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Meta-Analysis
. 2017 Nov 30;12(11):e0188890.
doi: 10.1371/journal.pone.0188890. eCollection 2017.

Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis

Ci Zhang  1 , Xianhong Li  1 , Mary-Lynn Brecht  2 , Deborah Koniak-Griffin  2
Affiliations
Meta-Analysis

Can self-testing increase HIV testing among men who have sex with men: A systematic review and meta-analysis

Ci Zhang et al. PLoS One. .

Abstract

Background: Globally, four out of ten individuals living with HIV have not been tested for HIV. Testing is especially important for men who have sex with men (MSM), among whom an increasing HIV epidemic has been identified in many regions of the world. As a supplement to site-based HIV testing services, HIV self-testing (HIVST) provides a promising approach to promote HIV testing. However, evidence is scattered and not well-summarized on the effect of HIVST to improve HIV testing behaviors, especially for MSM.

Methods: Seven databases (PubMed, Web of Science, Cochrane Library, PsycINFO, CINAHL Plus, WanFang, and China National Knowledge Internet) and conference abstracts from six HIV/sexually transmitted infections conferences were searched from January 2000-April 2017.

Results: Of 1,694 records retrieved, 23 studies were identified, 9 conducted in resource-limited countries and 14 in high-income countries. The pooled results showed that HIVST increased HIV test frequency for MSM by one additional test in a 6-month period (mean difference = 0.88 [95% CI 0.52-1.24]). The pooled proportion of first-time testers among those who took HIVST was 18.7% (95% CI: 9.9-32.4) globally, with a rate 3.32 times higher in resource-limited country settings (32.9% [95% CI: 21.3-47.6]) than in high-income countries (9.9% [95% CI: 7.4-13.8]). The pooled proportions included non-recent testers, 32.9% (95% CI: 28.1-38.3); ever or currently married MSM, 16.7% (95% CI: 14.5-19.4); and HIV positive men, 3.8% (95% CI: 2.0-5.7) globally; 6.5% [95% CI: 0.38-12.3] in resource-limited country settings; and 2.9% [95% CI: 2.0-5.0] in high-income countries). The rates reported for linkage to care ranged from 31.3% to 100%.

Conclusions: HIVST could increase HIV testing frequency and potentially have capacity equivalent to that of site-based HIV testing services to reach first-time, delayed, married, and HIV-infected testers among MSM and link them to medical care. However, more rigorous study designs are needed to explore the specific self-testing approach (oral-fluid based or finger-prick based) on improving HIV testing for MSM in different social and economic settings.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of selection procedure and outcomes of this systematic review.
Fig 2
Fig 2. Meta-analysis on mean number of HIV tests for MSM in a 6-month period.
Fig 3
Fig 3. Meta-analysis of the proportion of first-time testers among MSM ever taking HIVST.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 4
Fig 4. Meta-analysis of the proportion of first-time testers in high-income countries.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 5
Fig 5. Meta-analysis of the proportion of first-time testers in resource constrained countries.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 6
Fig 6. Meta-analysis of the proportion of non-recent testers among MSM.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 7
Fig 7. Meta-analysis of the proportion of non-recent testers in high-income countries.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 8
Fig 8. Meta-analysis of the proportion of non-recent testers in resource constrained countries.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 9
Fig 9. Meta-analysis of the proportion of ever or currently married MSM.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 10
Fig 10. Meta-analysis of the proportion of HIV-positive men among MSM.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 11
Fig 11. Meta-analysis of the proportion of HIV-positive men in high-income countries.
Without comparison, this figure just presented OR value of pooled single proportion.
Fig 12
Fig 12. Meta-analysis of the proportion of HIV-positive men in resource-limited countries.
Without comparison, this figure just presented OR value of pooled single proportion.
See this image and copyright information in PMC

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