Facilitators, Barriers, and Outcomes of Self-Initiated HIV Testing: An Integrative Literature Review

Abstract

Background and PurposeHIV testing is an essential tool for identifying people at risk for HIV infection and linking those who are infected to care. Despite the recommendation for routine HIV testing for people who are vulnerable to HIV infection, healthcare professionals experience difficulties initiating discussions related to sexual health and recommending HIV testing. Healthcare professionals not offering HIV testing is a frequently reported reason for delays in testing. Self-initiated HIV testing is understudied and vital to improving HIV testing rates, treatment, and the process of HIV prevention. The main aim of this integrative literature review is to identify facilitators, barriers, and outcomes of self-initiated HIV testing.MethodA search of PubMed, CINAHL, PsycINFO, EBSCO host, and Google Scholar, revealed 31 studies that met the inclusion criteria.ResultsSelf-initiated HIV testing is voluntarily requested and completed by individuals either using self-testing kits or in a setting that provides HIV testing. Perception of susceptibility to HIV infection, privacy, access to HIV testing sites or self-testing kits, and knowledge related to HIV infection and testing, were some of the salient facilitators and barriers to self-initiated HIV testing. Findings from our review indicate several benefits to self-initiated HIV testing, including early identification of acute HIV infection, increased likelihood for the uptake of HIV prevention interventions, and a reduction in sexual risk behaviors.Implication for PracticeNursing initiatives geared toward promoting self-initiated HIV testing will lead to prompt diagnoses and linkages to treatment which will further improve nursing care and a variety of health outcomes.

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

“…14,[23][24][25] Further, there is evidence suggesting this method can increase HIV testing uptake and early diagnosis. [26][27][28][29][30][31][32][33] HIVST is particularly relevant for stigmatized populations as it provides individuals with increased privacy and greater control over their testing needs. 34 The option to test privately at times and locations of choice creates the opportunity to reduce stigma, a significant barrier for MSM, [35][36][37][38][39] BMSM, 36,[39][40][41][42] sex workers, 43,44 prisoners, 45,46 and transgender women.…”

“…50 Several systematic or literature reviews discuss conditions for HIVST use among key populations, including one demonstrating that individuals who self-initiate HIVST are those having perception of risk for HIV and knowledge about HIV testing availability. 27 A recent literature review found high rates of acceptability of HIVST among MSM but notes that values and preferences of other key populations remain understudied. 51 There are some concerns that HIVST is sub-optimal compared to testing in clinical settings, both in terms of test sensitivity when comparing oral versus blood-based results and options for linkage to care.…”

“The right place and the right time”: A qualitative study of the decision‐making process of self‐initiated HIV testing among young adults

“…To increase HIV testing uptake among young adults, it is crucial to identify and promote alternative strategies for encouraging testing. An exploration of self-initiated HIV testing, that is, testing that is initiated and completed by an individual without an immediate clinician recommendation, could provide vital information for future strategies aimed at improving the uptake of HIV testing among young adults (Adebayo & Salerno, 2019;Joore, Geerlings, Brinkman, van Bergen, & Prins, 2017;Ma, Malcolm, Diaz-Albertini, & Klinoff, 2016). Self-initiated HIV testing includes behaviors such as requesting HIV tests from locations that offer testing or the use of self-testing kits; however, these are not typical testing behaviors among young adults (Adebayo & Salerno, 2019;Joore et al, 2017;Pai et al, 2013).…”

“…An exploration of self-initiated HIV testing, that is, testing that is initiated and completed by an individual without an immediate clinician recommendation, could provide vital information for future strategies aimed at improving the uptake of HIV testing among young adults (Adebayo & Salerno, 2019;Joore, Geerlings, Brinkman, van Bergen, & Prins, 2017;Ma, Malcolm, Diaz-Albertini, & Klinoff, 2016). Self-initiated HIV testing includes behaviors such as requesting HIV tests from locations that offer testing or the use of self-testing kits; however, these are not typical testing behaviors among young adults (Adebayo & Salerno, 2019;Joore et al, 2017;Pai et al, 2013). Previous studies have found associations between self-initiated HIV testing and increased likelihood of future HIV tests, increased engagement in sexual risk reduction, and improved sexual health outcomes (Adebayo & Salerno, 2019;Joore et al, 2017;Ma et al, 2016;Pai et al, 2013).…”

“…Self-initiated HIV testing includes behaviors such as requesting HIV tests from locations that offer testing or the use of self-testing kits; however, these are not typical testing behaviors among young adults (Adebayo & Salerno, 2019;Joore et al, 2017;Pai et al, 2013). Previous studies have found associations between self-initiated HIV testing and increased likelihood of future HIV tests, increased engagement in sexual risk reduction, and improved sexual health outcomes (Adebayo & Salerno, 2019;Joore et al, 2017;Ma et al, 2016;Pai et al, 2013). Despite the notable benefits of self-initiated HIV testing, little is known about how young adults engage in this testing behavior.…”