HIV Testing & Diagnosis

HIV counseling and testing occurs in a wide range of contexts in the Ryan White HIV/AIDS Program. Situations as diverse as community outreach, partner testing, pregnancy, and labor and delivery call for special counseling approaches on the part of clinical staff. The technology of testing has continued to evolve with rapid tests, oral tests, and home tests. Finally, legal requirements for offering and documenting tests in a health care settings have also shifted in many states and jurisdictions.

Best Practices

  • Center for Innovation and Engagement
    Collection of implementation guides on evidence-informed best practices in HIV care delivery.
  • HRSA Bureau of Primary Health Care (BPHC), Centers for Disease Control and Prevention (CDC)
    Toolkit to help Health Centers expand the provision of HIV services.
  • AIDS Action Foundation

    Workbooks describing ways to help connect people living with HIV/AIDS to medical care. Estos cuadernos describen la manera de asistir a conectar personas que viven con VIH/SIDA con el sistema médico.  

  • SPNS Latino Access Initiative, UCSF Center for AIDS Prevention Studies

    Monographs describing interventions for the engagement and retention of Latinos in HIV care.

  • SPNS Systems Linkages Project

    Insights from a multi-state demonstration and evaluation of innovative models for linkages to and retention in HIV care.

  • AIDS Alliance for Children Youth and Families

    Resource for programs interested in developing or expanding outreach services to identify HIV-positive youth and engage and retain them in care.

  • Best Practices Compilation
    Nine sites implemented four evidence-based interventions, collectively known as Addressing STIs: Ask.Test.Treat.Repeat. The four intervention components are audio computer-assisted self-interview sexual history taking, patient self-collection of urogenital and extragenital site chlamydia/gonorrhea nucleic acid amplification test specimens, sexual and gender minority welcoming indicators, and provider training, with the overall goal to routinize STI screening, testing, and treatment in primary care. The interventions increased routine STI screening and testing of bacterial STIs based on reported behavioral risk.
  • Best Practices Compilation
    The Oregon Health Authority awarded contracts to local public health authorities across the state to work with community partners to integrate early intervention services and outreach services, link people to HIV care, and provide support to help clients reach viral suppression. Quick linkage to care resulted in a median of 57 days to viral suppression for Early Intervention Services and Outreach clients in 2019.
  • Best Practices Compilation
    The Huntridge Family Clinic launched the Rapid Start Initiative to provide same-day ART treatment and comprehensive case management to clients with a new diagnosis of HIV. Over 90% of clients received ART on the same day as diagnosis, and 78% of clients were retained in care within the first year of starting treatment.
  • Best Practices Compilation
    JumpstART launched in 2016 as part of New York State’s Ending the Epidemic initiative, changing the service delivery model of eight sexual health clinics to include an initial prescription of ART after an HIV diagnosis and prior to linkage to the community provider. Between November 2016 and September 2018, 60% of JumpstART clients received ART on the same day as diagnosis. JumpstART clients were also more likely to reach viral suppression within three months compared to non-JumpstART clients.
  • Best Practices Compilation
    Positive Care Center implemented the Rapid Access program in 2018, providing clients with ART on the same day as HIV diagnosis. Pharmacists, embedded within Positive Care Center’s care team, help clients with their treatment plans and adherence strategies. Over 90% of clients served through Rapid Access in 2021 received ART on the same day as diagnosis, and 82% of clients were retained in care at six months.
  • Best Practices Compilation
    Through the Practice Transformation Project, the Native American Community Clinic and Midwest AIDS Education and Training Center developed strategies to increase testing and linkage to care within the American Indian/Alaska Native population, and for those who inject drugs and are experiencing homelessness. These ongoing efforts have increased HIV testing rates by 10 percentage points through harm reduction, community outreach, and culturally sensitive strategies.
  • Center for Innovation and Engagement
    Project to increase HIV awareness through outreach and testing events on college campuses and in the larger community through partnerships and care linkages.
  • Best Practices Compilation
    The Maricopa Jail Project was implemented by five jails to decrease the wait time between incarceration and/or diagnosis to the start of treatment, and to better support clients to reach viral suppression. Maricopa hired a nurse practitioner to manage access and case manage across the jail system. The initiative was successful in increasing the number of clients who were virally suppressed.
  • Best Practices Compilation
    The Ruth M. Rothstein CORE Center launched Proyecto Promover to decrease HIV testing-related stigma, increase awareness of HIV status, and increase early linkage to and retention in care among Mexicanos with HIV. The program operates at the community level through social marketing, educational talks, networking, and testing. On the individual level, Proyecto Promover uses one-on-one conversations to identify and overcome barriers related to care engagement and retention. Evaluation showed promising rates of HIV testing, retention in care, and viral suppression.
  • Best Practices Compilation
    Routine Universal Screening for HIV (RUSH) provides non-medical case management services, opt-out HIV testing, and linkage to care for emergency department patients. The intervention automatically screens patients for HIV if they are aged 16 years or older, are having an IV inserted, or are having blood drawn for other reasons, unless the patient opts out. RUSH provides access to testing earlier in disease progression, bridging disparities that primarily impact people of color. It also promotes linkage to and retention in care for those with a positive HIV test result. Clients with a positive HIV test in the emergency department who had a prior diagnosis of HIV were more likely to be retained in care and to reach viral suppression.
  • Center for Innovation and Engagement
  • Best Practices Compilation
    Through the Test & Treat Rapid Access (TTRA) Program, clients with a new HIV diagnosis in Miami-Dade County can access ART, receive other services and counseling, start enrolling in RWHAP, and connect to HIV primary care during the initial visit. At Borinquen Health Care Center, one of the clinical sites participating in TTRA, 76% of clients were virally suppressed within three months of receiving a rapid ART start, and 95% were retained in care for 12 months.
  • Best Practices Compilation
    Bienestar developed TransActivate to improve timely engagement and retention in HIV care among Latina transgender women. Linkage coordinators/peer navigators use a strengths-based approach to help clients reach their goals of entering and staying in medical care to ultimately reach viral suppression.
  • Best Practices Compilation
    Virginia Rapid Start launched with HIV care providers across the state with goals to initiate ART for clients within 14 days of HIV diagnosis and to improve access to, and retention in, high-quality HIV care and support services. Through Virginia Rapid Start, providers initiated ART medications within an average of four days of HIV diagnosis, as compared with the statewide average of 28 days. Virginia Rapid Start clients had higher rates of viral suppression compared to both the RWHAP Part B overall and Virginia overall. The success of Virginia Rapid Start led VDH to expand the program to the entire Virginia RWHAP Part B.
  • Best Practices Compilation
    Viviendo Valiente aims to reduce ethnic disparities in HIV care and outcomes by providing culturally responsive services to the Latino/a community, specifically to people of Mexican descent. It is a multi-level intervention, featuring individual-, group-, and community-level activities, that links people to HIV care, offers HIV education and health literacy in group sessions, and promotes community-level testing for HIV and other sexually transmitted infections (STIs). Viviendo Valiente had positive impacts on HIV testing, retention in care, viral suppression, and client satisfaction.


