Despite intense global commitment to fight HIV/AIDS and years of preventative campaigns, there were an estimated 1.6 million AIDS-related deaths in 2012 (73% of which were in sub-Saharan Africa) and 2.3 million new infections [1]. There is a growing body of evidence showing that a reduction in HIV transmission at population level can be achieved through high coverage of regular HIV testing combined with access to lifelong antiretroviral therapy (ART) of all identified HIV-positive individuals [2-5]. Swaziland has the highest HIV prevalence in the world: approximately 31% of 18- to 49-year-olds are HIV positive, and it is estimated that each year 2.4% of HIV-negative Swazis become HIV positive [6]. Despite substantial efforts to expand access to HIV testing and counselling (HTC), more than one in three HIV-infected adults in Swaziland are unaware of their status [6].

In many generalised epidemics, including Swaziland, HTC coverage is higher among women than men [7]. This difference is largely explained by routine HIV testing in antenatal care services; in Swaziland, 94% of pregnant women undergo HIV testing [8]. Furthermore, the rural clinics in Swaziland were originally developed as maternal and child health services. Although they now provide primary health care including integrated HIV and tuberculosis care, it is possible that men are reluctant to attend as that they still perceive them to be ‘female’ spaces. Offering HTC in the community represents a crucial strategy for increasing HTC coverage among individuals who do not use health services regularly such as young men or individuals with work-related barriers [9].

Both home-based HTC (HBHCT) and mobile HTC (MHTC) have been successfully implemented in several sub-Saharan settings, demonstrating high uptake and high acceptability [10-12]. Relative to facility-based HTC, community-based strategies have been shown to reach HIV-positive populations earlier in the course of their HIV infection [12], thereby enabling earlier access to treatment and a reduction in avoidable morbidity, mortality and transmission of the virus. In 2012, Médecins Sans Frontières (MSF) introduced intensive community-based HTC in the rural Shiselweni region of the country in collaboration with the Regional Health Department of the Ministry of Health (MoH) of Swaziland.