A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status.
BACKGROUND
Alternatives to conventional HIV counseling and testing (HIV-CT) have been used to improve receipt of HIV test results.


OBJECTIVE
To determine the effectiveness of alternative HIV-CT methods on the receipt of HIV test results.


METHODS
Studies were identified by a systematic search of the literature using English-language databases from 1990 to 2005. Studies were included if they used an alternative method for HIV-CT, reported the receipt of HIV test results and had a comparison group. Pooled effect sizes [risk ratios (RR)] were calculated using a random effects model.


RESULTS
Seventeen effect sizes (k) were included n = 21 096). Alternative HIV-CT methods included rapid testing (k = 12), oral fluid testing (k = 2), home testing (k = 1), and telephone post-test counseling (k = 2). All alternatives except for oral fluid testing significantly increased receipt of results compared with conventional testing. In stratified analysis, rapid testing was most effective [RR, 1.80; 95% confidence interval (CI), 1.46-2.22] followed by telephone post-test counseling (RR, 1.38. 95% CI, 1.24-1.47).


CONCLUSIONS
There is strong evidence that clients are substantially more likely to receive their HIV test results with rapid testing than with conventional tests or other alternatives. Therefore, to increase knowledge of HIV status, rapid testing is preferable in settings with low rates of return for test results.
Hutchinson
Angela B
AB
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30306, USA. ahutchinson@cdc.gov
Branson
Bernard M
BM
Kim
Angela
A
Farnham
Paul G
PG
D015492:AIDS Serodiagnosis / Q000379:methods*; D003376:Counseling / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012648:Self Care; D013689:Telephone