Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review

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Background:
Stigma, discrimination, lack of privacy, and long waiting times partly explain why six out of ten individuals living with HIV do not access facility-based testing. By circumventing these barriers, self-testing offers potential for more people to know their sero-status. Recent approval of an in-home HIV self test in the US has sparked self-testing initiatives, yet data on acceptability, feasibility, and linkages to care are limited. We systematically reviewed evidence on supervised (self-testing and counselling aided by a health care professional) and unsupervised (performed by self-tester with access to phone/internet counselling) self-testing strategies.

Methods and Findings:
Seven databases (Medline [via PubMed], Biosis, PsycINFO, Cinahl, African Medicus, LILACS, and EMBASE) and conference abstracts of six major HIV/sexually transmitted infections conferences were searched from 1st January 2000–30th October 2012. 1,221 citations were identified and 21 studies included for review. Seven studies evaluated an unsupervised strategy and 14 evaluated a supervised strategy. For both strategies, data on acceptability (range: 74%–96%), preference (range: 61%–91%), and partner self-testing (range: 80%–97%) were high. A high specificity (range: 99.8%–100%) was observed for both strategies, while a lower sensitivity was reported in the unsupervised (range: 92.9%–100%; one study) versus supervised (range: 97.4%–97.9%; three studies) strategy. Regarding feasibility of linkage to counselling and care, 96% (n = 102/106) of individuals testing positive for HIV stated they would seek post-test counselling (unsupervised strategy, one study). No extreme adverse events were noted. The majority of data (n = 11,019/12,402 individuals, 89%) were from high-income settings and 71% (n = 15/21) of studies were cross-sectional in design, thus limiting our analysis.

Conclusions:
Both supervised and unsupervised testing strategies were highly acceptable, preferred, and more likely to result in partner self-testing. However, no studies evaluated post-test linkage with counselling and treatment outcomes and reporting quality was poor. Thus, controlled trials of high quality from diverse settings are warranted to confirm and extend these findings.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review. PLoS Med 10(4): e32767. doi:10.1371/journal.pmed.1001414
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001414

Souhrn

Zdroje

1. US Food and Drug Administration- Consumer Health Information (2012) First rapid home-use HIV kit approved for self-testing. Silver Spring (Maryland): US Food and Drug Administration.

2. Mavedzenge S, Baggaley R, Lo Y, Corbett E (2011) HIV self-testing among health workers. Geneva: World Health Organization.

3. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) (2004) UNAIDS/WHO Policy Statement on HIV Testing. Geneva: United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO),.

4. SpielbergF, KurthA, GorbachPM, GoldbaumG (2001) Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations. AIDS Educ Prev 13: 524–540.

5. Joint United Nations Programme on HIV/AIDS (UNAIDS) UaWHOW (2010) Towards universal access - scaling up priority HIV/AIDS interventions in the health sector - progress report. Geneva: World Health Organization.

6. RichterM, VenterWD, GrayA (2010) Home self-testing for HIV: AIDS exceptionalism gone wrong. S Afr Med J 100: 636–642.

7. SpielbergF, LevineRO, WeaverM (2004) Self-testing for HIV: a new option for HIV prevention? Lancet Infect Dis 4: 640–646.

8. WalenskyRP, BassettIV (2011) HIV self-testing and the missing linkage. PLoS Med 8: e1001101 doi:10.1371/journal.pmed.1001101

9. Pant PaiN, BalramB, ShivkumarS, Martinez-CajasJL, ClaessensC, et al. (2012) Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis. Lancet Infect Dis 12: 373–380.

10. SabapathyK, Van den BerghR, FidlerS, HayesR, FordN (2012) Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med 9: e1001351 doi:10.1371/journal.pmed.1001351

11. von ElmE, AltmanDG, EggerM, PocockSJ, GotzschePC, et al. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4: e296 doi:10.1371/journal.pmed.0040296

12. Kalibala S, Tun W, Muraah W, Cherutich P, Oweya E, et al.. (2011) ‘Knowing myself first’: feasibility of self-testing among health workers in Kenya. Nairobi: Population Council

13. OraSure Technologies (2012) Final Advisory Committee Briefing Materials: Available for Public Release. OraQuick In-Home HIV Test. Washington (D.C.): Food and Drug Administration: Blood Products Advisory Committee.

14. HopewellS, ClarkeM, MoherD, WagerE, MiddletonP, et al. (2008) CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Med 5: e20 doi:10.1371/journal.pmed.0050020

15. AttreeP, MiltonB (2006) Critically appraising qualitative research for systematic reviews: defusing the methodological cluster bombs. Evidence & Policy 2: 109–126.

