Dornsife School of Public Health, 37412Drexel University, Philadelphia, PA, USA.
Independent Consultant, Washington, DC, USA.
Int J STD AIDS. 2022 Nov;33(13):1090-1105. doi: 10.1177/09564624221111277. Epub 2022 Jul 3.
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 ( = 18), 96% were newly diagnosed (CI: 77-100%). Across studies reporting linkage to HIV care ( = 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.
目的:与女性相比,感染艾滋病毒的男性更不可能了解自己的状况、接受抗逆转录病毒治疗和病毒抑制。本综述检查了男性社区为基础的艾滋病毒检测服务(CB-HTS)的结果。
设计:系统评价和荟萃分析。
方法:我们通过 2018 年 7 月检索了七个数据库和会议摘要。我们使用随机效应模型估算了每种结果的汇总比例和/或风险比(用于荟萃分析)。
结果:188 项研究符合纳入标准。常见的检测模型包括目标外展(例如移动检测)、家庭检测和独立社区站点检测。在 25 项报告采用率的研究中,81%(CI:75-86%)的男性接受了提供的检测。通过 CB-HTS 接触到的男性的采用率高于通过设施 HTS(RR = 1.39;CI:1.13-1.71)。在 184 项研究中,有超过 69%(CI:64-71%)的接受 CB-HTS 检测的男性检测呈阳性。在报告男性新艾滋病毒阳性的 18 项研究中,有 96%(CI:77-100%)为新诊断。在报告 HIV 护理衔接的 8 项研究中,有 70%(CI:36-103%)的男性与护理衔接。在 57 项报告 CB-HTS 在关键人群中进行的性别分类数据的研究中,男性的采用率很高(80%;CI:70-88%),几乎所有人都是新诊断和与护理衔接(95%;CI:94-100%;和 94%;CI:88-100%,分别)。
结论:CB-HTS 是一种从一般人群和关键人群中发现未确诊艾滋病毒男性的重要策略,特别是使用目标外展模型。与设施 HTS 相比,通过 CB-HTS 检测的男性更有可能接受检测,并且几乎所有通过 CB-HTS 检测呈阳性的男性都是新诊断的。护理衔接可能是 CB-HTS 之后的一个挑战,需要更多的努力和研究,以有效实施促进快速 ART 启动和与预防服务衔接的检测策略。
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