The Practice and Potential Role of HIV Self-testing in China: Systematic Review and Meta-analysis

Abstract

Background HIV self-testing (HIVST) is recommended by the World Health Organization as a valid approach to routine HIV testing services. The scale of HIVST use has gradually been expanded in China over the past 5 years. To take a closer look at the role of HIVST in China, we reviewed the promotion and application of HIVST within China. Objective The main objective of this study was to systematically analyze the proportion of past use and actual uptake of HIVST within China. Moreover, we aimed to quantify the effect of HIVST on HIV prevention and treatment. Methods In all, 5 medical databases and 2 registration systems, including PubMed, Web of Science, MEDLINE, WanFang, China National Knowledge Internet, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were systematically searched for studies reporting the prevalence of HIVST use from January 1, 2010, to December 25, 2021. Meta-analyses of the pooled proportion estimates were carried out by the meta-package in R software (version 4.1.2). Statistical heterogeneity among the studies was estimated using Cochran Q test and the inconsistency index (I2). Results A total of 50 studies were included in our systematic review. The estimated pooled prevalence of HIVST use in China was 29.9% (95% CI 22.5%-37.9%). Among individuals who have ever used HIVST, 47.5% (95% CI 37.2%-57.8%) were tested for HIV for the first time. The pooled reactive rate of HIVST was 4.2% (95% CI 3.1%-5.8%). When HIVST revealed a reactive result, 81.3% (95% CI 70.9%-91.6%) of individuals sought medical care. Conclusions In recent times, HIVST has become a valuable tool for HIV prevention in China. The widespread use of HIVST in non–men who have sex with men populations needs to be endorsed and promoted. The long-term applications of HIVST and the potential consequences of self-financing of HIVST in China have yet to be explored. Trial Registration PROSPERO CRD42022304846; https://tinyurl.com/54d9pxy8

Investigating the effectiveness of web‐based HIV self‐test distribution and linkage to HIV treatment and PrEP among groups at elevated risk of HIV in Viet Nam provinces: a mixed‐methods analysis of implementation from pilot to scale‐up

“…Our findings are similar to previous studies which have indicated that many participants self-testing are often willing to share their results, especially when interventions are led by the community [36,37]. Optimizing PrEP initiations and maintenance through the service also represents a novel area of research for web-based HIVST approaches, which may generate improved data for HIVST uptake and use [35].…”

“…Despite these differences, with scale‐up the test‐result report proportion aligned with other digitally assisted HIVST programmes, including SMS‐assisted models (54–94%), as well as other scale‐up programmes in China (48–88%) [11, 35]; despite less active follow‐up of results post‐self‐test by the service administrators, there remained a comparable level of results reporting. The reported reactive proportion was also greater in scale‐up than the pilot, and there was a greater absolute number of people initiating ART.…”

The impact of HIV self-testing on risk behaviors among men who have sex with men: a mixed-methods study

“…In several areas of China, over half of MSM utilized HIVST ( 19 ). Approximately half of MSM who have used HIVST in China were tested for HIV for the first time ( 20 , 21 ), suggesting the potential of HIVST to reach hidden HIV infections within MSM. And numerous studies confirmed that HIVST could promote facility-based HIV testing ( 22 , 23 ).…”

The association between the CD4/CD8 ratio and surgical site infection risk among HIV-positive adults: insights from a China hospital

“…The HIV/AIDS epidemic is characterized by a low prevalence rate, with an estimated 0.1% of the adult population living with HIV/AIDS; the number of infections is also increasing annually in China ( 9 ). Currently, in China the only effective treatment is antiretroviral therapy (ART), commonly known as “cocktail” therapy.…”