16. Carballo-DieguezA, FrascaT, DolezalC, BalanI (2012) Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res 49: 379–387.

17. ChavulaK, DesmondN, ChokoA, MavedzengeSN, MakombeS, et al. (2011) Convenient, voluntary and confidential: can supervised self-testing improve on current best practices for hiv testing and counseling in Malawi? Boston Available: http://retroconference.org/2011/PDFs/1074.pdf

18. MacPhersonP, WebbEL, ChokoAT, DesmondN, ChavulaK, et al. (2011) Stigmatising attitudes among people offered home-based HIV testing and counselling in Blantyre, Malawi: construction and analysis of a stigma scale. PLoS One 6: e26814 doi:10.1371/journal.pone.0026814

19. Spielberg F, Quraishy ZB, Crean K, Wilson D, Kumar P, et al.. (2007) Computer counselling and self-testing for HIV prevention in Southern India. Seattle, Washington. Available: http://www.eventure-online.com/eventure/publicAbstractView.do?id=48166&congressId=642

20. Helm Jvd, Zuure F, Fennema H, Davidovich U, Prins M (2012) Announcing a new method of HIV testing: the planning of robust home testing for HIV combined with internet counseling. Washington (D.C.). Available: http://www.iasociety.org/Abstracts/A200746436.aspx

21. BelzaMJ, Rosales-StatkusME, HoyosJ, SeguraP, FerrerasE, et al. (2012) Supervised blood-based self-sample collection and rapid test performance: a valuable alternative to the use of saliva by HIV testing programmes with no medical or nursing staff. Sex Transm Infect 88: 218–221.

22. Carballo-Dieguez A, Balan I, Frasca T, Dolezal C, Valladares J (2012) Use of a rapid HIV home test to screen potential sexual partners prevents HIV exposure in a high-risk sample of MSM. Washington (D.C.). Available: http://pag.aids2012.org/abstracts.aspx?aid=4982

23. de la FuenteL, Rosales-StatkusME, HoyosJ, PulidoJ, SantosS, et al. (2012) Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results? PLoS One 7: e46555 doi:10.1371/journal.pone.0046555

24. GaydosCA, HsiehYH, HarveyL, BurahA, WonH, et al. (2011) Will patients “opt in” to perform their own rapid HIV test in the emergency department? Ann Emerg Med 58: S74–78.

25. Katz D, Golden M, Hughes J, Farquhar C, Stekler J (2012) Acceptability and ease of use of home self-testing for HIV among MSM. Seattle (Washington). Available: http://www.retroconference.org/2012b/PDFs/1131.pdf

26. Lee S, Roehler M, Miller T, Kardos K, Almeidasantos A, et al.. (2012) Development of an oral fluid self-test for HIV infection: evaluation in a population of unknown risk. Washington (D.C.). Available: http://pag.aids2012.org/abstracts.aspx?aid=9754

27. LeeVJ, TanSC, EarnestA, SeongPS, TanHH, et al. (2007) User acceptability and feasibility of self-testing with HIV rapid tests. J Acquir Immune Defic Syndr 45: 449–453.

28. NgOT, ChowAL, LeeVJ, ChenMI, WinMK, et al. (2012) Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS One 7: e45168 doi:10.1371/journal.pone.0045168

29. Pant Pai N, Bhargava M, Sharma J, Balram B, Bois C, et al.. (2012) Will HIV self testing be accepted by low to medium risk educated populations? a pilot cross sectional study in students of McGill University, Montréal. Montréal, QuebecCanada. Abstract Canadian HIV AIDS Conference 2012. Available: http://www.pulsus.com/journals/JnlSupToc.jsp?sCurrPg=journal&jnlKy=3&supKy=495

30. SkolnikHS, PhillipsKA, BinsonD, DilleyJW (2001) Deciding where and how to be tested for HIV: what matters most? J Acquir Immune Defic Syndr 27: 292–300.

31. SpielbergF, BransonBM, GoldbaumGM, LockhartD, KurthA, et al. (2003) Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men. J Acquir Immune Defic Syndr 32: 318–327.

32. Spielberg F, Camp S, Ramachandra E (2003) HIV home self-testing: can it work? Atlanta, Georgia. Available: http://www.aegis.org/DisaplayConf/?Abstract=96613

33. ChokoAT, DesmondN, WebbEL, ChavulaK, Napierala-MavedzengeS, et al. (2011) The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med 8: e1001102 doi:10.1371/journal.pmed.1001102

34. Balram B, Pant Pai N (2010) Reporting of patient centered outcomes: to GRADE or not to GRADE? Abstract Canadian HIV AIDS Conference (CAHR). Saskatoon, Canada.