The Testing Imperative: Why the US Ending the HIV Epidemic Program Needs to Renew Efforts to Expand Human Immunodeficiency Virus Testing in Clinical and Community-based Settings

Data from several modeling studies demonstrate that large-scale increases in human immunodeficiency virus (HIV) testing across settings with a high burden of HIV may produce the largest incidence reductions to support the US Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections 90% by 2030. Despite US Centers for Disease Control and Prevention's recommendations for routine HIV screening within clinical settings and at least yearly screening for individuals most at risk of acquiring HIV, fewer than half of US adults report ever receiving an HIV test. Furthermore, total domestic funding for HIV prevention has remained unchanged between 2013 and 2019. The authors describe the evidence supporting the value of expanded HIV testing, identify challenges in implementation, and present recommendations to address these barriers through approaches at local and federal levels to reach EHE targets. Large-scale increases in HIV testing across high-burden settings is a recommended strategy to support the goals of the US Ending the HIV Epidemic initiative. Recommendations are presented to address barriers in the implementation of increased HIV testing.