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Cited by 210HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskBlood donation and transfusion practices

Comparing the effects of HIV self-testing to standard HIV testing for key populations: a systematic review and meta-analysis

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Witzel, T. Charles, Eshun-Wilson, Ingrid, Jamil, Muhammad S., Tilouche, Nerissa, Figueroa, Carmen, Johnson, Cheryl C., Reid, David, Baggaley, Rachel +4 more·2020·BMC Medicine
DOI 10.1186/s12916-020-01835-zPMC PMC7713313
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Abstract

Background: We update a previous systematic review to inform new World Health Organization HIV self-testing (HIVST) recommendations. We compared the effects of HIVST to standard HIV testing services to understand which service delivery models are effective for key populations. Methods: We did a systematic review of randomised controlled trials (RCTs) which compared HIVST to standard HIV testing in key populations, published from 1 January 2006 to 4 June 2019 in PubMed, Embase, Global Index Medicus, Social Policy and Practice, PsycINFO, Health Management Information Consortium, EBSCO CINAHL Plus, Cochrane Library and Web of Science. We extracted study characteristic and outcome data and conducted risk of bias assessments using the Cochrane ROB tool version 1. Random effects meta-analyses were conducted, and pooled effect estimates were assessed along with other evidence characteristics to determine the overall strength of the evidence using GRADE methodology. Results: After screening 5909 titles and abstracts, we identified 10 RCTs which reported on testing outcomes. These included 9679 participants, of whom 5486 were men who have sex with men (MSM), 72 were trans people and 4121 were female sex workers. Service delivery models included facility-based, online/mail and peer distribution. Support components were highly diverse and ranged from helplines to training and supervision. HIVST increased testing uptake by 1.45 times (RR=1.45 95% CI 1.20, 1.75). For MSM and small numbers of trans people, HIVST increased the mean number of HIV tests by 2.56 over follow-up (mean difference = 2.56; 95% CI 1.24, 3.88). There was no difference between HIVST and SoC in regard to positivity among tested overall (RR = 0.91; 95% CI 0.73, 1.15); in sensitivity analysis of positivity among randomised HIVST identified significantly more HIV infections among MSM and trans people (RR = 2.21; 95% CI 1.20, 4.08) and in online/mail distribution systems (RR = 2.21; 95% CI 1.14, 4.32). Yield of positive results in FSW was not significantly different between HIVST and SoC. HIVST reduced linkage to care by 17% compared to SoC overall (RR = 0.83; 95% CI 0.74, 0.92). Impacts on STI testing were mixed; two RCTs showed no decreases in STI testing while one showed significantly lower STI testing in the intervention arm. There were no negative impacts on condom use (RR = 0.95; 95% CI 0.83, 1.08), and social harm was very rare. Conclusions: HIVST is safe and increases testing uptake and frequency as well as yield of positive results for MSM and trans people without negative effects on linkage to HIV care, STI testing, condom use or social harm. Testing uptake was increased for FSW, yield of positive results were not and linkage to HIV care was worse. Strategies to improve linkage to care outcomes for both groups are crucial for effective roll-out.

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  • Findings are similar to those reported in HIV self-testing studies, which indicated high levels of safety and efficacy across self-testing in different disease areas.

    “Findings are similar to those reported in HIV self-testing studies, which indicated high levels of safety and efficacy across self-testing in different disease areas (76-78).”

    From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [78]

    The Conclusions report that HIV self-testing was safe and increased testing uptake and frequency for men who have sex with men and trans people, although results for female sex workers were mixed. This paper addresses HIV self-testing only; it does not support the claim about self-testing across different disease areas. (LLM, conf=0.87)

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Authors
Witzel, T. C., Eshun-Wilson, I., Jamil, M. S., Tilouche, N., Figueroa, C., Johnson, C. C., Reid, D., Baggaley, R., Siegfried, N., Burns, F. M., Rodger, A. J., & Weatherburn, P.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • World Health Organization (CH)
  • University College London (GB)
Corresponding author
Witzel, T. Charles
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2020-12
Volume
18
Issue
1
Pages
381-381
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-020-01835-z
PMC
PMC7713313
OpenAlex
W3109229692
Cited by
210
References
43
Citations by year
2026: 24 · 2025: 36 · 2024: 43 · 2023: 36 · 2022: 45 · 2021: 23 · 2020: 3
FWCI
1.26
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute for Health Research (PG-1212-20006)
  • Bill and Melinda Gates Foundation (OPP1177903)
  • Unitaid (PO#10140–0-600, PO#8477–0-600)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Social Sciences › Business, Management and Accounting › Management of Technology and Innovation › Blood donation and transfusion practices
Keywords
HIV self-testing, key populations, men who have sex with men, transgender people, female sex workers, HIV testing uptake, linkage to care, HIV seropositivity, facility-based HIV testing, HIV prevention, service delivery models
MeSH terms
HIV Testing, Self-Testing, Female, Humans, Male, HIV Infections, Homosexuality, Male

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