Researcher-Professor Graduate Course in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, São Paulo University of Sorocaba Piracicaba, Brazil
Background: HIV testing is an important prevention strategy to reduce the number of unknown and late diagnosis, resulting in better individual outcomes, lower risk of HIV transmission, and better engagement with health services. Self-tests are convenient, offer privacy and are easy to use; thus, they are valuable for HIV screening in key populations, who face barriers to access health care.
Objectives: To identify and assess strategies to promote HIV self-testing among men who have sex with men (MSM).
Methods: Integrative literature review designed to evaluate strategies to increase HIV testing among MSM. We reported the results of self-testing delivery system strategy. Search was performed on eight electronic databases, without language restriction. We included randomized and non-randomized clinical trials, quasi-experimental studies, and observational studies. Study selection and data extraction were both performed independently by pairs and disagreements were solved by a third reviewer. The screening of the studies was carried out through the selection of titles/abstracts and the reading of full texts of the pre-selected studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data extraction was conducted using a structured form.
Results: We found 11 reports/10 studies (8 randomized clinical trials; 1 non-randomized clinical trial, and 1 retrospective cohort study) conducted in the United States, the United Kingdom, China, and Australia, approaching 13,672 MSM in the community, gay-friendly venues, health centers, and social media. Self-testing delivery systems were effective in promoting HIV testing in all but one study (retrospective cohort). Self-testing delivery increased HIV testing when comparing home-based self-tests vs. clinic-based testing, home-based self-tests vs. mail invitation to undergone testing, free self-test distribution through electronic vending machines vs. community outreach workers, and combined use of self-tests with promotional material and motivational interviews vs. non-combined self-tests. The quality and ease of use of the available self-test products appear to influence the effectiveness of the strategy. The replacement of clinic-based testing with self-tests and non-confirmation of positive test results owing to the use of self-tests could lead to poor health outcomes.
Conclusions: Self-testing delivery systems were effective in promoting HIV-self-testing among MSM in different settings.
