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Objectives  To evaluate the feasibility (population reached, costs) and effectiveness (positivity rates, linkage to care) of two strategies of community‐based  HIV  testing and counselling ( HTC ) in rural Swaziland.    Methods  Strategies used were mobile  HTC  ( MHTC ) and home‐based  HTC  ( HBHTC ). Information on age, sex, previous testing and  HIV  results was obtained from routine  HTC  records. A consecutive series of individuals testing  HIV ‐positive were followed up for 6 months from the test date to assess linkage to care.    Results  A total of 9 060 people were tested: 2 034 through  MHTC  and 7 026 through  HBHTC . A higher proportion of children and adolescents (<20 years) were tested through  HBHTC  than  MHTC  (57%  vs . 17%;  P  < 0.001).  MHTC  reached a higher proportion of adult men than  HBHTC  (42%  vs . 39%;  P  = 0.015). Of 398  HIV ‐positive individuals, only 135 (34%) were enrolled in  HIV  care within 6 months. Of 42 individuals eligible for antiretroviral therapy, 22 (52%) started treatment within 6 months. Linkage to care was lowest among people who had tested previously and those aged 20–40 years.  HBHTC  was 50% cheaper ( US $11 per person tested; $797 per individual enrolled in  HIV  care) than  MHTC  ($24 and $1698, respectively).    Conclusion  In this high  HIV  prevalence setting, a community‐based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their  HIV  status (particularly underserved populations such as men and young people). However, for community  HTC  to impact mortality and incidence, strategies need to be implemented to ensure people testing  HIV ‐positive in the community are linked to  HIV  care.

Feasibility and effectiveness of two community‐based HIV testing models in rural Swaziland