Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches

Amitabh B. Suthar, Nathan Ford, Pamela J. Bachanas, Vincent J. Wong, Jay S. Rajan, Alex K. Saltzman, Olawale Ajose, Ade O. Fakoya, Reuben M. Granich, Eyerusalem K. Negussie, Rachel C. Baggaley

Publication details

Editors: PLoS Med
Publication date: 13 August 2013
Languages: English



Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC) to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC.


Three decades into the AIDS epidemic, about 34 million people (most living in resource-limited countries) are infected with HIV, the virus that causes AIDS. Every year another 2.2 million people become infected with HIV, usually through unprotected sex with an infected partner, and about 1.7 million people die. Infection with HIV, which gradually destroys the CD4 lymphocytes and other immune system cells that provide protection from life-threatening infections, is usually diagnosed by looking for antibodies to HIV in the blood or saliva. Disease progression is subsequently monitored in HIV-positive individuals by counting the CD4 cells in their blood. Initiation of antiretroviral drug therapy—a combination of drugs that keeps HIV replication in check but that does not cure the infection—is recommended when an individual's CD4 count falls below 500 cells/µl of blood or when he or she develops signs of severe or advanced disease, such as unusual infections.

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