HIV testing in community settings in resource-rich countries: A systematic review of the evidence

A. C. Thornton, V. Delpech, M. M. Kall, A. Nardone*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    96 Citations (Scopus)

    Abstract

    Objectives: Community HIV testing represents an opportunity for diagnosing HIV infection among individuals who may not have contact with health services, especially in hard-to-reach groups. The aim of this review was to assess the evidence for feasibility, acceptability and effectiveness of HIV testing strategies in community settings in resource-rich countries. Methods: The PubMed database was searched for English language studies of outreach HIV testing in resource-rich countries. Studies were included if they reported one of the following outcome measures: uptake of testing; seropositivity; client acceptability; or provider acceptability. Results: Forty-four studies were identified; the majority took place in the USA and targeted men who have sex with men. Uptake of HIV testing varied between 9 and 95% (in 14 studies). Seropositivity was ≥1% in 30 of 34 studies. In 16 studies the proportion of patients who received their test results varied from 29 to 100% and rapid testing resulted in a higher proportion of clients receiving their results. Overall, client satisfaction with community HIV testing was high. However, concern remained over confidentiality, professional standards and the need for post-test counselling. Staff reported positive attitudes towards community testing. Conclusions: In the majority of studies, the reported seropositivity was higher than 1/1000, the threshold deemed to be cost-effective for routinely offering testing. Rapid testing improved the return of HIV test results to clients. HIV testing in outreach settings may be important in identifying undiagnosed infections in at-risk populations, but appropriate data to evaluate these initiatives must be collected.

    Original languageEnglish
    Pages (from-to)416-426
    Number of pages11
    JournalHIV Medicine
    Volume13
    Issue number7
    DOIs
    Publication statusPublished - Aug 2012

    Keywords

    • Community
    • Diagnosis
    • HIV
    • Outreach
    • Testing

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