Strategic HIV testing and counseling models for the Eastern Caribbean.

HIV testing and counseling (HTC) serves as a critical gateway for treatment and prevention services shown to reduce HIV transmission efficiency and incidence. While it is clear that diagnosis of HIV is a critical intervention the strategy for providing HTC that would be most effective for each country is not. Selection of the most effective strategy depends on several factors including: the nature of the HIV epidemic the socio-cultural context and current services structures and resources for HIV. Recent guidelines from the World Health Organization (WHO) recommend PITC testing based on index HIV and TB cases and mobile and outreach testing as service delivery strategies for low-level and concentrated HIV epidemics in places like the Organization of Eastern Caribbean States (OECS). In this paper we present a review of available grey and published literature to summarize the current situation in the OECS in relation to the HIV epidemic and testing services. This summary includes an assessment of WHO recommendations as well as new innovations in HTC service provision including use of rapid testing and network-based approaches. A mix of HTC strategies are presented that can increase the number of people who test and receive care and treatment services including approaches that reach more clandestine populations or those that may not identify themselves as at-risk for HIV. Strategies for the use of existing data sources and surveillance systems to inform the selection of HTC service provision are also discussed.