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

Introduction: Laboratory testing is critical for diagnosis and treatment management for people with HIV, but it 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 the 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 user fees. A higher percentage of reporting user fees was from middle-income countries and from countries receiving Global Fund or PEPFAR country support, which may reflect settings with ongoing health funding gaps. Conclusion: 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.