HIV testing strategies, types of tests, and uptake by men who have sex with men and transgender women: a systematic review and meta-analysis


BACKGROUND: Men who have sex with men (MSM) and transgender women (TGW) still face several barriers to HIV testing. The aim was to investigate the effectiveness of testing strategies (community- and facility-based testing)and types of HIV tests (standard laboratory, rapid, self, and multiple test combinations)to reach MSM and TGW, and barriers to testing.
METHODS: A systematic review and meta-analysis was performed according to the PRISMA and registered in the PROSPERO. Several databases were searched between June-July/2020. Observational, intervention, and mixed studies that implemented HIV testing strategies for MSM and TGW were included. The outcomes analyzed were HIV infection prevalence, new HIV diagnosis detection, and HIV testing uptake. The prevalence and respective confidence intervals(95%CI) were calculated using a random-effects model.
RESULTS: A total of 6,820 references were selected, and 263 were included in the review. Most studies included in this research were from high-income countries. Most the studies used the community or the internet as strategies for demand creation. Standard laboratory test had the highest uptake for MSM (100.0%, 95%CI 99.3'100.0) and multiple test combinations for TGW (100.0%, 95%CI98.6'100.0). The testing strategy with the highest uptake was facility-based for MSM (96.4%,95% CI 96.2'96.7) and TGW (100.0%,95%CI 98.6'100.0). Facility-based testing strategy showed a high HIV infection prevalence and new HIV diagnosis detection for the MSM (7.7%,95%CI 7.5'8.0; 6.9%,95%CI 6.7'7.2, respectively) and TGW groups (20.4%,95%CI 15.7'25.8; 20.4%, 95%CI 15.7'25.8, respectively). Standard laboratory test showed the highest HIV infection prevalence among MSM (14.3%,95%CI 13.3'15.3) and multiple test combinations among TGW (14.7%,95%CI 12.3'17.3). Urine test detected the highest rate of new HIV diagnosis detection for MSM (7.1%,95%CI 6.0'8.3) and multiple test combinations for TGW (14.7%,95%CI 12.3'17.3).Psychosocial and structural factors, such as stigma, and fear of positive test results, were the main barriers to HIV testing.
CONCLUSIONS: Facility-based testing and standard laboratory test stood out, but the study draws attention to the need for strategy diversification. Multiple test combinations may represent an important strategy to reach key populations that are difficult to access, as they offer autonomy of choice.

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