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Meta-Analysis
. 2017 Aug;29(8):1003-1013.
doi: 10.1080/09540121.2017.1282105. Epub 2017 Feb 2.

Effectiveness of peer-led interventions to increase HIV testing among men who have sex with men: a systematic review and meta-analysis

Sylvia Shangani  1   2 , Daniel Escudero  3 , Kipruto Kirwa  2   3 , Abigail Harrison  1 , Brandon Marshall  3 , Don Operario  1
Affiliations
Meta-Analysis

Effectiveness of peer-led interventions to increase HIV testing among men who have sex with men: a systematic review and meta-analysis

Sylvia Shangani et al. AIDS Care. 2017 Aug.

Abstract

HIV testing constitutes a key step along the continuum of HIV care. Men who have sex with men (MSM) have low HIV testing rates and delayed diagnosis, especially in low-resource settings. Peer-led interventions offer a strategy to increase testing rates in this population. This systematic review and meta-analysis summarizes evidence on the effectiveness of peer-led interventions to increase the uptake of HIV testing among MSM. Using a systematic review protocol that was developed a priori, we searched PubMed, PsycINFO and CINAHL for articles reporting original results of randomized or non-randomized controlled trials (RCTs), quasi-experimental interventions, and pre- and post-intervention studies. Studies were eligible if they targeted MSM and utilized peers to increase HIV testing. We included studies published in or after 1996 to focus on HIV testing during the era of combination antiretroviral therapy. Seven studies encompassing a total of 6205 participants met eligibility criteria, including two quasi-experimental studies, four non-randomized pre- and-post intervention studies, and one cluster randomized trial. Four studies were from high-income countries, two were from Asia and only one from sub-Saharan Africa. We assigned four studies a "moderate" methodological rigor rating and three a "strong" rating. Meta-analysis of the seven studies found HIV testing rates were statistically significantly higher in the peer-led intervention groups versus control groups (pooled OR 2.00, 95% CI 1.74-2.31). Among randomized trials, HIV testing rates were significantly higher in the peer-led intervention versus control groups (pooled OR: 2.48, 95% CI 1.99-3.08). Among the non-randomized pre- and post-intervention studies, the overall pooled OR for intervention versus control groups was 1.71 (95% CI 1.42-2.06), with substantial heterogeneity among studies (I2 = 70%, p < 0.02). Overall, peer-led interventions increased HIV testing among MSM but more data from high-quality studies are needed to evaluate effects of peer-led interventions on HIV testing among MSM in low- and middle-income countries.

Keywords: HIV testing; MSM; Peers; interventions; meta-analysis; systematic review.

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Figures

Figure 1
Figure 1
Flow chart of article inclusion and exclusion for review.
Figure 2
Figure 2
Study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM. Note: event= number of MSM tested for HIV
Figure 3
Figure 3
Figure 3a. Subgroup analyses by socio-economic status of study site (high-income versus low-and middle-income country). Values show study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM. Figure 3b. Subgroup analyses by quality rating assigned to study. Values show study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM.
Figure 3
Figure 3
Figure 3a. Subgroup analyses by socio-economic status of study site (high-income versus low-and middle-income country). Values show study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM. Figure 3b. Subgroup analyses by quality rating assigned to study. Values show study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM.
Figure 4
Figure 4
Sensitivity analyses to examine robustness of results after excluding two studies with outliers (Geibel et al. 2012 and Young et al. 2015). Values show study-specific and overall sizes of the effect of peer-led interventions on rate of HIV testing among MSM.
See this image and copyright information in PMC

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