HIV point-of-care testing in non-urban settings: A scoping review

Although HIV point-of-care testing (HIV POCT) is available in many jurisdictions in Canada and elsewhere, challenges in access and uptake of POCT remain, particularly in non-urban settings. Our team undertook a scoping review of the HIV POCT peer-reviewed literature to determine how this type of testing could potentially be scaled-up in non-urban locations in Canada. We searched Ovid MEDLINE, EMBASE, EBM Reviews, PsycINFO and CINAHL. All English-Language, empirical quantitative and qualitative papers that examined the use of HIV point-of-care testing in non-urban areas including factors such as uptake, acceptability, loss to follow-up and linkage to care rates were included. We also identified models that use allied health professionals and/or provide testing outside of traditional clinical settings in efforts to improve access and uptake. We reviewed 3,142 references for eligibility and of these, 17 peer-reviewed studies met the eligibility criteria. HIV POCT programs were implemented and evaluated in non-urban settings, including community health centres, door-to-door outreach, hospital, pharmacy, primary care, prisons, and substance abuse clinics. The feasibility and acceptability of HIV POCT were demonstrated in diverse sites including dental offices, home testing, pharmacies, primary care, and sexual health/HIV clinics. Innovative HIV POCT models are particularly relevant to non-urban settings, including attention to safeguarding privacy and confidentiality, improving overall health-care, and reaching diverse populations. However, testing innovations such as HIV POCT in non-urban communities in Canada will require additional research to understand how best to scale up novel approaches in contexts with limited or no current access to testing.