| Stafylis et al., 2018[@161890] |
US |
High risk populations |
Implementation study |
HIVST kits with linkage information
Local information about medical assistance and the AIDS Healthcare Foundation's 24/7 Linkage-to-Care hotline was attached to the test kits in case of a reactive test result. |
Among those reporting a reactive HIV result, seven (41%; 7/17) had sought confirmatory testing and four of them (24%; 4/17) had initiated treatment. Two participants (12%; 2/17) were linked to care. Two participants requested linkage-to-care assistance.
Note: Linkage time was not reported. |
Management of cases with an initial positive result and loss to follow up remained as important challenges in linkage to care. |
| Bhattacharjee et al., 2019[@161891] |
Kenya |
MSM |
Implementation study
(Protocol) |
HIVST kits with linkage information and follow-up
Provide referral cards and information about HIV prevention and treatment services along with test kits distribution.
Trained personnel make follow-up text messages and calls to the MSM who receive HIVST and remind them about prevention and treatment services. |
Effectiveness of linkage to HIV prevention and treatment services for MSM who self-test.
Note: Linkage measurement was not specified. |
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| Gabriel et al., 2018[@161892] |
UK |
MSM, TGW, TGM |
RCT
(Protocol) |
Web-based HIVST
Study website provides guidance on how to find local health care service to assist participants in dealing with a new diagnosis and accessing confirmatory testing and HIV care services. |
A laboratory-confirmed HIV diagnosis, with date of diagnosis defined as the date of the first confirmatory test at clinic. |
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| Stephenson et al., 2017[@161896] |
US |
MSM couple |
RCT
(Protocol) |
HIVST with real-time video counselling
Intervention arm: couples will receive HIV self-testing kits and will conduct tests under the facilitation of a VSee-based video couples HIV testing and counselling session.
Control arm: couples will receive HIV self-testing kits. |
Within 3 months of HIV diagnosis:
(1) attending at least one clinical care appointment
(2) having at least one CD4 test performed
(3) having at least one viral load test performed |
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| Stephenson et al., 2017[@161897] |
US |
TG Youth |
RCT
(Protocol) |
HIVST with real-time video counselling
Intervention arm: Participants will receive one HIVST package and will be instructed for the video-chat counselling session.
Control arm: Participants will receive one HIVST package.
Follow-up:
Participants who test positive will be linked to a health provider and will be followed up from the next business day at least three more times to confirm (1) an appointment was scheduled, (2) the appointment was attended, and (3) a confirmatory test result was reported. |
Within 3 months of HIV diagnosis:
(1) attending at least one clinical care appointment
(2) having at least one CD4 test performed
(3) having at least one viral load test performed within three months of HIV diagnosis |
– |
| Phanuphak et al., 2020[@161898] |
Thailand |
MSM and TGW |
Implementation study |
Online HIVST and counselling with intensive follow-up
Study staff contacted referred participants at week 2, months 1, 3, 6 and 12 in the Offline and Mixed groups, and at day 3, weeks 1, 2, and every two to four weeks in the Online group, to ensure linkage to care. |
Among 60 baseline HIV positive and 18 seroconversion
participants, successful ART initiation in the Online group (52.8%) was lower than the Offline (84.8%) and Mixed groups (77.8%).
Note: Linkage time was not reported. |
Linkages to HIV confirmatory testing and ART initiation once tested HIV-reactive, as well as HIV prevention services among HIV-negative individuals are challenging. |
| Chan et al., 2021[@161899] |
China |
MSM |
Implementation study |
Online real-time counselling
Online real-time pre-test/post-test counselling for HIVST users via live chat application.
Psychological support and CBO staff support for those who received positive results and referral for a free confirmatory HIV antibody testing. |
Four HIVST-online users were screened to be HIV positive and linked to the treatment.
Note: Linkage time was not reported. |
Ensure linkage to care is one major strength of HIVST-online: with real-time counselling, administrators know all the users' sero-status and provide immediate support to the users. |
| Wray et al., 2020[@161895] |
US |
MSM |
RCT
(Registered clinical trial) |
HIVST post-test phone counselling
eTest condition: the eTest system ensure researchers to be notified when users initiated HIVST and provide post-test counselling within 24 hours and refer them to other needed services, including PrEP.
Standard condition: HIVST without active follow-up.
Control: reminders to get tested for HIV at a local clinic every 3 months. |
At 1, 4-, 7-, 10-, and 12-months post-enrolment:
(1) the proportion of participants who consulted with a physician about PrEP.
(2) received a PrEP prescription.
(3) received any STI testing during the study period.
(4) received STI testing at least once during each 6-month period. |
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| Pai et al., 2018[@161893] |
Canada |
MSM |
Cross-sectional Study |
Mobile app-guided HIVST
HIVSmart! interprets and stores data confidentially, links users to counselling or care within a rapid turnaround time and encourages them to stay in care. |
In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. |
With HIVSmart!, participants could get rapidly linked to care. |
| Sullivan, 2020[@161894] |
US |
MSM, TGW |
RCT
(Registered clinical trial) |
Mobile app-guided HIVST
Intervention arm: Participants will use Know@Home app or website which were developed to serve as a comprehensive mobile HIV prevention platform for MSM or TGW, with HIV prevention and care information and links to resources.
