Flinders Health and Medical Research Institute, College of Medicine and Health Sciences, Flinders University, Adelaide, South Australia.
School of Public health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
BMC Prim Care. 2024 Oct 15;25(1):369. doi: 10.1186/s12875-024-02612-0.
BACKGROUND: Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice. METHODS: We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies. RESULTS: A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34-67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill. CONCLUSIONS: HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919).
背景：在撒哈拉以南非洲（SSA），年轻人（YP）不成比例地受到艾滋病毒大流行的影响，但尽管全球目标是到 2030 年检测 95%的艾滋病毒感染者，但检测率仍然很低。艾滋病毒自我检测（HIVST）最近已被引入，以覆盖这些高危人群。因此，需要综合新兴的关于 YP 在 SSA 中接受和使用 HIVST 的证据，以便生成全面的信息，为政策和实践提供信息。
方法：我们采用了一种混合方法系统评价，对截至 2023 年 10 月 31 日发表的关于 YP 中涉及任何设计的 HIVST 的定量和定性文献进行了综述。该综述综合了关于 HIVST 可接受性和使用的定量证据，以及 YP 对 HIVST 的看法的定性证据。我们搜索了已发表文章的数据库（例如 MEDLINE、CINAHL）和灰色文献来源（例如 Google、Google Scholar）。搜索的概念包括自我检测、艾滋病毒/艾滋病和 SSA 国家。两名作者独立筛选、检索全文并评估研究质量。
结果：共检索到 4150 篇研究，最终有 32 篇研究纳入综述。在 SSA 的 YP 中，从询问 YP 对 HIVST 的偏好、意愿或需求的单项计算得出的 HIVST 可接受性为中度（34-67%）至高度（≥67%）。14 项报告接受度的研究中有 9 项发现 HIVST 接受度很高。HIVST 的使用率范围为 0.8%至 100%，而在大多数研究中，使用率低于 50%。HIVST 使用的主要障碍是在没有咨询和支持的情况下应对阳性检测结果、身体不适和试剂盒成本。被认为的促进因素包括 HIVST 促进个人赋权和自主权的看法；隐私和保密性；以及在地点、时间和技能方面的便利性。
结论：HIVST 在 SSA 的 YP 中高度接受但使用不足。YP 对地点和服务提供方式表现出多样化的需求和混合偏好。总体而言，该综述在方法、人群、结果测量和结果方面存在异质性证据。该综述已在国际前瞻性系统评价注册中心（PROSPERO：ID=CRD42021278919）注册。
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