title: Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review.
abstract: OBJECTIVE
  To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure.
  
  
  METHODS
  Cochrane systematic review and meta-analysis.
  
  
  METHODS
  We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction.
  
  
  METHODS
  We included controlled studies that compared rapid VCT with conventional testing among people at risk for HIV exposure.
  
  
  METHODS
  Two reviewers extracted data. We used Cochrane risk of bias tool and GRADE criteria: risk of bias, inconsistency, indirectness, imprecision and publication bias. For observational studies we used the Newcastle-Ottawa Scale. We used the PRISMA-Equity reporting guideline.
  
  
  RESULTS
  From 2441 articles, we included 8 randomised controlled trials and 5 observational studies. Rapid VCT was associated with a threefold increase in HIV-testing uptake (relative risk (RR)=2.95 95% CI 1.69 to 5.16) and a twofold increase in the receipt of test results (RR=2.14, 95% CI 1.08 to 4.24). Women accepted testing more often than men in rapid VCT arm, but no differences in effect for age or socioeconomic status. Observational studies also showed rapid VCT led to higher rates of uptake of testing. Heterogeneity was high. A cluster-randomised trial reported an 11% reduction in HIV incidence in intervention communities (RR=0.89, 95% CI=0.63 to 1.24) over 3 years trial.
  
  
  CONCLUSIONS
  Rapid VCT in health facilities and communities was associated with a large increase in HIV-testing uptake and receipt of results. This has implications for WHO guidelines. The routine use of rapid VCT may also help avoid human rights violations among marginalised populations where testing may occur without informed consent and where existing stigma may create barriers to testing.
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care Ottawa Hospital Research Institute, The Ottawa Hospital.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pottie
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Olanrewaju
authors.initials: O
authors.lastname: Medu
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Vivian
authors.initials: V
authors.lastname: Welch
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Canada Foundation for Nepal, Ottawa, Ontario, Canada.
authors.forename: Govinda P
authors.initials: GP
authors.lastname: Dahal
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care.
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tamara
authors.initials: T
authors.lastname: Rader
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, The Ottawa Hospital.
authors.forename: George
authors.initials: G
authors.lastname: Wells
mesh_terms: D003376:Counseling; D057210:Delayed Diagnosis / Q000517:prevention & control; D006678:HIV; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012306:Risk
keywords: HIV Services; HIV Testing; Rapid VCT