Measuring linkage to HIV treatment services following HIV self‐testing in low‐income settings

Choko, Augustine; Jamil, Muhammad S; MacPherson, Peter; Corbett, Elizabeth L.; Chitembo, Lastone; Ingold, Heather; Aza, Elkin Bermudez; d’Elbée, Marc; DiCarlo, Meghan; Majam, Mohammed; Schewchuk, Tanya; Wong, Vincent; Baggaley, Rachel; Johnson, Cheryl

doi:10.1002/jia2.25548

Cited by 28 publications

(23 citation statements)

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“…Globally, HIVST country policy adoption has been rapid; however, implementation and large-scale procurement has lagged behind [7]. Many countries and programmes have hesitated in introducing HIVST due to concerns around linkage and social harm [54]. This review shows that HIVST appears to be a safe intervention and consistently effective in identifying additional people with HIV with a range of service delivery and support models and linking them to care with similar success as SoC.…”

Section: Discussionmentioning

confidence: 99%

Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis

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Background: We updated a 2017 systematic review and compared the effects of HIV self-testing (HIVST) to standard HIV testing services to understand effective service delivery models among the general population. Methods: We included randomized controlled trials (RCTs) comparing testing outcomes with HIVST to standard testing in the general population and published between January 1, 2006 and June 4, 2019. Random effects meta-analysis was conducted and pooled risk ratios (RRs) were reported. The certainty of evidence was determined using the GRADE methodology. Findings: We identified 14 eligible RCTs, 13 of which were conducted in sub-Saharan Africa. Support provided to self-testers ranged from no/basic support to one-on-one in-person support. HIVST increased testing uptake overall (RR:2.09; 95% confidence interval: 1.69À2.58; p < 0.0001;13 RCTs; moderate certainty evidence) and by service delivery model including facility-based distribution, HIVST use at facilities, secondary distribution to partners, and community-based distribution. The number of persons diagnosed HIV-positive among those tested (RR:0.81, 0.45À1.47; p = 0.50; 8 RCTs; moderate certainty evidence) and number linked to HIV care/ treatment among those diagnosed (RR:0.95, 0.79À1.13; p = 0.52; 6 RCTs; moderate certainty evidence) were similar between HIVST and standard testing. Reported harms/adverse events with HIVST were rare and appeared similar to standard testing (RR:2.52: 0.52À12.13; p = 0.25; 4 RCTs; very low certainty evidence). Interpretation: HIVST appears to be safe and effective among the general population in sub-Saharan Africa with a range of delivery models. It identified and linked additional people with HIV to care. These findings support the wider availability of HIVST to reach those who may not otherwise access testing.

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Section: Discussionmentioning

confidence: 99%

Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis

et al. 2021

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“…Although the young people in our study expressed a preference for the oral-based HIVST in comparison to facility-based testing, concerns were raised regarding to the lack of pre- and post-test counselling and linkage to care. Such concerns have contributed towards the delay in expansion and adoption of HIVST in national HIV policies or programmes in low-income settings [ 40 , 41 ]. Therefore, there is need to better understand pragmatic and innovative strategies to monitor HIVST use and facilitate linkage to care and support services.…”

Section: Discussionmentioning

confidence: 99%

“…Preferred method for follow-up included leveraging digital tools, such as hotlines, and individual-level follow-up by a trusted individual or healthcare worker. Given the emergence of social media and technology, mHealth platforms has been shown to be acceptable among young people in other settings [ 42 , 43 ] and may provide an avenue to monitor HIVST usage and linkage [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Young people’s preferences for HIV self-testing services in Nigeria: a qualitative analysis

et al. 2021

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Background HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people’s preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. Methods Semi-structured in-depth interviews with a purposive sample of young people 14–24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. Results A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people’s preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38–USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). Conclusion HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people’s HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.

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“…This should be facilitated where possible. 31 This study reviewed data collected from five studies conducted in three countries as part of the STAR Initiative. The similarity of protocols and distribution models across STAR Initiative studies, is a strength of this study,…”

Section: Discussionmentioning

confidence: 99%

ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data

et al. 2021

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IntroductionMeasuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates.MethodsFive STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the months of intervention at clinics in HIVST and comparison areas were presented graphically, and study effects combined using meta-analysis. Meta-regression was used to estimate associations between the impact of community-based HIVST distribution and indicators of implementation context, intensity and reach. Effect size estimates used (1) prespecified trial definitions of ART timing and comparator facilities and (2) exploratory definitions accounting for unexpected diffusion of HIVST into comparison areas and periods with less distribution of HIVST than was expected.ResultsCompared with arms with standard testing only, ART initiations were higher in clinics in HIVST distribution areas in 4/5 studies. The prespecified meta-analysis found positive but variable effects of HIVST on facility ART initiations (RR: 1.14, 95% CI 0.93 to 1.40; p=0.21). The exploratory meta-analysis found a stronger impact of HIVST distribution on ART initiations (RR: 1.29, 95% CI 1.08 to 1.55, p=0.02).ART initiations were higher in studies with greater self-reported population-level intensity of HIVST use (RR: 1.12; 95% CI 1.04 to 1.21; p=0.02.), but did not differ by national-level indicators of ART use among people living with HIV, number of HIVST kits distributed per 1000 population, or self-reported knowledge of how to link to care after a reactive HIVST.ConclusionCommunity-based HIVST distribution has variable effect on ART initiations compared with standard testing service alone. Optimising both support for and approach to measurement of effective and timely linkage or relinkage to HIV care and prevention following HIVST is needed to maximise impact and guide implementation strategies.

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Measuring linkage to HIV treatment services following HIV self‐testing in low‐income settings

Cited by 28 publications

References 4 publications

Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis

Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis

Young people’s preferences for HIV self-testing services in Nigeria: a qualitative analysis

ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data

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