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%).

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.