India’s HIV response has evolved dramatically over the past decade. Annual AIDS-related mortality has declined by 79%, while new infections have fallen by 44% since 2010—progress that exceeds global averages. Yet the scale of the challenge remains significant. With an estimated 2.56 million people living with HIV, India has the world’s second-largest epidemic.
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he next phase of the response depends on reaching those still outside the system. Many remain undiagnosed or are not linked to treatment, particularly in underserved and marginalised communities. Closing this gap requires approaches that extend beyond clinical settings and into everyday spaces.

A Blueprint for Reaching Underserved Communities

In 2021, Palladium India, with support from India Cares, launched the Community Based HIV Testing and Linkages (CBHTL) programme. The initiative focuses on bringing testing and care closer to populations that are often missed by traditional health services.

“A public health response must adapt to the communities it serves,” says Amit Patjoshi, Chief Executive Officer of Palladium India. “With CBHTL, we are focused on bridging the gap between health facilities and the people who need services most.”

Since its launch, the programme has expanded from 14 districts to 39 across nine states. Over five years, it has delivered more than 1.15 million HIV screenings, increasing from 88,000 tests in its first year to over 306,000 in 2025.

Extending Access Beyond the Clinic

A central feature of the programme is its emphasis on community-based delivery. Fixed-site clinics often fail to reach individuals facing stigma, mobility constraints, or economic barriers. CBHTL addresses this through its MOONLIGHT testing initiative, which provides flexible evening services in high-footfall community locations such as markets, bus stations, and local gathering points.

MOONLIGHT—Mainstreaming Out of Network Laymen, Intersexed, Gay, Hijras, and Transgender individuals—focuses on groups that remain largely outside formal health systems. By operating beyond standard clinic hours and in familiar settings, the initiative increases access in environments where people feel more comfortable engaging with services.

This targeted approach is reflected in improved case detection. Sero-positivity rates rose from 0.9% in 2021 to 1.54% in 2025, indicating that outreach efforts are successfully identifying individuals at higher risk who were previously underserved.

The model is supported by detailed testing micro-plans and coordination with the National Health Mission and Panchayati Raj Institutions. Frontline health workers and local leaders help identify priority locations and mobilise communities, strengthening trust and expanding access at the local level.

Ensuring Continuity from Diagnosis To Treatment

Testing is only one part of the response. Ensuring that individuals receive timely care is essential to improving outcomes and preventing further transmission.

CBHTL uses an accompanied referral approach, where trained staff support individuals with reactive results to access confirmatory testing and treatment services. This direct follow-up reduces the risk of clients being lost between diagnosis and care.

The programme aligns with India’s national “Test and Treat” policy, which aims to initiate antiretroviral therapy as early as possible. In 2025, CBHTL achieved a 94.9% linkage rate to treatment, reflecting consistent follow-through from screening to care.

Dr V. Sam Prasad, Country Programme Director at India Cares, highlights the importance of early access. “Community-based testing enables earlier diagnosis and faster connection to treatment, which improves outcomes for individuals and reduces transmission.”

Building A Coordinated System for Delivery

CBHTL operates through partnerships across government and community institutions. State AIDS Control Societies provide strategic oversight, while coordination with antiretroviral therapy centres supports continuity of care.

At the community level, engagement with local leaders and frontline workers helps address stigma and encourages participation in testing programmes. These relationships enable the programme to adapt to local contexts and maintain service delivery even during disruption. During the COVID-19 pandemic, this network helped sustain outreach efforts despite mobility restrictions and operational challenges.

India’s progress has created a strong foundation, but the remaining challenge lies in reaching those who continue to fall outside the system. CBHTL demonstrates how targeted outreach, local partnerships, and sustained follow-up can extend services to these populations.

Palladium India is now focused on expanding the model to additional geographies while maintaining high testing quality and treatment linkage rates. This includes refining “smart testing” strategies to prioritise high-risk populations and improve efficiency at scale.

“India’s public health landscape is at a critical juncture,” adds Patjoshi. “We are focused on scaling community-based solutions that ensure people are identified early and connected to treatment without delay.”

Expanding this approach could play a decisive role in accelerating progress towards the 2030 HIV targets. Reaching more people at the right time—and ensuring they are linked to care—will determine whether the next phase of India’s response builds on its progress or stalls short of its goals.