Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Oct;28(10):3338-3349.
doi: 10.1007/s10461-024-04415-x. Epub 2024 Jul 4.

Understanding Practical, Robust Implementation and Sustainability of Home-based Comprehensive Sexual Health Care: A Realist Review

Cornelia Johanna Dorothy Hanneke Goense  1   2   3 , Thuan-Huong P Doan  4 , Eneyi E Kpokiri  5 , Ymke J Evers  6   7 , Claudia S Estcourt  8 , Rik Crutzen  9 , Jeffrey D Klausner  4 , Weiming Tang  10 , Paula Baraitser  11 , Christian J P A Hoebe  6   7   12 , Nicole H T M Dukers-Muijrers  7   9
Affiliations
Review

Understanding Practical, Robust Implementation and Sustainability of Home-based Comprehensive Sexual Health Care: A Realist Review

Cornelia Johanna Dorothy Hanneke Goense et al. AIDS Behav. 2024 Oct.

Abstract

This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations.

Keywords: Comprehensive care; HIV testing; Home care services; Intervention; Key populations; Realist review; STI testing; Sexual health care.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Initial program theory: theoretical framework of context, mechanisms, and outcomes
Fig. 2
Fig. 2
Flowchart of study search strategy through an iterative search process
Fig. 3
Fig. 3
Context and mechanisms that enhance maintenance of home-based comprehensive sexual health care and uptake of STI/HIV testing
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization. Report on global sexually transmitted infection surveillance. 2018. https://apps.who.int/iris/handle/10665/277258. Accessed 16 Dec 2022.
    1. World Health Organization. Global prevalence and incidence of selected curable sexually transmitted infections overview and estimates. 2001. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-in...). Accessed 16 Dec 2022.
    1. Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010;20:422–32. - PubMed
    1. Denison HJ, Bromhead C, Grainger R, Dennison EM, Jutel A. Barriers to sexually transmitted infection testing in New Zealand: a qualitative study. Aust N Z J Public Health. 2017;41:432–7. - PMC - PubMed
    1. Kersh EN, Shukla M, Raphael BH, Habel M, Park I. At-home specimen self-collection and self-testing for sexually transmitted infection screening demand accelerated by the COVID-19 pandemic: a review of laboratory implementation issues. J Clin Microbiol. 2021;59. - PMC - PubMed

LinkOut - more resources