Community-Based Rapid Testing for HIV in Europe and Central Asia: A Narrative Review of Models, Effectiveness, and Implementation Challenges

Laura Fernà ndez-López1– 3 1Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain; 2Institute for Health Science Research Germans Trias I Pujol (IGTP), Badalona, Spain; 3CIBER of Epidemiology and Public Health (CIBERESP), Madrid, SpainCorrespondence: Laura Fernà ndez-López, Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Ctra. de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Spain, Tel +34 93 497 8745, Email [email protected]: This narrative review examines the evolution, implementation, and impact of Community-Based HIV Testing (CBT) across Europe and Central Asia (ECA), a region where late diagnosis remains a persistent challenge and key populations continue to face substantial structural, legal, and social barriers to accessing conventional healthcare. This review synthesises evidence from academic studies, surveillance reports, and European initiatives to describe the diverse modalities of CBT, as well as their contribution to earlier diagnosis, improved case-finding among first-time testers, and more timely linkage to care. Across the region, CBT showed higher acceptability and positivity yields than facility-based testing, reaching populations disproportionately affected by HIV, such as men who have sex with men, people who inject drugs, migrants, and sex workers, and supports differentiated, person-centred service delivery aligned with World Health Organization and European Centre for Disease Prevention and Control guidance. Despite clear progress, major implementation gaps persist, driven by restrictive regulatory frameworks, uneven adoption of innovations such as lay provider testing and HIV self-testing, limited integration of community-generated data into national surveillance systems, and structural inequities including stigma, criminalisation, and lack of universal healthcare entitlements. This review also notes the resilience and adaptability of community-based models during recent crises, including COVID-19 and the war in Ukraine. Overall, the evidence demonstrates that CBT is a fundamental component of HIV prevention and diagnosis in ECA. Fully realising its potential requires updated policies that enable task-sharing, integration of multi-disease testing, strong referral pathways, sustainable financing, and formal incorporation of community-generated data into national monitoring frameworks. Strengthening these components is essential to accelerate progress toward the 2030 goal of ending AIDS as a public health threat.Keywords: differentiated service delivery, key populations, early diagnosis, linkage to care, lay providers, integrated screening, CBVCT, HIV self-testing