HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021)
Background: HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS),...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021003394 |
| _version_ | 1818904305109827584 |
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| author | Madison McGuire Anna de Waal Angela Karellis Ricky Janssen Nora Engel Rangarajan Sampath Sergio Carmona Alice Anne Zwerling Marta Fernandez Suarez Nitika Pant Pai |
| author_facet | Madison McGuire Anna de Waal Angela Karellis Ricky Janssen Nora Engel Rangarajan Sampath Sergio Carmona Alice Anne Zwerling Marta Fernandez Suarez Nitika Pant Pai |
| author_sort | Madison McGuire |
| collection | DOAJ |
| description | Background: HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. Methods: We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. Findings: 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77–97%), preferred over in-person and hybrid options by more first-time testers (47–48%), highly feasible (93–95%), and were overall effective in supporting linkage to care (53–100%). Social media and app-based innovations also had high acceptability (87–95%) and linkage to care proportions (80–100%). SMS innovations increased kit return rates (54–94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54–93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. Interpretation: HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally. Funding: This work was funded by the Foundation for Innovative New Diagnostics. The agency had no role in the decision to submit it for publication, however the funders contributing to the writing of the manuscript. NPP also acknowledges support from the Fonds de recherche du Quebec Sante (Senior scientist scholar award), The Canadian Institutes of Health Research (PJT 153149 and HBR 422155), Grand Challenges Canada (Transition to Scale award, 071005), the India-Canada centre for Innovative Multidisciplinary Partnerships to Accelerate Community Transformation and Sustainability (IC-IMPACTS), and the MUHC Foundation. |
| first_indexed | 2024-12-19T21:05:19Z |
| format | Article |
| id | doaj.art-da0c8b666ac8406b89a3cf2433a61215 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-19T21:05:19Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-da0c8b666ac8406b89a3cf2433a612152022-12-21T20:05:40ZengElsevierEClinicalMedicine2589-53702021-09-0139101059HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021)Madison McGuire0Anna de Waal1Angela Karellis2Ricky Janssen3Nora Engel4Rangarajan Sampath5Sergio Carmona6Alice Anne Zwerling7Marta Fernandez Suarez8Nitika Pant Pai9Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada; The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada; The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, CanadaThe Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada; Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, CanadaDepartment of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the NetherlandDepartment of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the NetherlandFoundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, SwitzerlandFoundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, SwitzerlandSchool of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z, CanadaFoundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, SwitzerlandThe Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada; Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada; Corresponding author at: The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada.Background: HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. Methods: We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. Findings: 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77–97%), preferred over in-person and hybrid options by more first-time testers (47–48%), highly feasible (93–95%), and were overall effective in supporting linkage to care (53–100%). Social media and app-based innovations also had high acceptability (87–95%) and linkage to care proportions (80–100%). SMS innovations increased kit return rates (54–94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54–93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. Interpretation: HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally. Funding: This work was funded by the Foundation for Innovative New Diagnostics. The agency had no role in the decision to submit it for publication, however the funders contributing to the writing of the manuscript. NPP also acknowledges support from the Fonds de recherche du Quebec Sante (Senior scientist scholar award), The Canadian Institutes of Health Research (PJT 153149 and HBR 422155), Grand Challenges Canada (Transition to Scale award, 071005), the India-Canada centre for Innovative Multidisciplinary Partnerships to Accelerate Community Transformation and Sustainability (IC-IMPACTS), and the MUHC Foundation.http://www.sciencedirect.com/science/article/pii/S2589537021003394DigitalHIVSelf-testingOnlineMhealthIntervention |
| spellingShingle | Madison McGuire Anna de Waal Angela Karellis Ricky Janssen Nora Engel Rangarajan Sampath Sergio Carmona Alice Anne Zwerling Marta Fernandez Suarez Nitika Pant Pai HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) EClinicalMedicine Digital HIV Self-testing Online Mhealth Intervention |
| title | HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) |
| title_full | HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) |
| title_fullStr | HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) |
| title_full_unstemmed | HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) |
| title_short | HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021) |
| title_sort | hiv self testing with digital supports as the new paradigm a systematic review of global evidence 2010 2021 |
| topic | Digital HIV Self-testing Online Mhealth Intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021003394 |
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