P5-S7.17 Accepting the good with the bad: “barriers and facilitators of 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

With a global focus on increased HIV testing among high risk groups including men who have sex with men (MSM), many community-based HIV testing services have been established in recent years with the goal of increasing testing opportunities for populations at risk. To better understand the acceptability of community based HIV testing models targeting MSM from the provider and consumer perspective we systematically reviewed published studies.

Methods

We searched Medline, EMBASE and Cochrane databases from 1980 to October 2010. Studies were included if they described acceptability of community based HIV testing services targeting MSM, including outreach settings (eg, saunas, public events), collected through surveys, in-depth interviews, focus groups, or exit forms. A quantitative descriptive analysis of the barriers and facilitators of community based HIV testing identified by service providers and consumers was conducted.

Results

We identified 25 papers that met our selection criteria and were included in the review see Abstract P5-S7.17 table 1. Twenty one studies focused on facilitators from the consumers' perspective, with testing convenience, provision of rapid testing, and acceptability/feeling comfortable with settings reported at factors that facilitated seeking HIV testing at community based services. From the provider perspective (six studies) key factors enhancing service acceptability were client friendly protocols, service promotion, offering additional clinical services, and effective protocols for follow-up and referral. Sixteen studies captured barriers to using community based HIV testing services from the consumer perspective and the main issue reported related to readiness to receive results on the same day or in the community-based environment. Providers in six studies reported difficulties in follow-up, testing in outreach settings, cost, providing adequate staff training, managing workload and developing and maintaining referral pathways as key barriers.

Abstract P5-S7.17 Table 1

Summary of community HIV testing services (sample size) (n=25)

CategorySubcategoryAll services n (%)LocationCanada1 (4.0)Hong Kong1 (4.0)New Zealand1 (4.0)Switzerland1 (4.0)The Netherlands3 (12.0)UK3 (12.0)USA15 (60.0)Target groupMSM15 (60.0)Multiple7 (28.0)Unclear – CBO clients3 (12.0)Services type*CBO/community centre10 (40.0)STD clinic3 (12.0)Mobile testing facility1 (4.0)Needle exchange programs2 (8.0)Venue-based outreach (bar, club, sauna)9 (36.0)Combination (eg, CBO, outreach, mobile testing facility).5 (20.0)Rapid testing offeredYes13 (52.0)No5 (20.0)Yes– in combination with standard testing4 (16.0)Unclear3 (12.0)Study designCase studies1 (4.0)Clinical audit1 (4.0)Cross-sectional studies4 (16.0)Evaluation reports4 (16.0)Pilot/feasibility studies4 (16.0)Qualitative studies10 (40.0)Randomised trails (RCT)1 (4.0)Data collection methods*Client surveys (including exit forms)15 (60.0)Focus groups2 (8.0)In-depth interviews5 (20.0)Provider surveys2 (8.0)Qualitative phone interviews3 (12.0)Study participantsClients17 (68.0)Providers4 (16.0)Clients & providers4 (16.0)*

Service types and data collection methods are not mutually exclusive, so % do not add to 100%

Conclusion

Acceptability from both consumers and service providers is important to ensure an efficient and sustainable service. The experiences of many other services collated in this review will help other organisations address potential barriers and facilitators to the implementation of community-based HIV testing services.