Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis

Johnson, Cheryl; Kennedy, Caitlin E.; Fonner, Virginia A.; Siegfried, Nandi; Figueroa, Carmen; Dalal, Shona; Sands, Anita; Baggaley, Rachel

doi:10.7448/ias.20.1.21594

Cited by 323 publications

(354 citation statements)

References 29 publications

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“…Consistent with previous reports , all distribution models had high male participation in each country. Strategies that provide men with greater coverage of HIV testing and care are urgently needed both to address the disproportionately high testing gap and mortality from HIV in men, and also to reduce risk of onward transmission of HIV .…”

Section: Discussionmentioning

confidence: 99%

“…Peak HIV prevalence for men in southern Africa is now in the 40‐ to 49‐year‐old age‐group , with older men among least likely to have accessed standard HIV testing services . Older men appear relatively receptive to HIVST, however, as evidence by the data reported here as well as from implementation studies from Kenya, Lesotho and Zimbabwe . For adolescent boys, HIVST can provide the first opportunity to test without fear of judgement from parents and healthcare workers , explaining the high uptake among this age group when HIVST was offered at community level.…”

Section: Discussionmentioning

confidence: 99%

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HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe

Hatzold

Gudukeya²,

Mutseta³

et al. 2019

J Intern AIDS Soc

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144

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Introduction Social, structural and systems barriers inhibit uptake of HIV testing. HIV self‐testing ( HIVST ) has shown promising uptake by otherwise underserved priority groups including men, young people and first‐time testers. Here, we use characteristics of HIVST kit recipients to investigate delivery to these priority groups during HIVST scale‐up in three African countries. Methods Kit distributors collected individual‐level age, sex and testing history from all clients. These data were aggregated and analysed by country (Malawi, Zambia and Zimbabwe) for five distribution models: local community‐based distributor ( CBD : door‐to‐door, street and local venues), workplace distribution ( WD ), integration into HIV testing services ( IHTS ), or public health facilities ( IPHF ) and during demand creation for voluntary male medical circumcision ( VMMC ). Used kits were collected and re‐read from CBD and IHTS recipients. Results Between May 2015 and July 2017, 628,705 HIVST kits were distributed in Malawi (172,830), Zambia (190,787) and Zimbabwe (265,091). Community‐based models, the first to be established, accounted for 519,658 (82.7%) of kits distributed, with 275,419 (53.0%) used kits returned. Subsequent model diversification delivered 54,453 (8.7%) test‐kits through IHTS , 23,561 (3.7%) through VMMC , 21,183 (3.4%) through IPHF and 9850 (1.7%) through WD . Men took 294,508 (48.2%) kits, and 263,073 (43.1%) went to young people (16 to 24 years). A higher proportion of male self‐testers (65,577; 22.3%) were first‐time testers than women (54,096; 17.1%) with this apparent in Zimbabwe (16.2% vs. 11.4%), Zambia (25.4% vs. 17.7%) and Malawi (27.9% vs. 25.9%). The highest proportions of first‐time testers were in young (16 to 24 years) and older (>50 years) men (country‐ranges: 18.7% to 35.9% and 13.8% to 26.8% respectively). Most IHTS clients opted for HIVST in preference to standard HTS in each of 12 delivery sites, with those selecting HIVST having lower HIV prevalence, potentially due to self‐selection. Conclusions HIVST delivered at scale using several different models reached a high proportion of men, young people and first‐time testers in Malawi, Zambia and Zimbabwe, some of whom may not have tested otherwise. As men and young people have limited uptake under s...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe

Hatzold

Gudukeya²,

Mutseta³

et al. 2019

J Intern AIDS Soc

Self Cite

144

120

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“…A key concern with self‐testing is whether self‐testers would seek HIV treatment . This study demonstrated a noteworthy 100% linkage to HIV treatment; the national linkage rate is 31% .…”

Section: Discussionmentioning

confidence: 99%

Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

et al. 2018

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Introduction HIV self‐testing (HIVST) offers an alternative to facility‐based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment.MethodsA cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick® HIV antibody test) distribution to eligible MSM followed by a 3‐month follow‐up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits.ResultsThe median age of the participants was 25 years, 88.7% were literate and 17.9% were first‐time testers. Of the 257 participants (80.7% retention) who completed the three‐month follow‐up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self‐reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three‐month survey.ConclusionsHIVST distribution through KOLs was feasible and oral self‐testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self‐testing, this study showed that linkage to treatment can be achieved with active follow‐up and access to a trusted MSM‐friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

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“…HIV self‐testing (HIVST) can increase HIV testing coverage and frequency . Several studies in Malawi have shown HIVST to be highly acceptable and able to reach first‐time testers, young people (aged 16 to 25), men and couples and partners , with acceptable linkage into facility‐based services when combined with facilitated linkage strategies .…”

Section: Introductionmentioning

confidence: 99%

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

et al. 2019

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Introduction HIV self‐testing (HIVST) provides couples and individuals with a discreet, convenient and empowering testing option. As with all HIV testing, potential harms must be anticipated and mitigated to optimize individual and public health benefits. Here, we describe social harms (SHs) reported during HIVST implementation in Malawi, and propose a framework for grading and responding to harms, according to their severity. Methods We report findings from six HIVST implementation studies in Malawi (2011 to 2017) that included substudies investigating SH reports. Qualitative methods included focus group discussions, in‐depth interviews and critical incident interviews. Earlier studies used intensive quantitative methods (post‐test questionnaires for intimate partner violence, household surveys, investigation of all deaths in HIVST communities). Later studies used post‐marketing reporting with/without community engagement. Pharmacovigilance methodology (whereby potentially life‐threatening/changing events are defined as “serious”) was used to grade SH severity, assuming more complete passive reporting for serious events. Results During distribution of 175,683 HIVST kits, predominantly under passive SH reporting, 25 serious SHs were reported from 19 (0.011%) self‐testers, including 15 partners in eight couples with newly identified HIV discordancy, and one perinatally infected adolescent. There were no deaths or suicides. Marriage break‐up was the most commonly reported serious SH (sixteen individuals; eight couples), particularly among serodiscordant couples. Among new concordant HIV‐positive couples, blame and frustration was common but rarely (one episode) led to serious SHs. Among concordant HIV‐negative couples, increased trust and stronger relationships were reported. Coercion to test or disclose was generally considered “well‐intentioned” within established couples. Women felt empowered and were assertive when offering HIVST test kits to their partners. Some women who persuaded their partner to test, however, did report SHs, including verbal or physical abuse and economic hardship. Conclusions After more than six years of large‐scale HIVST implementation and in‐depth investigation of SHs in Malawi, we identified approximately one serious reported SH per 10,000 HIVST kits distributed, predominantly break‐up of married serodiscordant couples. Both “active” and “passive” reporting systems identified serious SH events, although with more complete capture by “active” systems. As HIVST is scaled‐up, efforts to support and further optimize community‐led SH monitoring should be prioritized alongside HIVST distribution.

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Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis

Cited by 323 publications

References 29 publications

HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe

HIV self‐testing: breaking the barriers to uptake of testing among men and adolescents in sub‐Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe

Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

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