Academic emergency medicine : official journal of the Society for Academic Emergency Medicine | 2021
Acceptability and uptake of HIV self-testing in emergency care settings: A systematic review and meta-analysis.
Abstract
BACKGROUND\nEmergency departments (ED) interface with large numbers of patients that are often missed by conventional HIV testing approaches. ED-based HIV self-testing (HIVST) is an innovative engagement approach which has potential for testing gains among populations that have failed to be reached. This systematic review and meta-analysis evaluated acceptability and uptake of HIVST, as compared to standard provider-delivered testing approaches, among patients seeking care in ED settings.\n\n\nMETHODS\nSix electronic databases were systematically searched (Dates: January 1990-May 2021). Reports with data on HIVST acceptability and/or testing uptake in ED settings were included. Two reviewers identified eligible records (κ=\xa00.84); quality was assessed using formalized criteria. Acceptability and testing uptake metrics were summarized, and pooled estimates were calculated using random-effects models with assessments of heterogeneity.\n\n\nRESULTS\nOf 5773 records identified, seven met inclusion criteria. The cumulative sample was 1942 subjects, drawn from three randomized control trials (RCTs) and four cross-sectional studies. Four reports assessed HIVST acceptability. Pooled acceptability of self-testing was 92.6% (95% confidence interval [CI]: 88.0%-97.1%). Data from two RCTs demonstrated that HIVST significantly increased testing uptake as compared to standard programs (risk ratio [RR]\xa0=\xa04.41, 95% CI: 1.95-10.10, I2\xa0 =\xa025.8%). Overall, quality of evidence was low (42.9%) or very low (42.9%), with one report of moderate quality (14.2%).\n\n\nCONCLUSIONS\nAvailable data indicate that HIVST may be acceptable and may increases testing among patients seeking emergency care, suggesting that expanding ED-based HIVST programs could enhance HIV diagnosis. However, given the limitations of the reports, additional research is needed to better inform the evidence-base.