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

AK Groves, P Stankard, SL Bowler… - … journal of STD & …, 2022 - journals.sagepub.com
AK Groves, P Stankard, SL Bowler, MS Jamil, LT Gebrekristos, PD Smith, C Quinn, NS Ba…
International journal of STD & AIDS, 2022journals.sagepub.com
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 …
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.
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