How to use this toolkit

This toolkit offers resources to support the planning, implementation, and monitoring of integrated network-based testing (NBT) service delivery for people and groups who are planning to implement or who already implement and desire to improve delivery of their network-based testing services. Resources presented in this toolkit include scientific evidence, example tools, ethical guidance, and training materials. It is recommended that programmes planning NBT services:

  • read through the planning considerations listed below, noting answers to key questions for the planned services;
  • review the training modules in the training section to better understand how NBT should be delivered;
  • create a draft NBT service delivery plan with all supporting implementation tools. Templates for implementation tools can be found in the implementation tools section; and
  • create a draft NBT monitoring and evaluation (M&E) plan. Templates for M&E tools can be found in the M&E tools section.

This toolkit is not intended to provide standalone guidance; rather, it draws from many different WHO guidance documents that have been previously published and should be used for reference throughout. Further, the resources in this toolkit should be interpreted and used following inputs from the specific contexts where implementation will occur. This guidance is meant as a general guide but should be modified to meet the needs and constraints of the specific context.

Planning considerations and key questions

Virus iconInfections and epidemics

Considering which infections should be prioritized for your epidemic setting and populations will help to plan integrated service delivery. This prioritization can be informed by local and regional epidemiology, national efforts such as triple elimination of mother-to-child transmission of HIV, hepatitis B, and syphilis, and local outbreaks. If data are lacking, consider global or regional data on most affected groups such as key populations. Key questions are: 

  • Which sexually- or blood-transmitted infections most affect the population(s)?  
  • Are there currently efforts to eliminate any of these infections? 
  • What do the data show in terms of new infections? 
  • Are there gaps in the data? 
people iconPopulations

Different populations will have distinct needs and risks that must be accounted for when planning NBT services implementation. This is particularly critical for priority and key populations, such as adolescents, pregnant and breastfeeding women, and members of key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender diverse people, and people in prisons and closed settings). Understanding the needs, barriers, and preferences of the population that will benefit from NBT is vital prior to planning service delivery. Key questions are: 

  • What population or populations are the primary beneficiaries of the service? 
  • What barriers do the population(s) face? 
  • What needs does the population have for service delivery? 
  • Has the population been consulted and given input about their preferences? 
  • Has the population given input about any potential harms/vulnerabilities, and mechanisms to monitor these? 
Guard iconRegulatory environment

It is imperative to understand what legal, policy, and guidance frameworks govern the services you provide. Before initiating service delivery, ensure that the planned services adhere to legal, policy, and normative guidance for your setting. Key questions are: 

  • What are the laws governing service provision to the population(s)? For instance, are there criminalization laws for certain populations, laws governing self-care options, or age of access or consent laws for minors seeking services? 
  • What policies or guidelines exist? 
  • What supportive social services exist and how do they interface with the legal framework? 
Justice iconStigma and discrimination

: Because stigma can be a barrier to accessing services for HIV, viral hepatitis and other STIs and populations can experience discrimination in healthcare settings, it is important to ensure that services are designed to be person-centred, voluntary, respectful, and to protect patient confidentiality. Healthcare workers should be trained on providing non-judgmental and non-discriminatory care. Key questions are: 

  • Are the services being provided in a voluntary, person-centred, respectful, and non-discriminatory way? 
  • Have all healthcare providers trained in ethical and person-centred care delivery? 
  • Is patient confidentiality being maintained in all steps of NBT? 
  • Have populations been consulted on how services should be offered/provided? 
Townhall iconMapping existing programmes and infrastructure

Where available, leveraging existing programmes, services, and infrastructure is important for the launch, delivery, or scaleup of NBT services. It is therefore essential to map existing services, resources, or other programmes that could be useful for linkage, support, and referrals.  Key questions are: 

  • What are the referral and linkage needs for the NBT programme? 
  • Are there specific prevention, testing, diagnostic, and treatment pathways that will be required for the included HIV, hepatitis B, hepatitis C, or other STI services that are offered? Where are these services available? 
  • What other programmes or services exist that provide support or care in the target population? 

Implementation considerations

When planning how to deliver network-based testing services, it may be helpful to consider the “who, what, when, where, how, and how much?” of network-based testing service delivery.

Network-based testing services implementation questions
(click on image to enlarge)

Many different modalities of network-based testing can be considered, and it is important to choose specific elements of service delivery that will work best for your population, setting, and epidemiology. Below are some specific service delivery considerations for NBT service implementation.

Self-care options

Self-care interventions are tools that support self-care, including diagnostics, medications, and applications that individuals can use without the guidance of trained health personnel. Self-care options that could be integrated into network-based testing services include:

  • Distribution of self-testing kits to sexual and/or injecting partners and other network contacts can be an important way to reach people who may otherwise not access traditional testing
  • WHO supports secondary distribution* of HIV, HCV, and syphilis self-tests** to anyone at considerable risk.

Integration of testing for multiple infections

Consider whether partners, social contacts, or family (including children)  and household members may be in need of testing for multiple infections when reached through network-based testing approaches. In some cases, multiplex tests may be available to test for multiple infections with one sample. Specific examples include:

  • Dual HIV/syphilis testing for partners of people with either HIV or syphilis, including among key populations and partners of pregnant women;
  • HIV, syphilis, and HBV testing for pregnant women for triple elimination of mother-to-child transmission; 
  • HIV, HBV and HCV testing for any network-based contacts (including sexual and injecting partners, as well as social network contacts) of people who inject drugs; and
  • Testing for partners and network contacts of people taking PrEP for HIV, depending on population and context.

Virtual interventions

Leverage digital platforms, including social media networks, geospatial dating applications, and virtual health interventions, to facilitate the identification and engagement of sexual and injecting partners, as well as other individuals within high-risk networks.  These:

  • Can be used to distribute self-testing and self-care interventions, including  delivery of HIV, syphilis*, and HCV self-testing and/or self-sampling kits for other STIs; and
  • Can also be used for signposting, guiding users to nearby or online services for testing, prevention, care, and treatment.

Linkage to prevention

Partners and other contacts who are reached through network-based testing should be offered information, and if appropriate, referral or provision of prevention options, including:

  • Condoms and lubricants;
  • PrEP or PEP for HIV;
  • Vaccination for hepatitis B, particularly for partners, family, and household contacts of people with chronic HBV infection, birth-dose for infants;
  • Harm reduction services for people who inject drugs;
  • Elimination of mother-to-child transmission services, including triple elimination of HIV, hepatitis B, and syphilis;
  • HBV antiviral prophylaxis for EMTCT;
  • Voluntary medical male circumcision for adolescent boys 15 and above; and
  • Linkage to re-testing.

Linkage to treatment

Referrals or linkage to treatment must be ensured prior to offering any kind of testing services. Before starting NBT service delivery, consider linkages to ensure:

  • Partners exposed to certain bacterial STIs can be offered expedited partner therapy (EPT);
  • Treatment for hepatitis B and C; and
  • Antiretrovirals for HIV.

* Secondary distribution of self-test kits is a network-based testing approach whereby individuals are provided with HIV, HCV, or syphilis self-testing kits to deliver to their sexual partners, drug-injecting partners, or other contacts within their social networks, to support expanded access to testing among populations at increased risk.

**There are currently no WHO-prequalified syphilis self-test kits, so these are not widely available.