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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries
Zhongzhe Pan1, Ellen Brazier2, Stephany N Duda3
1Department of Health Policy, Virginia Commonwealth University School of Public Health, Richmond 23219, United States.
Health Affairs Scholar
|August 8, 2026
Summary
Routine HIV laboratory testing availability was limited globally in 2019. While most clinics did not charge user fees, some middle-income countries with funding gaps did, highlighting resource challenges in HIV care.
Area of Science:
- Global Health
- Infectious Diseases
- Laboratory Medicine
Background:
- Laboratory testing is crucial for HIV diagnosis and treatment management.
- High costs of testing can be a barrier, leading to user fees for cost recovery, especially with constrained resources.
- Global HIV response funding has faced disruptions, impacting service delivery.
Purpose of the Study:
- To describe the global availability of routine HIV laboratory testing.
- To examine the charging of user fees for these essential tests.
- To understand the implications of user fees in resource-limited settings.
Main Methods:
- An international survey of 199 HIV clinics across 42 countries was conducted between September 2020 and March 2021.
- The survey captured data on routine HIV laboratory test availability and user fee practices as they were in 2019.
- Data were collected from clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA) global research consortium.
Main Results:
- On-site availability of routine HIV laboratory tests was generally limited across surveyed clinics.
- Over 90% of clinics reported not charging user fees for these tests.
- User fees were more common in middle-income countries and those receiving Global Fund or PEPFAR support, suggesting funding gaps.
Conclusions:
- Limited availability and the presence of user fees for essential HIV laboratory tests were observed globally in 2019.
- Monitoring user fees can offer insights into national health system responses to reduced global donor funding.
- These findings underscore the challenges in maintaining consistent access to vital HIV diagnostics amidst funding fluctuations.
