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Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

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  • Monisha Sharma

    (University of Washington)

  • Roger Ying

    (University of Washington)

  • Gillian Tarr

    (University of Washington)

  • Ruanne Barnabas

    (University of Washington
    University of Washington
    School of Medicine, University of Washington
    Fred Hutchinson Cancer Research Center)

Abstract

HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing modalities, characterizing community (home, mobile, index, key populations, campaign, workplace and self-testing) and facility approaches by population reached, HIV positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing and counselling had high coverage and uptake and identified HIV-positive people at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% confidence interval (CI) = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Community testing with facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and antiretroviral initiation (75%, 95% CI = 68–82%). Expanding home and mobile testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention, and decrease HIV burden. This article has not been written or reviewed by Nature editors. Nature accepts no responsibility for the accuracy of the information provided.

Suggested Citation

  • Monisha Sharma & Roger Ying & Gillian Tarr & Ruanne Barnabas, 2015. "Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa," Nature, Nature, vol. 528(7580), pages 77-85, December.
    • Handle: RePEc:nat:nature:v:528:y:2015:i:7580:d:10.1038_nature16044
    DOI: 10.1038/nature16044
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    Cited by:

    1. Marc d'Elbée & Métogara Mohamed Traore & Kéba Badiane & Anthony Vautier & Arlette Simo Fotso & Odé Kanku Kabemba & Nicolas Rouveau & Peter Godfrey-Faussett & Mathieu Maheu-Giroux & Marie-Claude Boily , 2021. "Costs and Scale-Up Costs of Integrating HIV Self-Testing Into Civil Society Organisation-Led Programmes for Key Populations in Côte d'Ivoire, Senegal, and Mali," Post-Print ird-03883601, HAL.
    2. Paul Wekesa & Jaquin Kataka & Kevin Owuor & Lennah Nyabiage & Fredrick Miruka & Stella Wanjohi & Samuel Omondi, 2020. "Time to HIV testing of sexual contacts identified by HIV-positive index clients in Siaya County, Kenya," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-11, September.
    3. Arielle Lasry & Mireille B Kalou & Paul R Young & Jacqueline Rurangirwa & Bharat Parekh & Stephanie Behel, 2019. "Cost implications of HIV retesting for verification in Africa," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-15, July.
    4. Winnie Kavulani Luseno & Samuel H. Field & Bonita J. Iritani & Fredrick S. Odongo & Daniel Kwaro & Stuart Rennie, 2022. "Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya," IJERPH, MDPI, vol. 19(6), pages 1-15, March.
    5. Lawrence Mwenge & Linda Sande & Collin Mangenah & Nurilign Ahmed & Sarah Kanema & Marc d’Elbée & Euphemia Sibanda & Thokozani Kalua & Gertrude Ncube & Cheryl C Johnson & Karin Hatzold & Frances M Cowa, 2017. "Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-16, October.
    6. Sailly Dave & Trevor Peter & Clare Fogarty & Nicolaos Karatzas & Nandi Belinsky & Nitika Pant Pai, 2019. "Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018)," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-18, July.
    7. Dominic Bukenya & Janet Seeley & Grace Tumwekwase & Elizabeth Kabunga & Eugene Ruzagira, 2020. "How Follow-Up Counselling Increases Linkage to Care Among HIV-Positive Persons Identified Through Home-Based HIV Counselling and Testing: A Qualitative Study in Uganda," SAGE Open, , vol. 10(1), pages 21582440199, January.
    8. Pamela Bachanas & Mary Grace Alwano & Refeletswe Lebelonyane & Lisa Block & Stephanie Behel & Elliot Raizes & Gene Ussery & Huisheng Wang & Faith Ussery & Molly Pretorius Holme & Connie Sexton & Sherr, 2021. "Finding, treating and retaining persons with HIV in a high HIV prevalence and high treatment coverage country: Results from the Botswana Combination Prevention Project," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-14, April.
    9. Joseph Kamanga & Kayla Stankevitz & Andres Martinez & Robert Chiegil & Lameck Nyirenda & Florence Mulenga & Mario Chen & Mulamuli Mpofu & Sam Lubasi & Moses Bateganya, 2021. "Improved HIV case finding among key populations after differentiated data driven community testing approaches in Zambia," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-13, December.
    10. Rachel A Silverman & Grace C John-Stewart & Ingrid A Beck & Ross Milne & Catherine Kiptinness & Christine J McGrath & Barbra A Richardson & Bhavna Chohan & Samah R Sakr & Lisa M Frenkel & Michael H Ch, 2019. "Predictors of mortality within the first year of initiating antiretroviral therapy in urban and rural Kenya: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-19, October.

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