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

HIV Med. 2012 Aug;13(7):416-26. doi: 10.1111/j.1468-1293.2012.00992.x. Epub 2012 Mar 14.


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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Community Health Services / organization & administration*
  • Counseling / methods*
  • Developed Countries / statistics & numerical data*
  • Early Diagnosis
  • Evidence-Based Medicine
  • Female
  • HIV Seropositivity / diagnosis*
  • HIV Seropositivity / epidemiology
  • Homosexuality, Male* / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Sexual Behavior
  • United States / epidemiology