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

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.

• Population(s)
  • Men who have sex with men
  • Children or Youth (less than 18 years old)
  • Transgender communities
  • People who use drugs
  • Ethnoracial communities
  • Sex workers
  • General HIV+ population
  • General HIV- population
• Testing
  • Testing