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

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 Electronic Health Interventions for Promoting HIV-Preventive Behaviors Among Men Who Have Sex With Men: Meta-Analysis Based on an Integrative Framework of Design and Implementation Features (Preprint)

10.2196/preprints.15977 ◽

2019 ◽

Author(s):

Meiqi Xin ◽

Kasisomayajula Viswanath ◽

Angela Yuen-Chun Li ◽

Wangnan CAO ◽

Yuhong HU ◽

...

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Treatment Duration ◽

Meta Analysis ◽

Preventive Behaviors ◽

Intervention Effects ◽

Design And Implementation ◽

Intervention Adherence ◽

Electronic Health ◽

Sex With Men

BACKGROUND The disproportionately high prevalence of HIV among men who have sex with men (MSM) is a global concern. Despite the increasing utilization of electronic health (eHealth) technology in the delivery of HIV prevention interventions, few studies have systematically explored its effectiveness and association with various intervention characteristics. OBJECTIVE This study aimed to conduct a meta-analysis of the effectiveness of eHealth technology–based interventions for promoting HIV-preventive behaviors among MSM and to determine effectiveness predictors within a framework integrating design and implementation features. METHODS A systematic literature search using terms related to eHealth technology, HIV, the MSM population, and an experimental study design was performed using 5 databases (ie, MEDLINE, PsycINFO, EMBASE, Web of Science, and ProQuest Dissertations & Theses) and other sources (eg, bibliographies of relevant reviews and JMIR Publications). First, primary meta-analyses were conducted to estimate the effectiveness of eHealth interventions (d+) in changing 3 HIV-preventive behaviors among MSM: unprotected anal intercourse (UAI), HIV testing, and multiple sex partnership (MSP). Moderation analyses were then conducted to examine a priori effectiveness predictors including behavioral treatment components (eg, theory use, tailoring strategy use, navigation style, and treatment duration), eHealth technology components (eg, operation mode and modality type), and intervention adherence. RESULTS A total of 46 studies were included. The overall effect sizes at end point were small but significant for all outcomes (UAI: d+=−.21, P<.001; HIV testing: d+=.38, P<.001; MSP: d+=−.26, P=.02). The intervention effects on UAI were significantly larger when compared with preintervention groups than with concurrent groups. Greater UAI reductions were associated with the increased use of tailoring strategies, provision of feedback, and tunneling navigation in interventions with a concurrent group, whereas reductions were associated with the use of self-paced navigation in interventions with a preintervention group. Greater uptake of HIV testing was associated with longer treatment duration; computer-mediated communication; and the use of messaging, social media, or a combined technology modality. Higher intervention adherence consistently predicted larger effects on UAI and HIV testing. CONCLUSIONS This study provided empirical evidence for the effectiveness of eHealth interventions in promoting HIV-preventive behaviors among MSM. Features of treatment content and eHealth technology might best predict the intervention effects on UAI and HIV testing, respectively. Most importantly, intervention adherence tended to play an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.

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HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-analysis

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/00126334-200207011-00011 ◽

2002 ◽

Vol 30 ◽

pp. S118-S129 ◽

Cited By ~ 5

Author(s):

Wayne D. Johnson ◽

Larry V. Hedges ◽

Gilbert Ramirez ◽

Salaam Semaan ◽

Lisa R. Norman ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Meta Analysis ◽

Prevention Research ◽

Sex With Men

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Behavioral Interventions Improve Condom Use and HIV Testing Uptake Among Female Sex Workers in China: A Systematic Review and Meta-Analysis

AIDS Patient Care and STDs ◽

10.1089/apc.2015.0043 ◽

2015 ◽

Vol 29 (8) ◽

pp. 454-460 ◽

Cited By ~ 8

Author(s):

Eric P.F. Chow ◽

Keith Tung ◽

Joseph D. Tucker ◽

Kathryn E. Muessig ◽

Shu Su ◽

...

