Feasibility of MHealth Interventions towards Promoting HIV Self-testing Uptake in Sub-Saharan Africa: A Systematic Review of Literature

Abstract

Background: HIV self-testing (HIVST) with mobile health technology (mHealth) support is the use of mobile phone-based interventions to complement HIVST in order to improve its efficiency and uptake. Existing reviews leaves a gap in the evidence that summarizes efforts on the feasibility of mHealth to promote HIVST uptake within Sub-Saharan Africa (SSA). Objective: This study synthesized existing research on the feasibility of mobile health technology (mHealth) aimed at promoting HIV self-testing (HIVST) uptake within SSA using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result: Eleven studies met the inclusion criteria and were narratively synthesized, 63% of which were observational studies while 37% were randomized control trials. Mobile applications, SMS or a combination of mHealth strategies were mostly used to promote HIVST uptake. Most studies were carried out in South Africa (54%), and in the general population (54%). Feasibility metrics were inconsistently reported across studies because its definitions varied, nonetheless most studies reported one or more feasibility metrics and HIVST uptake was the most common way (81%) of assessing feasibility. SMS-based interventions significantly increased HIVST uptake among hard-to-reach populations and were effective for reporting testing outcomes. Mobile applications guided participants through testing, result interpretation, and self-reporting HIVST results, and most studies reported high HIVST uptake (89.0%–100%). Compared to HIVST alone, call-based intervention enhanced HIVST uptake and linkage to care or prevention (p = 0.021). Most studies found combined mHealth interventions highly feasible (78.9%–99.2%). Conclusion: Feasibility was variable between the diverse mHealth supports used to promote HIVST uptake. While findings pave the way for greater use of mHealth supported HIVST, future research should consider using rigorous research designs and focus on populations disproportionately affected by HIV within diverse SSA regions to ensure broad applicability. Feasibility measures should also be standardized for uniform reporting across studies.