Promoting the uptake of HIV testing among men who have sex with men: systematic review of effectiveness and cost-effectiveness

Abstract Global AIDS guidelines have prioritized the expansion of HIV testing among the groups most exposed to the virus, such as those referred to as men who have sex with men (MSM). This paper analyses the relationships between the production of prevention strategies and sexual moralities based on the results of a systematic review of academic literature about testing with gays and MSM (2005-2015, using the PubMed, Sociological Abstract and Lilacs databases). The analysis of 65 articles reveals the recruitment strategies for identifying target-subjects and how they are held responsible for their serological self-surveillance, including routine tests. The findings also point to a diversification of testing locations. Implicit assumptions about sexuality and gay affection are conveyed through the interventions’ emphasis on sociability spaces and occasional sex, especially when facilitated by the use of apps. Attentive to the symbolic dimensions of the new prevention technologies and strategies, we argue that the expansion of testing with a focus on “MSM” signals a displacement of health interventions. If before actions to control the epidemic sought to intervene in sexual practices, the current efforts are concentrated on promoting self-surveillance of one’s serological status.

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Economic evaluation of HIV testing options for low-prevalence high-income countries: a systematic review

Health Economics Review ◽

10.1186/s13561-021-00318-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Olanrewaju Medu ◽

Adegboyega Lawal ◽

Doug Coyle ◽

Kevin Pottie

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Hiv Testing ◽

High Income ◽

Economic Evaluations ◽

Rapid Hiv Testing ◽

The Cost ◽

Low Prevalence

Abstract Introduction This study reviewed the economic evidence of rapid HIV testing versus conventional HIV testing in low-prevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches. Methods A systematic search of selected databases for relevant English language studies published between Jan 1, 2001, and Jan 30, 2019, was conducted. The methodological design quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Drummond tool. We reported the systematic review according to the PRISMA guidelines. Results Five economic evaluations met the eligibility criteria but varied in comparators, evaluation type, perspective, and design. The methodologic quality of the included studies ranged from medium to high. We found evidence to support the cost-effectiveness of rapid HIV testing approaches in low-prevalence high-income countries. Rapid HIV testing was associated with cost per adjusted life year (QALY), ranging from $42,768 to $90,498. Additionally, regardless of HIV prevalence, rapid HIV testing approaches were the most cost-effective option. Conclusions There is evidence for the cost-effectiveness of rapid HIV testing, including the use of saliva-based testing compared to usual care or hospital-based serum testing. Further studies are needed to draw evidence on the relative cost-effectiveness of the distinct options and contexts of rapid HIV testing.

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HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis

The Lancet HIV ◽

10.1016/s2352-3018(19)30239-5 ◽

2019 ◽

Vol 6 (11) ◽

pp. e769-e787 ◽

Cited By ~ 12

Author(s):

James Stannah ◽

Elizabeth Dale ◽

Jocelyn Elmes ◽

Roisin Staunton ◽

Chris Beyrer ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Meta Analysis ◽

Hiv Treatment ◽

Treatment Cascade ◽

Hiv Treatment Cascade ◽

Sex With Men

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HIV Testing Among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis

AIDS and Behavior ◽

10.1007/s10461-012-0225-y ◽

2012 ◽

Vol 16 (7) ◽

pp. 1717-1728 ◽

Cited By ~ 83

Author(s):

Huachun Zou ◽

Nan Hu ◽

Qianqian Xin ◽

Jack Beck

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Meta Analysis ◽

Sex With Men

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Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis

Journal of Medical Internet Research ◽

10.2196/14230 ◽

2020 ◽

Vol 22 (7) ◽

pp. e14230 ◽

Cited By ~ 1

Author(s):