Keyword(s):

Systematic Review ◽

Condom Use ◽

Hiv Testing ◽

Sex Workers ◽

Behavioral Interventions ◽

Female Sex Workers ◽

Meta Analysis ◽

Female Sex ◽

Testing Uptake

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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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The Effectiveness of Electronic Health Interventions for Promoting HIV-Preventive Behaviors Among Men Who Have Sex With Men: Meta-Analysis Based on an Integrative Framework of Design and Implementation Features

Journal of Medical Internet Research ◽

10.2196/15977 ◽

2020 ◽

Vol 22 (5) ◽

pp. e15977

Author(s):

Meiqi Xin ◽

Kasisomayajula Viswanath ◽

Angela Yuen-Chun Li ◽

Wangnan CAO ◽

Yuhong HU ◽

...

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Treatment Duration ◽

Meta Analysis ◽

Preventive Behaviors ◽

Intervention Effects ◽

Design And Implementation ◽

Intervention Adherence ◽

Electronic Health ◽

Sex With Men

Background The disproportionately high prevalence of HIV among men who have sex with men (MSM) is a global concern. Despite the increasing utilization of electronic health (eHealth) technology in the delivery of HIV prevention interventions, few studies have systematically explored its effectiveness and association with various intervention characteristics. Objective This study aimed to conduct a meta-analysis of the effectiveness of eHealth technology–based interventions for promoting HIV-preventive behaviors among MSM and to determine effectiveness predictors within a framework integrating design and implementation features. Methods A systematic literature search using terms related to eHealth technology, HIV, the MSM population, and an experimental study design was performed using 5 databases (ie, MEDLINE, PsycINFO, EMBASE, Web of Science, and ProQuest Dissertations & Theses) and other sources (eg, bibliographies of relevant reviews and JMIR Publications). First, primary meta-analyses were conducted to estimate the effectiveness of eHealth interventions (d+) in changing 3 HIV-preventive behaviors among MSM: unprotected anal intercourse (UAI), HIV testing, and multiple sex partnership (MSP). Moderation analyses were then conducted to examine a priori effectiveness predictors including behavioral treatment components (eg, theory use, tailoring strategy use, navigation style, and treatment duration), eHealth technology components (eg, operation mode and modality type), and intervention adherence. Results A total of 46 studies were included. The overall effect sizes at end point were small but significant for all outcomes (UAI: d+=−.21, P<.001; HIV testing: d+=.38, P<.001; MSP: d+=−.26, P=.02). The intervention effects on UAI were significantly larger when compared with preintervention groups than with concurrent groups. Greater UAI reductions were associated with the increased use of tailoring strategies, provision of feedback, and tunneling navigation in interventions with a concurrent group, whereas reductions were associated with the use of self-paced navigation in interventions with a preintervention group. Greater uptake of HIV testing was associated with longer treatment duration; computer-mediated communication; and the use of messaging, social media, or a combined technology modality. Higher intervention adherence consistently predicted larger effects on UAI and HIV testing. Conclusions This study provided empirical evidence for the effectiveness of eHealth interventions in promoting HIV-preventive behaviors among MSM. Features of treatment content and eHealth technology might best predict the intervention effects on UAI and HIV testing, respectively. Most importantly, intervention adherence tended to play an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.

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Association between opioid agonist therapy use and HIV testing uptake among people who have recently injected drugs: a systematic review and meta‐analysis

Addiction ◽

10.1111/add.15316 ◽

2020 ◽

Author(s):

Claire F. Ferraro ◽

Daniel E. Stewart ◽

Jason Grebely ◽

Lucy T. Tran ◽

Shally Zhou ◽

...

Keyword(s):

Systematic Review ◽

Hiv Testing ◽

Meta Analysis ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Testing Uptake

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HIV Prevention Research for Men Who Have Sex with Men: A Systematic Review and Meta-analysis

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/00042560-200207011-00011 ◽

2002 ◽

Vol 30 ◽

pp. S118-S129 ◽

Cited By ~ 91

Author(s):

Wayne D. Johnson ◽

Larry V. Hedges ◽

Gilbert Ramirez ◽

Salaam Semaan ◽

Lisa R. Norman ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Meta Analysis ◽

Prevention Research ◽

Sex With Men

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Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.783626 ◽

2022 ◽

Vol 8 ◽

Author(s):

Junyan Jin ◽

Runsong Sun ◽

Tingting Mu ◽

Taiyi Jiang ◽

Lili Dai ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Meta Analysis ◽

Post Exposure Prophylaxis ◽

Structural Barriers ◽

Post Exposure ◽

At Risk Populations ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Over Time

Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations.Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815).Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership.Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers.Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].

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