JMIR Publications

ABSTRACT

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 being increasingly being used to support HIV prevention efforts, and a growing number of studies have trialled 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. Sub-meta-analyses 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 randomised or observational cohort design with pre- and post-intervention measured and published in English between 2010 – 2018 were included. Pooled effect estimates were calculated using a random effects meta-analysis. Sub-analyses calculated effect estimates grouped by selected features of digital interventions

Results:

Thirteen randomised 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 categorised as interactive and allowed user engagement, and most directly facilitated testing (n=7) either through providing self-testing kits or referral to testing services. 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 unexposed MSM and TW (RR: 1.5; 95% CI: 1.3 – 1.7). Sub-analyses suggested 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 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.