5.1 HIV testing and counselling
Consolidated ARV guidelines, June 2013
5.1.3 Community-based HIV testing and counselling (part 1)
In addition to providing HIV testing and counselling in clinical settings, HIV testing and counselling can be offered in a variety of settings in the community.
New recommendations (2013)
In generalized HIV epidemics, community-based HIV testing and counselling with linkage to prevention, care and treatment services is recommended, in addition to provider-initiated testing and counselling (strong recommendation, low-quality evidence).
In all HIV epidemic settings, community-based HIV testing and counselling for key populations, with linkage to prevention, care and treatment services is recommended, in addition to provider-initiated testing and counselling (strong recommendation, low-quality evidence).
These guidelines include expanded criteria for eligibility for ART for children, adolescents, adults and pregnant and breastfeeding women living with HIV. To maximize the individual and public health benefits of these recommendations, people living with HIV must be diagnosed and linked to care early in the course of HIV infection. Although facility-based testing is a key approach, people living with HIV are often identified late in the course of HIV disease in clinical settings, and some populations, including men and adolescents, and especially key populations, have low utilization of health care services.
Community-based testing approaches may reach people with HIV earlier in the course of HIV disease than provider-initiated testing and counselling, as well as reaching populations that may not normally attend health services.
The use of rapid HIV diagnostic tests using blood from a finger-prick sample taken by trained lay counsellors and community health workers has facilitated the expansion of HIV testing and counselling in community settings including homes, transport stations, religious facilities, schools, universities, workplaces and venues frequented by key populations. Continued expansion of community-based testing to complement facilitybased testing is an important consideration in achieving universal knowledge of HIV status and earlier diagnosis linked to care and treatment. Community-based HIV testing and counselling includes using mobile, door-to-door, index, campaign, workplace and schoolbased HIV testing and counselling approaches (1).