title: HIV testing in community settings in resource-rich countries: a systematic review of the evidence.
abstract: OBJECTIVE
  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.
authors.affiliation: HIV STI Department, Health Protection Agency, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Thornton
authors.forename: V
authors.initials: V
authors.lastname: Delpech
authors.forename: M M
authors.initials: MM
authors.lastname: Kall
authors.forename: A
authors.initials: A
authors.lastname: Nardone
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003376:Counseling / Q000379:methods*; D019049:Developed Countries / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D014481:United States / Q000453:epidemiology