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Community-based HIV testing and counselling (HTC) has been recommended for improving access to prevention, care, and treatment services in at-risk populations. Earlier systematic reviews and meta-analyses have been undertaken, but due to some methodological limitations, their findings do not yet provide a practical significance. The purpose of this paper is to re-examine the recent evidence of the efficacy of community-based HTC approaches on the uptake of HTC in at-risk populations.

The database of PubMed online, Science Direct, the Lancet Global Health, the Cochrane Central Register of Controlled Trials, and Google Scholar were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to obtain empirical papers published between March 2013 and December 2015.

Of 600 collected papers, there were 6 cluster randomized trials papers which met the inclusion criteria. Compared to the health facilities-based HTC, community-based HTC approaches have been shown to improve the uptake of HIV testing from 5.8 to 37 per cent, and improve HIV testing in men and their partners together from 6.8 to 34 per cent. The community approaches also detected lower HIV-positive cases (0.29 per cent as compared to 4 per cent), improved access to treatment services from 0.3 to 25 per cent, demonstrated higher cluster differentiation 4 count in newly diagnosed patients (median of 400-438 cells/µl), and increased the rate of first-time HIV testing from 9 to 11.8 per cent. With respect to social and behavioural outcomes, community-based HTC increased social norms for HIV testing by 6 per cent (95 per cent CI 3-9), decreased multiple sex partners by 55 per cent (95 per cent CI 42-73), lowered casual sex by 45 per cent (95 per cent CI 33-62), increased knowledge about HIV (83.2 vs 28.9 per cent), improved positive attitudes towards HIV patients (73.0 vs 34.3 per cent), and increased the use of condoms (28.0 vs 12.3 per cent).

Community-based HTC combined with behavioural interventions have been found to be more effective in increasing the uptake of HIV testing as well as other outcomes as compared to the conventional health facilities-based testing and counselling approaches.

The health belief model (HBM) is the behavioral change theory most widely used in health behavior studies. Several studies have identified the limitations of this model, one of which concerns the validity in predicting behavioral changes. The purpose of this paper, scoping review, is to map the validity of HBM variables in predicting behavioral changes based on available synthesized evidences.

A scoping review was conducted using the Arksey and O’Malley’s framework. PubMed, Health Evidence, Cochrane Database of Systematic Reviews, ScienceDirect and Google Scholar were searched using a combination of keywords: health belief model, review, systematic review and meta-analysis between February 15 and March 18, 2016.

Of the 1,457 articles, 4 met the inclusion criteria. All results showed that HBM variables were consistently related to behaviors and the strength of the correlation were varied. Perceived barriers and perceived benefits were the strongest predictor, while perceived severity was the weakest. The association between HBM variables and behaviors was moderated by some aspects of behavioral outcomes, the study design and the time interval between measurement of the HBM variables and behavior.

Although the four main variables of HBM have been shown to be related to behavior, the overall outcomes are varied and have not demonstrated conclusive evidence during the last ten years. The results of this scoping review imply the need for a systematic review and meta-analysis of the results of recent studies. In addition, more longitudinal studies are needed to ensure the validity of HBM variables by considering any possible moderators.