Johnson Cheryl C, Kennedy Caitlin, Fonner Virginia, Siegfried Nandi, Figueroa Carmen, Dalal Shona, Sands Anita, Baggaley Rachel
Department of HIV, World Health Organization, Geneva, Switzerland.
Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
J Int AIDS Soc. 2017 May 15;20(1):21594. doi: 10.7448/IAS.20.1.21594.
HIV self-testing (HIVST) is a discreet and convenient way to reach people with HIV who do not know their status, including many who may not otherwise test. To inform World Health Organization (WHO) guidance, we assessed the effect of HIVST on uptake and frequency of testing, as well as identification of HIV-positive persons, linkage to care, social harm, and risk behaviour.
We systematically searched for studies comparing HIVST to standard HIV testing until 1 June 2016. Meta-analyses of studies reporting comparable outcomes were conducted using a random-effects model for relative risks (RR) and 95% confidence intervals. The quality of evidence was evaluated using GRADE.
After screening 638 citations, we identified five randomized controlled trials (RCTs) comparing HIVST to standard HIV testing services among 4,145 total participants from four countries. All offered free oral-fluid rapid tests for HIVST and were among men. Meta-analysis of three RCTs showed HIVST doubled uptake of testing among men (RR = 2.12; 95% CI: 1.51, 2.98). Meta-analysis of two RCTs among men who have sex with men showed frequency of testing nearly doubled (Rate ratio = 1.88; 95% CI: 1.17; 3.01), resulting in two more tests in a 12-15-month period (Mean difference = 2.13; 95% CI: 1.59, 2.66). Meta-analysis of two RCTs showed HIVST also doubled the likelihood of an HIV-positive diagnosis (RR = 2.02; 95% CI: 0.37, 10.76, 5.32). Across all RCTs, there was no indication of harm attributable to HIVST and potential increases in risk-taking behaviour appeared to be minimal.
HIVST is associated with increased uptake and frequency of testing in RCTs. Such increases, particularly among those at risk who may not otherwise test, will likely identify more HIV-positive individuals as compared to standard testing services alone. However, further research on how to support linkage to confirmatory testing, prevention, treatment and care services is needed. WHO now recommends HIVST as an additional HIV testing approach.
艾滋病毒自我检测（HIVST）是一种隐秘且便捷的方式，能够让那些尚不知自身感染状况的艾滋病毒感染者接受检测，其中包括许多原本可能不会进行检测的人。为了为世界卫生组织（WHO）的指导意见提供依据，我们评估了HIVST对检测接受率和检测频率的影响，以及对艾滋病毒阳性者的识别、与护理的联系、社会危害和风险行为。
我们系统检索了截至2016年6月1日将HIVST与标准艾滋病毒检测进行比较的研究。对报告了可比结果的研究进行荟萃分析，使用随机效应模型计算相对风险（RR）和95%置信区间。使用GRADE评估证据质量。
在筛选了638篇文献后，我们确定了五项随机对照试验（RCT），这些试验在来自四个国家的4145名参与者中比较了HIVST与标准艾滋病毒检测服务。所有试验都为HIVST提供免费的口腔液快速检测，且参与者均为男性。对三项RCT的荟萃分析表明，HIVST使男性的检测接受率翻倍（RR = 2.12；95% CI：1.51，2.98）。对两项针对男男性行为者（MSM）的RCT的荟萃分析表明，检测频率几乎翻倍（率比 = 1.88；95% CI：1.17；3.01），即在12至15个月期间多进行了两次检测（平均差 = 2.13；95% CI：1.59，2.66）。对两项RCT的荟萃分析表明，HIVST使艾滋病毒阳性诊断的可能性也翻倍（RR = 2.02；95% CI：0.37，10.76，5.32）。在所有RCT中，没有迹象表明HIVST会造成危害，且冒险行为的潜在增加似乎微乎其微。
在随机对照试验中，HIVST与检测接受率和检测频率的提高相关。与仅采用标准检测服务相比，这种提高，尤其是在那些原本可能不会检测的高危人群中，可能会发现更多艾滋病毒阳性个体。然而，需要进一步研究如何支持与确认性检测、预防、治疗及护理服务的联系。世卫组织现在推荐HIVST作为一种额外的艾滋病毒检测方法。
