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HIV testing in community settings in resource‐rich countries: a systematic review of the evidence

2012; Wiley; Volume: 13; Issue: 7 Linguagem: Inglês

10.1111/j.1468-1293.2012.00992.x

1468-1293

AC Thornton, Valérie Delpech, Meaghan Kall, Anthony Nardone,

Adolescent Sexual and Reproductive Health

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 P ub M ed database was searched for E nglish 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.