A systematic review and meta-analysis of the evidence for community-based HIV testing on men's engagement in the HIV care cascade. (November 2022)

• Record Type: Journal Article
• Authors: Groves, Allison K; Stankard, Petra; Bowler, Sarah L; Jamil, Muhammad S; Gebrekristos, Luwam T; Smith, Patrick D; Quinn, Caitlin; Ba, Ndoungou Salla; Chidarikire, Thato; Nguyen, Van Thi Thuy; Baggaley, Rachel; Johnson, Cheryl
• Is Part Of: International journal of STD & AIDS. Volume 33:Number 13(2022)
• Page Start: 1090
• Page End: 1105
• Publication Date: 2022-11
• Subjects: Community -- testing -- HIV care continuum -- HIV prevention -- gender -- men who have sex with men; Sexually transmitted diseases -- Periodicals; AIDS (Disease) -- Periodicals; 616.951
• DOI: 10.1177/09564624221111277
• Languages: English
• ISSNs: 0956-4624

Abstract

Objective: Men with HIV are less likely than women to know their status, be on antiretroviral therapy, and be virally suppressed. This review examined men's community-based HIV testing services (CB-HTS) outcomes. Design: Systematic review and meta-analysis. Methods: We searched seven databases and conference abstracts through July 2018. We estimated pooled proportions and/or risk ratios (for meta-analyses) for each outcome using random effects models. Results: 188 studies met inclusion criteria. Common testing models included targeted outreach (e.g. mobile testing), home-based testing, and testing at stand-alone community sites. Across 25 studies reporting uptake, 81% (CI: 75–86%) of men offered testing accepted it. Uptake was higher among men reached through CB-HTS than facility-based HTS (RR = 1.39; CI: 1.13–1.71). Over 69% (CI: 64–71%) of those tested through CB-HTS were men, across 184 studies. Across studies reporting new HIV-positivity among men ( n = 18), 96% were newly diagnosed (CI: 77–100%). Across studies reporting linkage to HIV care ( n = 8), 70% (CI: 36–103%) of men were linked to care. Across 57 studies reporting sex-disaggregated data for CB-HTS conducted among key populations, men's uptake was high (80%; CI: 70–88%) and nearly all were newly diagnosed and linked to care (95%; CI: 94–100%; and 94%; CI: 88–100%, respectively). Conclusion: CB-HTS is an important strategy for reaching undiagnosed men with HIV from the general population and key population groups, particularly using targeted outreach models. When compared to facility-based HIV testing services, men tested through CB-HTS are more likely to uptake testing, and nearly all men who tested positive through CB-HTS were newly diagnosed. Linkage to care may be a challenge following CB-HTS, and greater efforts and research are needed to effectively implement testing strategies that facilitate rapid ART initiation and linkage to prevention services.