Abstract
BackgroundGlobally, 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.MethodsSeven 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.ResultsOf 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%.ConclusionsHIVST 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.
Highlights
Approximately 36.7 million individuals are living with HIV, with about 2.2 million new cases identified annually over the past 5 years[1,2,3,4]
The pooled results showed that HIV self-testing (HIVST) increased HIV test frequency for men who have sex with men (MSM) by one additional test in a 6-month period
The pooled proportion of first-time testers among those who took HIVST was 18.7% globally, with a rate 3.32 times higher in resource-limited country settings (32.9% [95% confidence intervals (95% CI): 21.3–47.6]) than in high-income countries (9.9% [95% CI: 7.4–13.8])
Summary
Approximately 36.7 million individuals are living with HIV, with about 2.2 million new cases identified annually over the past 5 years[1,2,3,4]. Men who have sex with men (MSM) account for 30% of all HIV infected people in the world [3], and 49% of the cases in MSM are reported in Western Europe, Central Europe, and North America [3]. The HIV epidemic is rapidly growing among MSM in some regions of the world, especially in China with 29.4% of new infections occurring among MSM [5]. 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. Evidence is scattered and not well-summarized on the effect of HIVST to improve HIV testing behaviors, especially for MSM
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