Hu Siyue, Jing Fengshi, Fan Chengxin, Dai Yifan, Xie Yewei, Zhou Yi, Lv Hang, He Xi, Wu Dan, Tucker Joseph D, Tang Weiming
Dermatology Hospital of Southern Medical University, Guangzhou, China.
School of Public Health, Southern Medical University, Guangzhou, China.
medRxiv. 2023 Nov 6:2023.11.05.23298135. doi: 10.1101/2023.11.05.23298135.
Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST).
Using search terms related to social network interventions and HIVST, we searched five databases for trials published between January 1, 2010, and June 30, 2023. Outcomes included uptake of HIV testing, HIV seroconversion, and linkage to antiretroviral therapy (ART) or HIV Care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI).
Among the 3,745 manuscripts identified, 33 studies fulfilled the inclusion criteria, including one quasi-experimental study, 17 RCTs and 15 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 10 studies), and peer educators (distributed to unknown peers, 8 studies). The results showed that all of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Among social networks, peer distribution had the highest uptake of HIV testing (79% probability, SUCRA 0.92), followed by partner distribution (72% probability, SUCRA 0.71), and peer educator distribution (66% probability, SUCRA 0.29). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54-3.39, 5 studies) and partner distribution (RR 1.45, 95% CI 1.05-2.02, 7 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control. Linkage to ART or HIV Care remained comparable to facility-based testing across the three HIVST distribution strategies.
Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populations compared to facility-based testing. These strategies can be integrated with the existing HIV care services, to fill the testing gap among key populations globally.PROSPERO Number: CRD42022361782.
社交网络策略是利用社交网络来影响个人或社区，越来越多地被用于向重点人群提供人类免疫缺陷病毒（HIV）干预措施。我们总结并批判性地评估了关于社交网络策略在促进HIV自我检测（HIVST）有效性方面的现有研究。
使用与社交网络干预和HIVST相关的检索词，我们在五个数据库中检索了2010年1月1日至2023年6月30日期间发表的试验。结果包括HIV检测的接受情况、HIV血清转化以及与抗逆转录病毒治疗（ART）或HIV护理的联系。我们使用网络荟萃分析来评估通过社交网络策略进行HIV检测的接受情况与对照方法相比。对有比较组且报告了结果的研究进行成对荟萃分析，以评估相对风险（RR）及其相应的95%置信区间（CI）。
在识别出的3745篇手稿中，33项研究符合纳入标准，包括1项准实验研究、17项随机对照试验和15项观察性研究。网络HIVST检测由同伴（分发给已知同伴，15项研究）、性伴侣（分发给其性伴侣，10项研究）和同伴教育者（分发给未知同伴，8项研究）组织。结果表明，与基于标准机构的检测相比，所有这三种社交网络分发策略都提高了HIV检测的接受率。在社交网络中，同伴分发的HIV检测接受率最高（概率79%，SUCRA 0.92），其次是性伴侣分发（概率72%，SUCRA 0.71），同伴教育者分发（概率66%，SUCRA 0.29）。成对荟萃分析表明，与对照相比，同伴分发（RR 2.29，95% CI 1.54 - 3.39，5项研究）和性伴侣分发（RR 1.45，95% CI 1.05 - 2.02，7项研究）在重点人群检测期间也增加了检测到HIV反应性的概率。在三种HIVST分发策略中，与ART或HIV护理的联系与基于机构的检测相当。
与基于机构的检测相比，基于网络的HIVST分发被认为在提高HIV检测率和覆盖边缘化人群方面是有效的。这些策略可以与现有的HIV护理服务相结合，以填补全球重点人群中的检测缺口。PROSPERO编号：CRD42022361782。
