Objectives: In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA).
Methods: Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010–2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014–2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results: Eighty studies on HIV testing in non-health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1).
Conclusions: This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage.
Bibliographical noteFunding Information: This paper was funded by the European Centre for Disease Prevention and Control (ECDC) as part of a project to update the European HIV testing guidelines (Framework Contract Reference Number: ECDC/2016/035). We would like to thank the wider evidence synthesis working group: from Public Health England: Peter Kirwan, Cuong Chau, Matthew Hibbert, Meaghan Kall, Alison Brown, Zheng Yin, Nicola Pearce-Smith and Anh Tran; and from the Centre of Excellence for Health, Immunity and Infections (CHIP): Anne Louise Grevsen, Anne Raahauge, Jeff Lazarus, Maiken Mansfeld and Ida Sperle. We would like to thank Carole Kelly (PHE) not only for her involvement in screening studies, but for her input into developing the initial review protocol. We would also like to acknowledge Csaba Kodmon and other colleagues from ECDC involved in reviewing non-English articles.
European Centre for Disease Prevention and Control. Grant Number: ECDC/2016/035
Open Access: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Publisher Copyright: © 2019 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
Citation: Croxford, S., Tavoschi, L., Sullivan, A., Combs, L., Raben, D., Delpech, V., Jakobsen, S., Amato-Gauci, A. and Desai, S. (2020), HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance. HIV Med, 21: 142-162.
- HIV testing
- systematic review