Home testing for HIV infection in resource-limited settings

Home testing for HIV infection in resource-limited settings.

Among an estimated 33 million individuals who are infected with HIV worldwide, only 10% are aware of their status. HIV testing is the cornerstone to preventing further transmission and to caring for those infected, particularly as access to treatment improves in resource-limited settings. However, efforts to expand testing through facilities-based testing have not achieved adequate testing coverage, prompting efforts to reach more individuals through strategies such as home-based HIV testing. Home testing is showing promising early results in some high-prevalence, resource-limited settings. This article reviews the mechanisms and literature to date of this door-to-door approach.

This review contrasts the literature on self-specimen collection and self-testing at home in the United States of America with ‘counsellor-initiated home-based testing’ in high HIV prevalence resource-limited settings. Those most likely to benefit from the latter may be the poor who have the lowest uptake of traditional, facility-based testing and counselling. Home-based testing in low- and middle-income settings may reach couples and families more efficiently than other strategies but individuals and the public will only benefit if there are strong links to effective HIV prevention, medical care, and psychosocial support for those who learn their test result.