  • AETC National Coordinating Resource Center (NCRC)

    HIV clinical training resources for HRSA's AIDS Education and Training Centers Program.

  • SPNS Sexually Transmitted Infections Initiative
    Tools to help clinics improve screening, testing, and treatment of common bacterial STIs among people with HIV or at risk for HIV.
  • National Clinician Consultation Center

    Healthcare providers can receive no-cost expert clinical consultation in HIV prevention & care, HCV treatment, and substance use management.

  • University of Washington

    Online clinician training platform with evidence-based core competency training on HIV prevention, screening, diagnosis, care, and key populations.

  • U.S. Department of Health and Human Services

    U.S. HIV-related treatment guidelines, drug database, and glossary.

  • U.S. Department of Health and Human Services

    Federal guidelines for treatment, prevention and care of HIV disease, opportunistic infections, and common co-infections. 

  • Yale University School of Medicine

    Guide on how to implement an opt-out HIV testing program in a jail setting.

  • Centers for Disease Control and Prevention (CDC)

    Federal agency within HHS responsible for promotion of health and well-being of Americans.

Training Modules


Conference Presentations

Pacific AIDS Education and Training Center
Thomas Donohoe, Kristopher Lyon, Kathy Jacobson
2022 National Ryan White Conference on HIV Care & Treatment
Georgia AIDS Education and Training Center
Damon Johnson, Austin Chan, Mercilla Ryan-Harris
2020 National Ryan White Conference on HIV Care & Treatment
LSU Health Baton Rouge, A Division of Our Lady of the Lake Hospital
2020 National Ryan White Conference on HIV Care & Treatment
Pacific AETC
Thomas Donohoe, Sandra Cuevas, Kathy Jacobson, Kris Lyon, Kimberly Hernandez
2020 National Ryan White Conference on HIV Care & Treatment

Technical Assistance

  • The central hub of the AETC Program, the clinical training arm of the RWHAP, through HIV curricula, technical support to regional AETCs on practice transformation and best practices, and housing of all AETC-developed tools for HIV clinical staff. Project period: 2019-2024.
  • Clinician consultation on HCV management, HIV management, perinatal HIV/AIDS, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis, substance use. Project period: 2016-2025.

  • The NHC provides ongoing, up-to-date information needed to meet the core competency knowledge for HIV prevention, screening, diagnosis, and ongoing treatment and care to healthcare providers in the United States. Project period: 2020-2022.
  • The AETC Program offers clinician education and tailored capacity-building assistance. Project period: 2019-2024.
  • Initiative documenting best practice strategies and interventions that have been shown to improve HIV outcomes in a "real world" setting and can be replicated by other programs. Project period: 2021-2024.