Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 11, 2023
Date Accepted: Dec 14, 2023
Counseling Supporting HIV Self-testing and Linkage to Care Among Men Who Have Sex with Men: A Systematic Review and Meta-analysis
ABSTRACT
Background:
Counseling supporting HIV self-testing (HIVST) is helpful to facilitate linkage to care and to promote behavioral changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care.
Objective:
This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care.
Methods:
A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from MEDLINE, Global Health, Web of Science, Embase, APA Psyclnfo, and Scopus. This search encompassed published papers and preprints between July 3, 2012 and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST and/or quantitative outcomes for linkage to care among MSM and published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institute of Health (NIH) quality assessment tool. Data was extracted using random-effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and meta-regression were conducted to assess whether linkage to care varied by different study characteristics. All analyses were performed by R version 4.2.1 (R Core Team, 2022, Vienna, Austria) using the metafor package.
Results:
A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials (RCT), were identified. Among these studies, 50 provided active counseling support, while 5 provided passive counseling support. In studies providing active counseling support, the majority of MSM HIVST users were linked to various forms of care, including reporting test results (97.2%; 95% CI=74.3-99.8%), laboratory confirmation (92.6%; 95% CI=86.1-96.2%), antiretroviral therapy (ART) initiation (90.8%; 95% CI=86.7-93.7%), and referred to physicians (96.3%; 95% CI=85.0-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%; 95% CI=17.8-98.4%), ART initiation (79.1%; 95% CI=48.8-93.7%), and referred to physicians (79.1%; 95% CI=0.0-100.0%). Multivariate meta-regression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the utilization of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of studies varied from fair to good, with a low to high risk of bias.
Conclusions:
Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase linkage to care among MSM HIVST users. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews 2022 CRD42022346247
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