Should Trained Lay Providers Perform HIV Testing? A Systematic Review to Inform World Health Organization Guidelines

June 2017 - In Focus

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Kennedy, C.E., Yeh, P.T., Johnson, C., Baggaley, R. AIDS Care (April 2017), 24: 1–7, e-publication ahead of print, doi:10.1080/09540121.2017.1317710.

This article examined using trained lay providers for HIV testing services (HTS) as a means of achieving the 90-90-90 targets proposed by the Joint United Nations Programme on HIV/AIDS. The authors conducted a systematic review of five studies comparing the outcomes of HTS by trained lay providers using rapid diagnostic tests versus no intervention, as well as six studies assessing end users' perceptions of these services. One U.S.-based randomized trial found that patients' uptake of HTS with lay providers was twice that with health care providers (57% uptake versus 27%). In Malawi, a pre-/post-intervention study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity. Studies on values and preferences generally found support for lay providers conducting HTS. The authors noted that since many countries still mandate that only professional staff can perform HTS, expanding guidance to include lay workers could increase HTS uptake cost-effectively. They also urged further studies on the effectiveness of lay-based HTS provision and community views of such services.

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