Going door-to-door to reach men and young people with HIV testing services to achieve the 90–90–90 treatment targets

Setting: Mulanje District, Malawi.

Objective: To examine the effectiveness of door-to-door (DtD) testing in reaching young people and men in a remote, rural area with a high prevalence of human immunodeficiency virus (HIV) infection.

Design: This was a retrospective analysis of data collected for a pilot DtD program. HIV testing services (HTS) visited targeted villages for 1–2 weeks. All current residents aged 2 years not known to be HIV-positive were offered testing.

Results: Ninety per cent (13 783/15 391) of individuals eligible for testing accepted. Forty-one per cent (n = 5693) of those tested were males and 56% (n = 7752) were aged <20 years. The overall proportion who tested positive was 4% (n = 524), with half as many males as females testing positive (OR 0.49, 95%CI 0.40–0.60, P < 0.001). There was a higher positive yield rate for those aged 20 years (6% for men and 8% for women). Two thirds were first-time testers; males were half as likely as females to have been previously tested (OR 0.43, 95%CI 0.40–0.47, P < 0.001).

Conclusion: DtD-HTS can be an effective way to reach populations in remote, rural high-prevalence areas where access to fixed facilities is inadequate. It has the potential to reach young people and men better than facility-based testing or other community strategies, and can identify young HIV-positive children who may have been missed by other methods.