Comparing the Effects of Oral HIV Self-Testing With Those of Standard HIV Testing for Men Who Have Sex With Men (MSM): A Systematic Review and Meta-Analysis

The WHO recommends HIV self-testing (HIVST) as an innovative strategy and an additional testing approach to attain UNAIDS targets to end HIV by 2030. HIVST is a process whereby a person collects his or her own specimen (either oral fluid or blood), performs an HIV test, and interprets the result. It has been described as a discreet and convenient way to reach the hidden, unreached key populations (KPs) who do not know their HIV status or do not get tested. Among the KPs, men who have sex with men (MSM) is one such group that by far remains hidden due to feared stigma and discrimination associated both with their sexuality and HIV. Fear of pain and blood while HIV testing also deters MSM from getting tested. In this review, we assessed the effect of oral HIVST on the uptake and frequency of testing and risk behavior as compared to standard HIV testing. For this review, we systematically searched various electronic databases for clinical trials comparing HIVST to standard HIV testing from January 1, 2011, to December 31, 2021. A meta-analysis of studies was conducted using a random-effects model for relative risks (RRs) and 95% confidence intervals (CIs). The protocol was registered with PROSPERO, and PRISMA guidelines for systematic reviews and meta-analyses were followed. The quality of the clinical trials was assessed using Cochrane's risk of bias tool version 2.0 (RoB 2.0). We identified eight studies comparing HIVST to standard HIV testing services (HTSs). The eight randomized controlled trials (RCTs) enrolled 5,297 participants, of which 5,212 were MSM and 85 were transgender (TG) women. Seven RCTs were conducted in high-income countries (HICs): four in the USA, two in Australia, and one in Hong Kong. One was conducted in a low-middle-income country (LMIC) in Myanmar.In all the studies, HIVST intervention was provided with oral HIVST kits, except for one study in which both blood-based and oral HIVST kits were used. Meta-analysis (five RCTs) showed that HIVST increased the uptake of HIV testing by 1.43 times compared to standard of care (SoC) (RR = 1.43; 95% CI = 1.25, 1.64). Meta-analysis (four RCTs) found that HIVST increased the mean number of HIV tests by 2.34 during follow-up (mean difference = 2.34; 95% CI = 1.66, 3.02). Meta-analysis (four RCTs) showed that HIVST doubled the detection of new HIV infections among those tested (RR = 2.10; 95% CI = 1.35, 3.28) and reported higher repeat testing as compared to the control arm (RR = 2.04; 95% CI = 1.22, 3.42). A meta-analysis of three trials found no significant difference in risk behavior in respect of condomless anal intercourse (CAI) (odds ratio (OR) = 0.90; 95% CI = 0.67, 1.22) and multiple male partnership (RR = 0.89; 95% CI = 0.83, 0.94). Oral HIVST could increase the HIV testing and detection of new HIV infections among MSM who may not otherwise test, as compared to standard testing services alone. However, further research from low-middle-income countries is required for generalizability.