Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001, South Africa.
BMC Public Health. 2019 Jan 31;19(1):132. doi: 10.1186/s12889-019-6471-4.
BACKGROUND: Knowledge of HIV status is crucial for both prevention and treatment of HIV infection. However, according to the Joint United Nations Programme on HIV/AIDS in low-and-middle-income countries (LMICs), only 10% of the population has access to HIV testing services. Home-based HIV testing and counseling (HTC) is one of the approaches which have been shown to be effective in improving access to HIV testing in LMICs. The objective of this review was to map evidence on the use of home-based HTC in LMICs. METHODS: We searched PubMed, EBSCOhost, Google Scholar, Science Direct, World Health Organization library database and UNAIDS databases from January 2013 to October 2017. Eligibility criteria included articles pertaining to the use of home-based HTC in LMICs. Two reviewers independently reviewed the articles for eligibility. The following themes were extracted from the included studies: use, feasibility and effectiveness of home-based HTC on patient-centered outcomes in LMICs. The risk of bias for the included studies was assessed using mixed methods appraisal tool -version 2011. RESULTS: A total of 855,117 articles were identified from all the databases searched. Of this, only 17 studies met the inclusion criteria after full article screening and were included for data extraction. All included studies presented evidence on the use of Home-based HTC by most age groups (18 months to 70 years) comprising of both males and females. The included studies were conducted in the following countries: Zambia, Uganda, South Africa, Kenya, Ethiopia, Malawi, Swaziland, Pakistan, and Botswana. This study demonstrated that home-based HTC was used in LMICs alongside supervised HTC intervention using different types of HTC tests kits produced by different manufacturers. This study also showed that home-based HTC was feasible, highly effective, and increased uptake of HIV testing and counseling. This study further demonstrated a highly successful usage of supervised home-based HTC by most age groups in LMICs, with majority of users being females (89.1%). CONCLUSION: We therefore recommend primary studies in other LMICs to determine the feasibility and use of HTC to help achieve the UNAIDS 90:90:90 targets. Interventions to improve the use of home-based HTC by males are also recommended. TRIAL REGISTRATION: PROSPERO registration number: CRD42017056478.
背景：了解 HIV 状况对于预防和治疗 HIV 感染至关重要。然而，根据联合国艾滋病规划署在中低收入国家（LMICs）的联合方案，只有 10%的人口能够获得 HIV 检测服务。家庭为基础的 HIV 检测和咨询（HTC）是一种已被证明在改善 LMICs 获得 HIV 检测方面有效的方法。本研究的目的是绘制关于在 LMICs 中使用家庭为基础的 HTC 的证据。
方法：我们从 2013 年 1 月至 2017 年 10 月，在 PubMed、EBSCOhost、Google Scholar、Science Direct、世界卫生组织图书馆数据库和 UNAIDS 数据库中进行了搜索。符合条件的文章包括在 LMICs 中使用家庭为基础的 HTC 的文章。两名评审员独立审查了文章的资格。从纳入的研究中提取了以下主题：在 LMICs 中，以患者为中心的结果为重点，家庭为基础的 HTC 的使用、可行性和有效性。使用混合方法评估工具 - 2011 年版评估纳入研究的偏倚风险。
结果：从所有搜索的数据库中，共确定了 855117 篇文章。经过全文筛选，只有 17 篇研究符合纳入标准，并被纳入数据提取。所有纳入的研究都提供了关于家庭为基础的 HTC 在最多个年龄段（18 个月至 70 岁）的使用情况的证据，包括男性和女性。纳入的研究在以下国家进行：赞比亚、乌干达、南非、肯尼亚、埃塞俄比亚、马拉维、斯威士兰、巴基斯坦和博茨瓦纳。这项研究表明，家庭为基础的 HTC 与使用不同制造商生产的不同类型的 HTC 检测试剂盒的监督 HTC 干预一起在 LMICs 中使用。这项研究还表明，家庭为基础的 HTC 是可行的、高度有效的，并增加了 HIV 检测和咨询的采用率。这项研究进一步表明，在 LMICs 中，最多个年龄段的人高度成功地使用了监督家庭为基础的 HTC，大多数使用者是女性（89.1%）。
结论：因此，我们建议在其他 LMICs 进行初步研究，以确定 HTC 的可行性和使用情况，以帮助实现联合国艾滋病规划署的 90:90:90 目标。还建议采取干预措施，提高男性对家庭为基础的 HTC 的使用。
试验注册：PROSPERO 注册号：CRD42017056478。
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