Mapping the implementation process and outcomes of HIV counselling and testing programmes in low -middle-income countries: a scoping review protocol

Résumé

Background HIV counselling and testing (HCT) programmes remain a cornerstone of global HIV prevention, treatment, and care strategies, particularly in low- and middle-income countries (LMICs) where the burden of HIV is disproportionately high. Despite progress in expanding access to testing services, gaps persist in implementation, uptake, and effectiveness of HCT interventions. Variations in health system capacity, sociocultural factors, stigma, and resource constraints continue to influence programme delivery and experiences. Understanding implementation processes and outcomes is essential for identifying best practices and informing policy and practice. This scoping review seeks to map evidence on implementation processes and outcomes of HCT programmes in LMICs, highlighting challenges, facilitators, and areas requiring further research. Aim To map existing evidence on the implementation processes and outcomes of HIV Counselling and Testing programmes in LMICs, identify knowledge gaps, and inform policy, practice, and research. Method This systematic scoping review will follow the Joanna Briggs Institute methodology, the Arksey and O’Malley framework, and PRISMA. Grey literature relevant to HIV Testing Services implementation in LMICs will also be reviewed. Searches will be conducted in Embase, Global Health, African Index Medicus, PubMed, and Scopus for studies published between 2010 and 2025. Articles will be screened independently using predefined inclusion and exclusion criteria before full-text review and data extraction. Extracted data will be analysed using descriptive and thematic content analysis. Information on study characteristics, implementation strategies, target populations, barriers, facilitators, and outcomes will be charted. Findings will be synthesized narratively and presented using tables, charts, and thematic maps. Ethical approval is not required as the review uses publicly available literature. Findings The review will provide a comprehensive overview of implementation processes and outcomes of HCT programmes in LMICs, identify evidence gaps, and inform future HIV policy, implementation strategies, and research. Funding The review is part of a PhD project, Department of Public Health, Sefako Makgatho Health Sciences University. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Panel Research in context. Evidence before this study Before undertaking this scoping review, a comprehensive search of the literature will be conducted in electronic databases including Embase, Global health, African Index Medicals and PubMed. Additional sources will include reference lists of eligible studies and relevant grey literature. The search will include studies published from January 2000 to December 2025 using English Language. Search terms will include combinations of keywords and Medical Subject Headings (MeSH) related to “HIV counselling and testing”, “implementation,” “programme outcomes,” “barriers,” “facilitators,” “uptake,” “service delivery,” “low- and middle-income countries,” and related terms. Studies will be screened according to predefined inclusion and exclusion criteria focusing on HIV counselling and testing (HCT) programme implementation and outcomes in LMICs. The quality and methodological characteristics of the included studies will be described to provide context for interpreting the available evidence. As this is a scoping review, quantitative pooling or meta-analysis of findings will not be undertaken. Added value of this study This scoping review will provide a comprehensive mapping of the implementation processes and outcomes of HIV counselling and testing programmes across low- and middle-income countries. The review will synthesize evidence on implementation strategies, programme uptake, service utilization, barriers and facilitators, quality of services, accessibility, sustainability, and scalability of HCT programmes. It will also identify gaps in the literature and variations in implementation approaches across different settings and populations. The findings are expected to generate a broader understanding of how HCT programmes are implemented and what factors influence their effectiveness in LMIC contexts. Implications of all the available evidence The findings from this scoping review, together with the existing evidence, will help inform policy makers, programme implementers, healthcare providers, and researchers on effective approaches for strengthening HIV counselling and testing programmes in LMICs. The review will highlight implementation challenges and successful strategies that may support improvements in accessibility, quality, uptake, and sustainability of HCT services. In addition, the review will identify evidence gaps and priorities for future research aimed at enhancing HIV prevention, early diagnosis, linkage to care, and overall health system responses to HIV in resource-limited settings.

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