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Meta-Analysis
. 2024 Dec;27(12):e26388.
doi: 10.1002/jia2.26388.

Linkage to care and prevention after HIV self-testing: a systematic review and meta-analysis

Ying Zhang  1   2 , Su Mei Goh  3 , James Tapa  1   2 , Cheryl C Johnson  4 , Eric P F Chow  1   2   5 , Lei Zhang  1   2 , Tiffany Phillips  1   2 , Christopher K Fairley  1   2 , Jason J Ong  1   2   6
Affiliations
Meta-Analysis

Linkage to care and prevention after HIV self-testing: a systematic review and meta-analysis

Ying Zhang et al. J Int AIDS Soc. 2024 Dec.

Abstract

Introduction: Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.

Methods: Following PRISMA guidelines, a comprehensive search across eight databases (2010-October 2023) identified studies on linkage to care after HIVST, defined as receiving a confirmatory test or initiating 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 summarized the findings and meta-regression explored study-level covariates, such as world region, population type and service delivery model, that might explain the between-study heterogeneity.

Results: From 10,071 screened studies, 173 were included in the meta-analysis. The majority of studies focused on key populations in Africa using unassisted, oral fluid-based HIVST kits. Among those with reactive HIVST results, 92% (95% confidence interval [CI]: 88-95) were linked to confirmatory testing (n = 124 studies), and 89% (95% CI: 84-93) of newly diagnosed individuals initiated ART (n = 88 studies). Overall, 84% (95% CI: 74-93) of self-testers were linked to care (n = 69 studies). However, only 9% (95% CI: 2-19) of individuals with non-reactive HIVST results were linked to PrEP services (n = 9 studies). Assisted HIVST was associated with higher linkage rates to confirmatory testing and ART initiation compared to unassisted testing. Meta-regression revealed 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.

Discussion: In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly when assisted HIVST or SNA-based distribution is used.

Conclusions: Strengthening timely linkage is vital for improving health outcomes, reducing HIV transmission and achieving the UNAIDS 95-95-95 goal. Ongoing research and collaboration with community-based organizations are needed to overcoming barriers and ensuring positive outcomes for those using HIVST.

Prospero number: CRD42022357570.

Keywords: ART; HIV; PrEP; confirmatory testing; linkage; self‐test.

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Conflict of interest statement

All authors declare no competing interests.

Figures

Figure 1
Figure 1
Prisma flow diagram.
Figure 2
Figure 2
Forest plot for the proportion who were linked to confirmatory testing in social network‐based approach.
See this image and copyright information in PMC

References

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