Outcomes of interventions to optimize linkage to HIV care and antiretroviral therapy (ART) initiation after HIV self-testing: A scoping review.

Abstract

Human immunodeficiency virus (HIV) self-testing is an innovative solution to the problem of low HIV testing coverage. It can help in realizing the first "95" of the Joint United Nations Programme on HIV/AIDS targets in the HIV treatment cascade. However, there is limited information to guide how those who self-test and show positive results can successfully be linked to HIV care and treatment. Therefore, this scoping review aimed at synthesizing available evidence of the outcomes of intervention strategies to optimize linkage to HIV care after HIV self-testing. Our methodology followed Arksey and O'Malley's methodological framework. Two independent reviewers screened and extracted data based on predetermined criteria. The databases searched included PubMed, EBSCOhost, Web of Science, Cochrane Library, Scopus, Mednar, and the International Clinical Trials Registry Platform. A total of 4809 records were retrieved. After full-text screening, 14 studies met the inclusion criteria for the review. The intervention strategies reported were classified into four main categories: technology-assisted interventions, innovative HIV self-testing kits distribution mechanisms, financial incentive, social entrepreneurship models, and the use of key community opinion leaders and social media influencers. This scoping review found men who have sex with men as the main recipients of the interventions to improve the rate of linkage to HIV care following HIV self-testing. Studies that met the inclusion criteria reported mixed findings on the outcomes of interventions to improve the rate of linkage to HIV care following HIV self-testing. Financial incentives, interventions leveraging technology, and key opinion leaders were the most effective strategies. Given that the included studies did not employ a uniform system of measurement of effectiveness, there is a need for identification of standardized definitions and clear indicators for evaluating linkage to care and antiretroviral therapy (ART) initiation following HIV self-testing.