ORIGINAL RESEARCH HIV testing strategies across European countries S Mounier-Jack, 1 S Nielsen 2 and RJ Coker 1 1 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK and 2 Communicable Diseases Unit, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark With universal access to effective combination antiretroviral therapy (ART), people in need can gain effective treatment but are only able to benefit from these advances if they are aware of their serostatus and have effectively accessed testing services. Despite the expectation that ART would lead individuals to seek earlier testing, this trend has not been observed in practice, with stable or even increasing rates of late diagnosis in Europe being witnessed. Ahead of a gathering of key European stakeholders in Brussels in November 2007, we reviewed testing strategies across European countries. We show differences in policy and practices. Moreover, HIV testing strategies are changing, in line with new global guidelines issued by World Health Organization headquarters, and a number of countries are promoting an expansion of routine and opt-out testing. However, gaps in our understanding of effective testing strategies remain and, as a consequence, national policies across Europe remain incoherent and often lack an evidence base. This is likely to have serious public health implications. Keywords: access, diagnosis, Europe, health services, HIV Received: 29 February 2008, accepted 25 March 2008 The introduction of effective combination antiretroviral treatment (ART) in the mid-1990s heralded a new era in the clinical management of HIV/AIDS, offering the potential for improved health for infected individuals coupled with profound public health gain for society. The incentives for HIV-positive individuals to know their status appeared to be substantial. However, both the numbers of undiagnosed cases and late diagnoses of HIV remain high in Europe, indicating that testing strategies might to some extent be failing to identify populations at increased risk of HIV acquisition [1,2]. In the wake of changes in testing guidelines issued by the US Centers for Disease Control and Prevention (CDC) in 2006 and the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the World Health Organization (WHO) in May 2007, promoting provider-initiated op-out testing, there have been a number of calls to review and change HIV testing policies and practices [3]. The purpose of this paper is to review and map testing strategies across Europe and to present new developments in terms of HIV testing and reflect on their implications. Methods We conducted a survey on ‘unmet needs in Europe for HIV testing, treatment and care’ and collected country informa- tion on HIV testing policies and practices in Europe. We supplemented our survey with a review of the literature to inform our assessment of HIV testing strategies in Europe. A questionnaire was developed, piloted, and refined with the support of experts in the field. The questionnaire was sent to collaborators in 33 countries (the 27 member states of the European Union, Norway, Switzerland, Belarus, the Republic of Moldova, the Russian Federation and Ukraine) on 3 September 2007 and a reply requested by 30 September. Nonresponders were prompted by e-mail or telephone and, when no response was secured, an alternative responder was contacted. Collaborators were HIV experts involved in national public health institutes, ministries of health and major advocacy groups and were identified through the WHO Regional Office for Europe and through the London School of Hygiene and Tropical Medicine’s European Centre for Health of Societies in Transition (ECOHOST) network. Results Twenty-four country collaborators responded to our survey (73%). This represents 92% of the population of all 33 countries surveyed. The 24 countries have 94% of Correspondence: S. Mounier-Jack, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel: 1 44 207 9272926; fax: 1 44 207 6375391; e-mail: Sandra.mounier-jack@lshtm.ac.uk DOI: 10.1111/j.1468-1293.2008.00585.x r 2008 British HIV Association HIV Medicine (2008), 9 (Suppl. 2), 13–19 13