Zhang Ying, Goh Su Mei, Tapa James, Johnson Cheryl C, Chow Eric P F, Zhang Lei, Phillips Tiffany, Fairley Christopher K, Ong Jason J
School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
J Int AIDS Soc. 2024 Dec;27(12):e26388. doi: 10.1002/jia2.26388.
Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.
Following PRISMA guidelines, a comprehensive search across eight databases (2010-October 2023) identified studies on linkage to care after HIVST, defined as receiving a confirmatory test or initiating antiretroviral therapy (ART) if the self-test was reactive, and/or pre-exposure prophylaxis (PrEP) if the self-test was non-reactive. A random-effects meta-analysis summarized the findings and meta-regression explored study-level covariates, such as world region, population type and service delivery model, that might explain the between-study heterogeneity.
From 10,071 screened studies, 173 were included in the meta-analysis. The majority of studies focused on key populations in Africa using unassisted, oral fluid-based HIVST kits. Among those with reactive HIVST results, 92% (95% confidence interval [CI]: 88-95) were linked to confirmatory testing (n = 124 studies), and 89% (95% CI: 84-93) of newly diagnosed individuals initiated ART (n = 88 studies). Overall, 84% (95% CI: 74-93) of self-testers were linked to care (n = 69 studies). However, only 9% (95% CI: 2-19) of individuals with non-reactive HIVST results were linked to PrEP services (n = 9 studies). Assisted HIVST was associated with higher linkage rates to confirmatory testing and ART initiation compared to unassisted testing. Meta-regression revealed that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network-based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio = 1.28 [95% CI: 1.10-1.50], p = 0.001) compared to non-SNA service delivery model.
In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly when assisted HIVST or SNA-based distribution is used.
Strengthening timely linkage is vital for improving health outcomes, reducing HIV transmission and achieving the UNAIDS 95-95-95 goal. Ongoing research and collaboration with community-based organizations are needed to overcoming barriers and ensuring positive outcomes for those using HIVST.
CRD42022357570.
有效衔接预防与护理是HIV检测服务后的关键步骤。本系统评价旨在确定HIV自我检测（HIVST）后衔接预防与护理的个体比例，并描述与衔接相关的因素。
遵循PRISMA指南，对八个数据库（2010年至2023年10月）进行全面检索，以确定关于HIVST后衔接护理的研究，HIVST后衔接护理定义为：如果自我检测呈反应性，则接受确证检测或开始抗逆转录病毒治疗（ART）；如果自我检测呈非反应性，则接受暴露前预防（PrEP）。随机效应荟萃分析总结了研究结果，荟萃回归探讨了可能解释研究间异质性的研究水平协变量，如世界区域、人群类型和服务提供模式。
在10071项筛选的研究中，173项纳入荟萃分析。大多数研究聚焦于非洲的重点人群，使用的是无辅助的、基于口腔液的HIVST试剂盒。在HIVST结果呈反应性的人群中，92%（95%置信区间[CI]：88 - 95）接受了确证检测（n = 124项研究），新诊断个体中有89%（95% CI：84 - 93）开始接受ART治疗（n = 88项研究）。总体而言，84%（95% CI：74 - 93）的自我检测者衔接了护理（n = 69项研究）。然而，HIVST结果呈非反应性的个体中只有9%（95% CI：2 - 19）接受了PrEP服务（n = 9项研究）。与无辅助检测相比，辅助HIVST与确证检测及开始ART治疗的更高衔接率相关。荟萃回归显示，HIVST试剂盒的服务提供模式类型影响衔接情况，通过基于社交网络的方法（SNA）获得HIVST试剂盒的个体与非SNA服务提供模式相比，更有可能接受确证检测（调整优势比 = 1.28 [95% CI：1.10 - 1.50]，p = 0.001）。
在全球范围内扩大HIVST服务的背景下，我们发现HIVST后确证检测及开始ART治疗的衔接率总体较高，特别是在使用辅助HIVST或基于SNA的分发方式时。
加强及时衔接对于改善健康结局、减少HIV传播及实现联合国艾滋病规划署95 - 95 - 95目标至关重要。需要持续开展研究并与社区组织合作，以克服障碍并确保使用HIVST者获得积极结果。
PROSPERO编号：CRD42022357570。
