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Linkage to Care and Prevention after HIV Self-Testing: A Systematic Review and Meta-Analysis
17 Pages Posted: 8 Feb 2024
More...Abstract
Background: Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals who are linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.
Methods: An initial search was conducted across eight databases, including conference abstracts, up to October 2023. Linkage to care after HIVST was defined as getting a confirmatory test or antiretroviral therapy (ART) if the self-test was reactive, and/or pre-exposure prophylaxis (PrEP) if the self-test was non-reactive. A random-effects meta-analysis was performed to summarise the linkage to prevention and care.
Findings: Overall, 10,071 studies were screened, of which, 174 were included in this meta-analysis. Most studies examining linkage to confirmatory testing or ART initiation were conducted in the African region among key populations who used oral fluid-based HIVST kits without assistance. Overall, 92% (95% confidence interval(CI):89–96) of those whose HIVST was reactive were linked to confirmatory testing, and 89% (95%CI:84–93) of those newly-diagnosed with HIV initiated ART. Eighty-four percent (95%CI:74–93) of self-testers were linked to care. Of the individuals whose HIVST was non-reactive, 9% (95%CI:2–19) were linked to PrEP services. Studies utilising assisted HIVST demonstrated a higher linkage to confirmatory testing, and ART initiation compared to unassisted HIVST. Our meta-regression analysis found that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network–based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio=1·28 (95%CI:1·10–1·50), p=0·001) compared to non-SNA service delivery model.
Interpretation: In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly with assisted HIVST and when SNA was used to obtain the HIVST kits.
Funding: JO and EPFC are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Investigator Grant (GNT1193955 for JJO and GNT1172873 for EPFC). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). YZ is supported by an Australian Government Research Training Program (RTP) scholarship.
Declaration of Interest: All authors declare no competing interests.
Keywords: HIV, self-testing, linkage, confirmatory test, ART, care
Suggested Citation: Suggested Citation