The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access.

The role of voluntary counseling and testing (VCT)of HIV in resource-limited settings has recently broadened from primarily that of a prevention intervention to its identification as the key entry point into expanding access to life-saving antiretroviral therapy, additional HIV-specific medical care, and other support services. To fulfill this expanded mandate, calls for routine counseling and testing in diverse health care settings, in addition to other innovative approaches to traditional VCT, are emerging. The efficacy and cost-effectiveness of traditional facility-based VCT with respect to risk-behavior reduction of HIV have been demonstrated rigorously in resource-limited settings. Additional research is needed urgently to evaluate the feasibility, acceptability, and effectiveness of streamlined counseling and testing interventions that seek to reach as many individuals as possible to meet dual prevention and treatment goals.