Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
J Int AIDS Soc. 2024 Sep;27(9):e26353. doi: 10.1002/jia2.26353.
Social network-based testing approaches (SNAs) encourage individuals ("test promoters") to motivate sexual partners and/or those in their social networks to test for HIV. We conducted a systematic review to examine the effectiveness, acceptability and cost-effectiveness of SNA.
We searched five databases from January 2010 to May 2023, and included studies that compared SNA with non-SNA. We used random-effects meta-analysis to combine effect estimates. Certainty was assessed using the GRADE approach.
We identified 47 studies. SNA may increase uptake of HIV testing compared to non-SNA (RR 2.04, 95% CI: 1.06-3.95, Low certainty). The proportion of first-time testers was probably higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.49, 95% CI: 1.22-1.81, Moderate certainty). The proportion of people who tested positive for HIV may be higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.84, 95% CI: 1.01-3.35, Low certainty). There were no reports of any adverse events or harms associated with SNA. Based on six cost-effectiveness studies, SNA was generally cheaper per person tested and per person diagnosed compared to non-SNA. Based on 23 qualitative studies, SNA is likely to be acceptable to a variety of populations.
Our review collated evidence for SNA to HIV testing covering the key populations and the general population who may benefit from HIV testing. We summarized evidence for the effectiveness, acceptability and cost-effectiveness of different models of SNA. While we did not identify an ideal model of SNA that could be immediately scaled up, for each setting and population targeted, we recommend various implementation considerations as our meta-analysis showed the effectiveness might differ due to factors which include the testing modality (i.e. use of HIV self-testing), type of test promoters, long or short duration of recruitment and use of financial incentives.
Social network-based approaches may enhance HIV testing uptake, increase the proportion of first-time testers and those testing positive for HIV. Heterogeneity among studies highlights the need for context-specific adaptations, but the overall positive impact of SNA on HIV testing outcomes could support its integration into existing HIV testing services.
基于社交网络的检测方法（SNAs）鼓励个人（“检测促进者”）激励性伴侣和/或他们的社交网络中的人进行 HIV 检测。我们进行了一项系统评价，以检查 SNA 的有效性、可接受性和成本效益。
我们从 2010 年 1 月到 2023 年 5 月，检索了五个数据库，并纳入了比较 SNA 与非 SNA 的研究。我们使用随机效应荟萃分析来合并效应估计值。使用 GRADE 方法评估确定性。
我们确定了 47 项研究。与非 SNA 相比，SNA 可能会增加 HIV 检测的采用率（RR 2.04，95%CI：1.06-3.95，低确定性）。与非 SNA 相比，使用 SNA 的检测促进者的性伴侣或社交联系人中首次检测的比例可能更高（RR 1.49，95%CI：1.22-1.81，中等确定性）。与非 SNA 相比，使用 SNA 的检测促进者的性伴侣或社交联系人中 HIV 检测呈阳性的比例可能更高（RR 1.84，95%CI：1.01-3.35，低确定性）。没有报道与 SNA 相关的任何不良事件或危害。基于六项成本效益研究，SNA 每检测一人和每诊断一人的成本通常比非 SNA 低。基于 23 项定性研究，SNA 可能被各种人群所接受。
我们的综述汇集了 SNA 对关键人群和可能受益于 HIV 检测的一般人群的 HIV 检测的有效性、可接受性和成本效益的证据。我们总结了不同 SNA 模型的有效性、可接受性和成本效益的证据。虽然我们没有确定一种可以立即推广的理想 SNA 模式，但针对每个目标人群和环境，我们建议考虑各种实施因素，因为我们的荟萃分析表明，由于检测模式（即使用 HIV 自我检测）、检测促进者的类型、招募的长短以及使用经济激励措施等因素，有效性可能会有所不同。
基于社交网络的方法可能会增加 HIV 检测的采用率，增加首次检测者和 HIV 检测阳性者的比例。研究之间的异质性突出表明需要进行特定背景的调整，但 SNA 对 HIV 检测结果的总体积极影响可能支持将其纳入现有的 HIV 检测服务中。
