An HIV-inconclusive status means, in high prevalence settings, that the first reactive test result was not confirmed by additional testing using subsequent HIV assays or that, in low prevalence settings, the first two test results were reactive but the third assay was non-reactive. All clients with an HIV-inconclusive status should be encouraged to return in 14 days for additional testing to confirm their diagnosis.
Receiving an HIV-inconclusive status may be confusing and stressful for the individual or couple and may be difficult for the provider to explain. As with many other tests for medical conditions, resolving the discrepancy with a third test is not useful, given the high probability that it may equally produce a false-reactive result. Most, if not all, HIV-inconclusive statuses can be resolved with retesting 14 days later. Clients with an HIV-inconclusive status should be told that a definitive diagnosis cannot be provided that day and that immediate referral to HIV care or ART initiation is not appropriate. They should be given a clear plan for follow-up testing.
Unconfirmed results occur when clients who have an initially reactive HIV test result do not receive additional testing in the same visit to confirm their HIV diagnosis. This may occur in community settings where only one assay is performed, an approach known as test for triage. It is the responsibility of providers and counsellors to explain that this initial result is not an HIV diagnosis and needs confirmation and to refer clients with a reactive test result to a site where they can receive an HIV diagnosis. These providers should encourage clients to go as soon as possible to a facility, such as a clinic or laboratory, for additional HIV testing and a diagnosis. It is not necessary for these clients to wait 14 days to go to the facility. After the test result is confirmed and an HIV diagnosis is given, HIV-positive clients should receive post-test counselling. In particular, every effort is needed to reduce loss to follow-up between a test for triage and additional testing and HIV diagnosis.