Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review

Simple item page
dc.contributor.authorPai, Nitika Panten_ZA
dc.contributor.authorSharma, Jigyasaen_ZA
dc.contributor.authorShivkumar, Sushmitaen_ZA
dc.contributor.authorPillay, Sabrinaen_ZA
dc.contributor.authorVadnais, Carolineen_ZA
dc.contributor.authorJoseph, Lawrenceen_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.contributor.authorPeeling, Rosanna Wen_ZA
dc.date.accessioned2016-01-11T06:51:39Z
dc.date.available2016-01-11T06:51:39Z
dc.date.issued2013en_ZA
dc.description.abstractBackground: 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.en_ZA
dc.identifier.apacitationPai, N. P., Sharma, J., Shivkumar, S., Pillay, S., Vadnais, C., Joseph, L., ... Peeling, R. W. (2013). Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. <i>PLOS Medicince</i>, http://hdl.handle.net/11427/16252en_ZA
dc.identifier.chicagocitationPai, Nitika Pant, Jigyasa Sharma, Sushmita Shivkumar, Sabrina Pillay, Caroline Vadnais, Lawrence Joseph, Keertan Dheda, and Rosanna W Peeling "Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review." <i>PLOS Medicince</i> (2013) http://hdl.handle.net/11427/16252en_ZA
dc.identifier.citationPai, N. P., Sharma, J., Shivkumar, S., Pillay, S., Vadnais, C., Joseph, L., ... & Peeling, R. W. (2013). Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. PLoS Med, 10(4), e1001414. doi:10.1371/journal.pmed.1001414en_ZA
dc.identifier.ris TY - Journal Article AU - Pai, Nitika Pant AU - Sharma, Jigyasa AU - Shivkumar, Sushmita AU - Pillay, Sabrina AU - Vadnais, Caroline AU - Joseph, Lawrence AU - Dheda, Keertan AU - Peeling, Rosanna W AB - 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. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pmed.1001414 DP - University of Cape Town J1 - PLOS Medicince LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review TI - Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review UR - http://hdl.handle.net/11427/16252 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16252
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pmed.1001414
dc.identifier.vancouvercitationPai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, et al. Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. PLOS Medicince. 2013; http://hdl.handle.net/11427/16252.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Pant Pai et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLOS Medicinceen_ZA
dc.source.urihttp://journals.plos.org/plosmedicineen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherQualitative studiesen_ZA
dc.subject.otherAIDSen_ZA
dc.subject.otherInterneten_ZA
dc.subject.otherMalawien_ZA
dc.subject.otherSpainen_ZA
dc.titleSupervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic reviewen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Pai_Supervised_Unsupervised_Self_Testing_for_HIV_2013.pdf
Size:
371.62 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles