Effectiveness of HIV testing interventions for high-risk populations
Key take-home messages
- People infected with HIV who are unaware of their HIV status may be driving the epidemic in high-risk populations. Interventions that promote the uptake of HIV testing among men who have sex with men and members of other groups at high risk have the potential to increase early diagnoses, thereby getting people into care sooner and reducing the likelihood of onward transmission.
- HIV testing coverage is often inadequate in populations at high risk and varies widely across jurisdictions. People at risk often do not comply with testing guidelines and recommendations.
- A few HIV testing interventions have been shown to increase testing uptake, resulting in high seropositivity rates (between 1% and 14%) at follow-up.
- Service-delivery interventions that have been shown to be effective include: offering rapid HIV testing in outreach settings and implementation of “opt-out” testing policies and guidelines promoting regular HIV testing.
- Community-level interventions using peer education and recruitment, social marketing, media and web-based campaigns have shown limited success and inconclusive results; however they are more successful when targeted to very specific sub-populations. For example, one study showed that a holistic group intervention, led by trained peers, increased testing among a group of socioeconomically disadvantaged Black men who have sex with men. These interventions are resource intensive and may be difficult to implement.
- Intensive long-term interventions that reach a greater proportion of at-risk populations over longer timeframes are likely to have more impact on HIV testing rates.
- Strategies to promote testing should be implemented as part of a comprehensive approach to HIV prevention.
- Long-term impact evaluations of HIV testing interventions that measure changes in HIV or incidence of sexually transmitted infections (STIs) over time are needed to identify the most effective elements to reach high-risk populations.
The Ontario HIV Treatment Network: Rapid Response Service
- General HIV- population
- Education/media campaigns
- Health Systems
- Delivery arrangements