LOS ANGELES–(BUSINESS WIRE)–A new Correspondence Letter in The Lancet HIV from AIDS Healthcare Foundation (AHF) raises concerns that the World Health Organization’s recommended three-test system for HIV diagnosis—designed to avoid rare false-positive results—may unintentionally slow down how quickly people begin lifesaving HIV treatment. While the strategy aims to improve accuracy, many clinics lack the staff, supplies, and time required to carry out three separate rapid tests during a single visit.
AHF teams working in countries such as Kenya report that the extra testing steps often lead to longer wait times and delayed antiretroviral therapy (ART) initiation, especially when multiple health-care workers must be involved. The Letter notes that false positives are already extremely rare when two high-quality rapid tests are used correctly, raising questions about the added value of a third test in many real-world settings.
The authors suggest a practical alternative already in use in some countries, including Brazil: begin treatment after two positive rapid tests, while sending a blood sample for a confirmatory viral load test. If later results show the person is not living with HIV, treatment can be safely stopped early. This approach protects accuracy while avoiding harmful delays that can jeopardize health outcomes.
The Letter encourages countries to tailor their HIV testing policies to local realities. Modern verification tools—such as viral load testing, rapid molecular options, or advanced fourth-generation assays—can maintain high accuracy without slowing treatment, especially in busy or resource-limited clinics.
The Correspondence Letter is authored by Dr. Adele Benzaken, Dr. Fernanda Fonseca, Dr. Penninah Iutung, Dr. Marcus Lacerda, and Michael Weinstein of AHF. Full text available at:
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(25)00323-6/fulltext
Letters in the Correspondence section represent the authors’ views and not necessarily those of The Lancet journals; they are not normally externally peer-reviewed.
AIDS Healthcare Foundation (AHF) is a global non-profit organization providing cutting-edge medicine and advocacy to over 2.6 million people in 50 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Europe. We are currently the largest non-profit provider of HIV/AIDS medical care in the world. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare and Instagram: @aidshealthcare
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