HIV Testing Strategies Employed in Health Care Settings in the European Union/European Economic Area (EU/EEA)

Evidence From a Systematic Review

S Desai; L Tavoschi; AK Sullivan; L Combs; D Raben; V Delpech; SF Jakobsen; AJ Amato-Gauci; S Croxford


HIV Medicine. 2020;21(3):163-179. 

In This Article


This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for the reporting of systematic reviews.[15] A full description of the methodology is described elsewhere.[16] Briefly, five electronic databases (OVID Medline, Embase, PsycINFO, Scopus and the Cochrane Library of Systematic Reviews) (January 2010 to March 2017) and the proceedings of six conferences (2014–2017) were searched using key search terms covering concepts including 'HIV', 'HIV testing' and 'Europe' (Tables S1–S5). Only studies pertaining to adults and set in the 30 EU/EEA countries (Table S6) and outside occupational settings were included in the review. No language restrictions were applied.

Two reviewers independently undertook title review, full-text review and data extraction. ECDC completed all reviews for non-English studies, with data extraction in English. Data on qualitative and quantitative outcome indicators were extracted, including information on HIV coverage, test positivity and intervention feasibility and acceptability. Two reviewers carried out quality assessment and risk of bias assignment for published studies based on National Institute for Health and Clinical Excellence (NICE) checklists and the AXIS quality assessment tool (Table S7). Studies were rated as being high, medium or low quality and having high, medium or low bias. Conference proceedings were not appraised for quality and bias. Critical appraisal results can be found in Table S8.

This paper focuses on studies of HIV testing in health care settings including STI clinics, primary care, hospitals, pharmacies, prisons, drug services and TB services. HIV testing strategies involved interventions categorized as testing provision, education programmes, campaigns, use of communication technologies, use of clinical decision-making tools and other interventions. Data from HIV testing provision studies were examined for the impact of testing on HIV testing coverage. Studies documenting the feasibility and/or acceptability of HIV testing interventions studies were also included. The remaining studies covering barriers to testing, economic evaluations, audits and non-health care settings are included in the wider systematic review findings that informed the guidance (n = 238).[17] European regions referred to are based on the United Nations geoscheme for Europe.