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Meta-Analysis
. 2022 Nov;33(13):1090-1105.
doi: 10.1177/09564624221111277. Epub 2022 Jul 3.

A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade

Allison K Groves  1 , Petra Stankard  2 , Sarah L Bowler  1 , Muhammad S Jamil  3 , Luwam T Gebrekristos  1 , Patrick D Smith  1 , Caitlin Quinn  3 , Ndoungou Salla Ba  3 , Thato Chidarikire  4 , Van Thi Thuy Nguyen  3 , Rachel Baggaley  3 , Cheryl Johnson  3
Affiliations
Meta-Analysis

A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade

Allison K Groves et al. Int J STD AIDS. 2022 Nov.

Erratum in

Abstract

Objective: Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men's community-based HIV testing services (CB-HTS) outcomes.

Design: Systematic review and meta-analysis.

Methods: We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models.

Results: 188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75-86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13-1.71). Over 69% (CI: 64-71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men (n = 18), 96% were newly diagnosed (CI: 77-100%). Across studies reporting linkage to HIV care (n = 8), 70% (CI: 36-103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men's uptake was high (80%; CI: 70-88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94-100%; and 94%; CI: 88-100%, respectively).

Conclusion: CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.

Keywords: Community; HIV care continuum; HIV prevention; gender; men who have sex with men; testing.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Consort diagram.
Figure 2.
Figure 2.
Uptake and new HIV diagnoses of men reached through CB-HTS.
Figure 3.
Figure 3.
Comparing uptake of HIV testing for men reached through CB HTS and facility-based HTS.
Figure 4.
Figure 4.
Comparing proportion of males among those tested through CB HTS and facility-based HTS.
See this image and copyright information in PMC

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