Vanessa Veronese ◽

Kathleen Elizabeth Ryan ◽

Chad Hughes ◽

Megan SC Lim ◽

Alisa Pedrana ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Hiv Testing ◽

Communication Technology ◽

Digital Technology ◽

Digital Communication ◽

Meta Analysis ◽

Digital Interventions ◽

Testing Uptake ◽

Sex With Men

Background HIV continues to disproportionately affect men who have sex with men (MSM) and transgender women (TW). Undiagnosed HIV is a major driver of HIV transmission rates, and increasing the uptake of regular HIV testing and facilitating timely initiation of HIV treatment is a global HIV prevention priority. However, MSM and TW experience a range of barriers that limit their access to testing and other prevention services. Given their growing ubiquity, digital communication technologies are increasingly being used to support HIV prevention efforts, and a growing number of studies have trialed the use of digital technology to promote HIV testing among MSM and TW. Objective We undertook a systematic review and meta-analysis to assess the impact of digital communication technology on HIV testing uptake among MSM and TW. Subanalyses aimed to identify the features and characteristics of digital interventions associated with greater impact. Methods A systematic literature review was undertaken using select databases and conference repositories. Studies describing the use of a digital technology—internet-enabled devices, including phones, tablets, and computers—to increase HIV testing uptake among MSM or TW using either randomized or observational cohort design with measurement of HIV testing rates measured pre- and postintervention, and published in English between 2010 and 2018 were included. Pooled effect estimates were calculated using a random effects meta-analysis. Subanalyses calculated effect estimates grouped by selected features of digital interventions. Results A total of 13 randomized or observational studies were included in the final review. Digital interventions most commonly used mainstream, existing social media platforms (n=7) or promotion through online peer educators (n=5). Most interventions (n=8) were categorized as interactive and allowed user engagement and most directly facilitated testing (n=7) either by providing self-testing kits or referral to testing services. A total of 1930 participants were included across the 13 studies. HIV testing uptake among MSM and TW exposed to digital interventions was 1.5 times higher than that of unexposed MSM and TW (risk ratio [RR] 1.5; 95% CI 1.3-1.7). Subanalyses suggested an increased impact on HIV testing uptake among interventions that were delivered through mainstream social media–based platforms (RR 1.7; 95% CI 1.3-2.1), included direct facilitation of HIV testing (RR 1.6; 95% CI 1.4-1.9), were interactive (RR 1.6; 95% CI 1.4-1.8), and involved end users in the design process (RR 1.6; 95% CI 1.3-2.0). Conclusions These findings provide broad support for the integration of technology with existing approaches to promote and facilitate HIV testing among MSM and TW. Our findings identified key features that may be associated with greater impact on HIV testing uptake and can be used to inform future development efforts given the growing interest and application of digital technologies in HIV prevention. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42017070055; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017070055.

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Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.14230 ◽

2019 ◽

Author(s):

Vanessa Veronese ◽

Kathleen Elizabeth Ryan ◽

Chad Hughes ◽

Megan SC Lim ◽

Alisa Pedrana ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Hiv Testing ◽

Communication Technology ◽

Digital Technology ◽

Digital Communication ◽

Meta Analysis ◽

Digital Interventions ◽

Testing Uptake ◽

Sex With Men

BACKGROUND HIV continues to disproportionately affect men who have sex with men (MSM) and transgender women (TW). Undiagnosed HIV is a major driver of HIV transmission rates, and increasing the uptake of regular HIV testing and facilitating timely initiation of HIV treatment is a global HIV prevention priority. However, MSM and TW experience a range of barriers that limit their access to testing and other prevention services. Given their growing ubiquity, digital communication technologies are increasingly being used to support HIV prevention efforts, and a growing number of studies have trialed the use of digital technology to promote HIV testing among MSM and TW. OBJECTIVE We undertook a systematic review and meta-analysis to assess the impact of digital communication technology on HIV testing uptake among MSM and TW. Subanalyses aimed to identify the features and characteristics of digital interventions associated with greater impact. METHODS A systematic literature review was undertaken using select databases and conference repositories. Studies describing the use of a digital technology—internet-enabled devices, including phones, tablets, and computers—to increase HIV testing uptake among MSM or TW using either randomized or observational cohort design with measurement of HIV testing rates measured pre- and postintervention, and published in English between 2010 and 2018 were included. Pooled effect estimates were calculated using a random effects meta-analysis. Subanalyses calculated effect estimates grouped by selected features of digital interventions. RESULTS A total of 13 randomized or observational studies were included in the final review. Digital interventions most commonly used mainstream, existing social media platforms (n=7) or promotion through online peer educators (n=5). Most interventions (n=8) were categorized as interactive and allowed user engagement and most directly facilitated testing (n=7) either by providing self-testing kits or referral to testing services. A total of 1930 participants were included across the 13 studies. HIV testing uptake among MSM and TW exposed to digital interventions was 1.5 times higher than that of unexposed MSM and TW (risk ratio [RR] 1.5; 95% CI 1.3-1.7). Subanalyses suggested an increased impact on HIV testing uptake among interventions that were delivered through mainstream social media–based platforms (RR 1.7; 95% CI 1.3-2.1), included direct facilitation of HIV testing (RR 1.6; 95% CI 1.4-1.9), were interactive (RR 1.6; 95% CI 1.4-1.8), and involved end users in the design process (RR 1.6; 95% CI 1.3-2.0). CONCLUSIONS These findings provide broad support for the integration of technology with existing approaches to promote and facilitate HIV testing among MSM and TW. Our findings identified key features that may be associated with greater impact on HIV testing uptake and can be used to inform future development efforts given the growing interest and application of digital technologies in HIV prevention. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42017070055; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017070055.

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The Effectiveness of Social Marketing Interventions to Improve HIV Testing Among Gay, Bisexual and Other Men Who Have Sex with Men: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-019-02507-7 ◽

2019 ◽

Vol 23 (9) ◽

pp. 2273-2303 ◽

Cited By ~ 3

Author(s):

Lisa McDaid ◽

Julie Riddell ◽

Gemma Teal ◽

Nicola Boydell ◽

Nicky Coia ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Social Marketing ◽

Sex With Men

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The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081700 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1700 ◽

Cited By ~ 8

Author(s):

Kevin Pottie ◽

Tamara Lotfi ◽

Lama Kilzar ◽

Pamela Howeiss ◽

Nesrine Rizk ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

High Risk ◽

Hiv Testing ◽

Systematic Reviews ◽

Rapid Test ◽

European Economic Area ◽

Rapid Testing ◽

Migrant Populations ◽

Resource Requirements

Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.

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