Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries

Background Laboratory testing is critical for diagnosis and treatment management for people with HIV, but is costly. When HIV resources are constrained, even before recent disruptions in US funding for the global HIV response, user fees have been used for cost recovery. We describe availability and charging of user fees for routine HIV laboratory testing globally. Methods Routine test availability and charging of user fees were examined via an HIV clinic survey conducted September 2020–March 2021; responses reflected clinical practices in 2019. HIV clinics came from 42 low-, middle-, and high-income countries from the International epidemiology Databases to Evaluate AIDS (IeDEA) global research consortium. Results Across 199 clinics, on-site test availability was generally limited, reflecting constraints in routine test availability across health conditions more broadly. Over 90% of clinics did not report charging of user fees. A higher percentage reporting user fees were from middle-income countries and from countries receiving Global Fund or PEPFAR country support, which may reflect settings with ongoing health funding gaps. Conclusions Availability and user fees for essential HIV-related laboratory tests were limited in 2019. Monitoring user fees may provide insights about how national health systems are responding to steep reductions in global donor funding.