P5-S7.16 Easy access “community-based HIV testing services for gay men: a systematic review”
Authors: Pedrana A , Stoove M , Bowring A , Hellard M , Guy R 
Published: July 2011

Background

Community-based HIV testing has been widely utilised with the goal of increasing testing opportunities for gay men and decreasing the number of men who are unaware of their HIV status. Yet there remains ongoing debate as to whether such models offer advantages over routine clinical services. As such, there has been low uptake of community-based HIV testing in some countries. To better understand the processes and outcomes of these programs to inform future implementation, we systematically reviewed published studies.

Methods

We searched Medline, EMBASE and Cochrane databases from 1980 to October 2010. Included studies described HIV testing outcomes of community based testing services that included gay men as clients. The primary outcomes were client testing history and HIV positivity.

Results

We identified 33 papers that described 44 community-based HIV testing services. There were 18 on-site only services (community based organisations/community clinics, including one multi-fixed site), seven on-site services with outreach and 19 outreach only services, including eight outreach services in venues (bar, club, sauna); six mobile testing facilities and five community outreach sites in multiple locations (See Abstract P5-S7.16 table 1). The majority of the services were in the US (28 of 44) and 34 of 44 offered rapid HIV antibody testing on-site at the point-of-care. OraQuick Advance Rapid HIV-1/2 Antibody or Abbott Determine HIV-1/2 rapid with finger-stick were the most common tests used. Among services reporting testing outcomes specifically for gay men (22 of 44), the median proportion of men who had never tested for HIV prior to attending the community-based testing service was 34.1% (range: 7.8%–44.0% per service). The median HIV positivity was 3.9% (range: 0.3%–60.0% per service) and the median return rate for confirmatory testing was 83.8% (range: 22.7%–95.0% per service); higher in community-based organisation services (84.2%) and lower in outreach models (33.0%).

Abstract P5-S7.16 Table 1

Summary of community HIV testing services by setting and key outcomes of interest (n=44)

CategorySubcategoryAll services n (%)Location (n=44)Australia3 (6.8)Hong Kong1 (2.3)Spain1 (2.3)Switzerland1 (2.3)The Netherlands3 (6.8)New Zealand1 (2.3)UK6 (13.6)USA28 (63.6)Target group (n=44)†Men who have sex with men (only)15 (34.6)Broader population including:MSM6 (13.6)Ethnic minority3 (6.8)Young people3 (6.8)Transgender3 (6.8)IDUs3 (6.8)Multiple11 (25.0)Not reported3 (6.8)Service type (n=44)On-site CBO8 (18.2)Community clinic*10 (25.0)Outreach Mobile testing facility (MTF)6 (13.6) Venue-based outreach (bar, club, sauna)8 (18.2) Multiple sites (venues, MTF, homeless shelter)5 (11.4)On-site and outreach services (combination of venues)7 (15.9)Number of sites (n=44)1–229 (65.9)5–102 (4.6)Multiple sites–number not reported12 (27.3)Not Specified1 (2.3)Rapid HIV testing offered (n=44)Yes30 (68.2)Yes in parallel with conventional EIA testing4 (9.1)No10 (22.7)Type of Rapid Testing (n=28)† ‡Abbott Determine HIV-1/2 rapid test12 (42.9)Abbott-Murex Single Use Diagnostic System for HIV-1 [SUDS]3 (10.7)Inverness Clearview HIV 1/2 STAT-PAK1 (3.6)OraSure OraQuick Advance Rapid HIV-1/2 Antibody12 (42.9)OraSure OraQuick Rapid HIV-1 Antibody10 (35.7)Unigold Recombigen HIV4 (14.3)Cost to patient (n=32)Nil - (covered by service/study)17 (38.6)Nil + incentive received for participating11 (25.0)$10–€20 payment for test4 (11.4)Operating hours (n=16)2–5 h/week10 (62.5)5–10 h/week1 (6.3)>10 h/week5 (31.3)Staff types (n=26)†Administrative staff4 (15.4)HIV counselling & testing staff/counsellors16 (61.5)Nurses/healthcare workers/clinic co-ordinator8 (30.8)Phlebotomists2 (7.7)Physicians/medical officers4 (15.4)Psychotherapists2 (7.7)Sexual health educators/peer-workers/outreach workers9 (34.6)Social workers/case managers2 (7.7)Volunteers4 (15.4)No Staff/shift (n=19)11 (5.3)2–313 (68.4)4–75 (26.3)*

Community clinics refer to services that offer direct medical services to clients; for example, STI/HIV testing and treatment, vaccinations, dental services and may have a licensed pharmacies or laboratory on-site.

†

Target group, type of rapid test and staffing types are not mutually exclusive, so percentages do not add up to 100%.

‡

Some studies reported offering more than type of rapid test, therefore numbers do not add up to n=28.

Conclusion

Community-based HIV testing services provide a model of HIV testing that attracts a significant proportion of gay men who have never tested before, and these men are at high risk of HIV as evidenced by the HIV positivity rate.