abstract 153LB.
  12. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association. 2016;316(2):171-81. Available from:
  13. Grulich AE, Bavinton BR, Jin F, et al. HIV transmission in male serodiscordant couples in Australia, Thailand and Brazil. 22nd Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 2015. Late breaker poster 1019 LB.
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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication Prevention in Focus: Spotlight on Programming and Research. Visit CATIE's Web site to find out more about their activities, publications and services.

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