HIV Testing in Community Settings in Resource-rich Countries
HIV Testing in Community Settings in Resource-rich Countries
The results of the studies included in this review indicate that community testing initiatives are successful in diagnosing previously undiagnosed HIV infections among MSM communities and people from BME communities and are acceptable to both clients and staff. Rapid testing technologies increased the likelihood of a person receiving their test result and are acceptable to clients.
The proportions of patients testing in community settings who had never previously tested were generally small. In addition, comparisons of seropositivity among clients attending community testing settings and those attending more traditional settings were conflicting. Therefore, although it is clear that community testing services are providing an important choice for individuals regarding where they have an HIV test, whether the services are diagnosing individuals who would otherwise not test until they are unwell is less clear.
Evidence from the studies included in this review demonstrates the importance of selecting appropriate venues, building relationships with venue owners and choosing suitable locations within those venues. The location should be conducive to providing a confidential testing service of equal professional standard to those services in healthcare facilities. In addition, training of staff conducting the tests as well as of staff working in the venues will increase confidence and acceptability.
There are some limitations to our review. Studies were only included if they had been published in peer-reviewed journals and were written in English. Given that a large number of community testing projects may be conducted by small nongovernmental, nonacademic organizations, much of the information that exists on projects may only be published in grey literature or in local languages. Almost all studies were observational and only five had a comparison group, making the true effect of community testing on the outcome measures more difficult to measure compared with more traditional strategies. Information on the stage at which people are diagnosed (CD4 cell count at diagnosis) is lacking and therefore it is not possible to assess whether patients are diagnosed earlier as a result of community testing initiatives.
In evaluating HIV testing strategies it is important that feasibility, acceptability, effectiveness and cost-effectiveness are considered and, to allow meaningful comparisons of studies, there is a need for use of comparable measures. This review highlights the range of outcome measures that are used to evaluate these testing strategies. For example, in the studies included in this review, serpositivity was not always reported and transfer to care of newly diagnosed individuals was rarely reported.
Our review did not consider the costs associated with community HIV testing. This will be an important factor in implementing these strategies and to date there have been few studies, none of which have compared the cost of testing in the community with that of testing in more traditional services. The cost-effectiveness of community HIV testing for MSM has been considered in a recent review, which also found limited evidence.
This review has shown that community HIV testing strategies provide an acceptable alternative to HIV testing in healthcare settings and are feasible to implement. However, these strategies require careful planning to ensure that they reach the population most at need of alternative testing venues and are able to transfer any individuals newly diagnosed with HIV into appropriate treatment and care pathways.
Discussion
The results of the studies included in this review indicate that community testing initiatives are successful in diagnosing previously undiagnosed HIV infections among MSM communities and people from BME communities and are acceptable to both clients and staff. Rapid testing technologies increased the likelihood of a person receiving their test result and are acceptable to clients.
The proportions of patients testing in community settings who had never previously tested were generally small. In addition, comparisons of seropositivity among clients attending community testing settings and those attending more traditional settings were conflicting. Therefore, although it is clear that community testing services are providing an important choice for individuals regarding where they have an HIV test, whether the services are diagnosing individuals who would otherwise not test until they are unwell is less clear.
Evidence from the studies included in this review demonstrates the importance of selecting appropriate venues, building relationships with venue owners and choosing suitable locations within those venues. The location should be conducive to providing a confidential testing service of equal professional standard to those services in healthcare facilities. In addition, training of staff conducting the tests as well as of staff working in the venues will increase confidence and acceptability.
There are some limitations to our review. Studies were only included if they had been published in peer-reviewed journals and were written in English. Given that a large number of community testing projects may be conducted by small nongovernmental, nonacademic organizations, much of the information that exists on projects may only be published in grey literature or in local languages. Almost all studies were observational and only five had a comparison group, making the true effect of community testing on the outcome measures more difficult to measure compared with more traditional strategies. Information on the stage at which people are diagnosed (CD4 cell count at diagnosis) is lacking and therefore it is not possible to assess whether patients are diagnosed earlier as a result of community testing initiatives.
In evaluating HIV testing strategies it is important that feasibility, acceptability, effectiveness and cost-effectiveness are considered and, to allow meaningful comparisons of studies, there is a need for use of comparable measures. This review highlights the range of outcome measures that are used to evaluate these testing strategies. For example, in the studies included in this review, serpositivity was not always reported and transfer to care of newly diagnosed individuals was rarely reported.
Our review did not consider the costs associated with community HIV testing. This will be an important factor in implementing these strategies and to date there have been few studies, none of which have compared the cost of testing in the community with that of testing in more traditional services. The cost-effectiveness of community HIV testing for MSM has been considered in a recent review, which also found limited evidence.
This review has shown that community HIV testing strategies provide an acceptable alternative to HIV testing in healthcare settings and are feasible to implement. However, these strategies require careful planning to ensure that they reach the population most at need of alternative testing venues and are able to transfer any individuals newly diagnosed with HIV into appropriate treatment and care pathways.
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