Control arm: participants in this study arm will receive mail-out HIV self-testing kits. |
Up to Month 4:
linkage of participants to HIV treatment.
linkage of participants to PrEP treatment.
linkage of participants to STI testing.
linkage of participants to HIV prevention services.
linkage of participants to HIV social services. |
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| Balán et al., 2020[@161885] |
US |
MSM, TGW |
Implementation study |
Mobile app-guided HIVST
Participants conducted HIVST using a smartphone app providing a video, pictorial step-by-step instructions, and sample test results presented textually.
Participants' feedback and preferences regarding linkage to care were integrated into the app. |
SMARTtest app provided linkage resources for all 60 participants and their partners. Participants' perception and needs regarding linkage to care service were interviewed.
Note: Linkage time was not reported. |
The SMARTest app incorparated extensive information on linkage resources (Test Accuracy, Window Period, Disease Info, Nearby Clinics, Call Hotline), which could be referred by test users timely when appling HIVST. |
| Zhong et al., 2017[@161907] |
China |
MSM |
Implementation study |
Social entrepreneurship testing model
Participants bought the HIVST kits at $23 which was refunded upon successfully performing the HIVST and reporting the results to health workers. The CBO contacted the participants to provide counselling services, confirmation testing and linkage to care. |
All the 8 newly identified self-tested positive individuals were confirmed to be HIV positive, and they were linked to care and underwent their first CD4 count measurement.
Note: Linkage time was not reported. |
The social entrepreneurship model using mobile health technologies to track self-testing and linkage to care among MSM is feasible and acceptable. |
| Tun et al., 2018[@161900] |
Nigeria |
MSM |
Cohort study |
HIVST kits distribution through KOLs and follow-up
The counsellor followed up with participants by calling participants at five, 30 and 80 days after participants received the HIVST kits to provide support for usage and facilitate referrals for HIV treatment for those testing positive. |
Among the 14 who tested positive, all were confirmed HIV positive and all accepted and have initiated HIV treatment.
Note: Linkage time was not reported. |
The high linkage to treatment in this study is likely due to follow-up calls by the counsellor after HIVST distribution, the participant's access to their KOLs, and the linkage to a well-trusted MSM-friendly facility that offers not only HIV prevention services but also HIV treatment. |
| Green et al., 2018[@161901] |
Vietnam |
MSM |
Implementation study |
CBO led HIV lay testing and HIVST
MSM CBOs staffs were trained to offer HIVST information and support clients with HIV-reactive results. MSM with an HIV-reactive result from peer testing or self-testing were accompanied by CBO staff for confirmatory testing at the closest district health centre, and those that were HIV diagnosed were helped with ART enrolment. |
Among MSM who opted for HIVST, 297 (7%) people tested HIV-reactive, 269 (90.6%) were confirmed HIV positive, and 243 (90.3%) were registered for treatment (May 2016 to September 2017).
Note: Linkage time was not reported. |
CBO led HIV lay testing and HIVST could significantly increase HIV testing among harder-to-reach and higher-risk MSM and effectively enroll them in ART. |
| Zhang et al., 2020[@161902] |
China |
MSM |
Implementation study |
SMKOL HIVST delivery strategy and CBO-based HIVST
SMKOLs distributed HIVST advertisements to MSM through WeChat public platforms. HIVST staff provided pretest and post-test counselling through the WeChat public platform, the individual WeChat app, or by telephone.
CBOs distributed HIVST program messages to local MSM through social media tools (WeChat moments, QQ, and Blued) and offline events.
Trained volunteers from local CBOs paired up with local health departments to help ensure linkage of participants to confirmatory testing, care, and treatment.
Participants were required to pay a deposit to apply for the HIVST kit and had their deposit refunded after completing an online survey and uploading HIVST results. |
SMKOL group: 2.9% (45/1561) received HIVST-positive results, 82.2% (37/45) were linked to care, 33 (2.1%) were confirmed as HIV-seropositive, and 31 (94.4%) initiated ART.
CBO group: 12.5% (100/803) received HIVST-positive results, 100 (100%) were confirmed as HIV-seropositive, 72.0% (72/100) were linked to care, and 29 (29.0%) initiated ART.
Note: Linkage time was not reported. |
The proportion of ART in the CBO group was low comparing to that of SMKOL, which may be explained by the significantly lower education level in the CBO group than that of the SMKOL group. |
| Chanda et al., 2017[@161903] |
Zambia |
FSW |
RCT |
Peer educators HIVST delivery
Trained peer educators distributed HIVST kits, gave HIV risk reduction counselling, and provided participants with HIV self-test training, including self-test use, results interpretation, and linkage to care.
(1) delivery arm (direct distribution of an oral HIVST from the peer educator)
(2) coupon arm (a coupon for collection of an oral HIVST from a health clinic/pharmacy)
(3) routine HIV testing |
Linkage to care/ATR initiation at 1 month:
routine testing: 44 (74.6%)/27 (46.6%)
peer educator HIVST delivery: 25 (51.0%)/11 (22.5%)
coupon clinic/pharmacy collection of HIVST kits: 19 (52.8%)/9 (25.0%).
Linkage to care/ATR initiation at 4 month:
routine testing: 72 (85.7%)/54 (64.3%)
peer educator HIVST delivery: 53 (71.6%)/35 (48.0%)
coupon clinic/pharmacy collection of HIVST kits: 59 (76.6%)/44 (57.1%) |
Linkage to care and ART initiation following a positive HIV self-test was high and increased over time. Future studies should consider linkage to care and ART interventions following HIVST, including the role of peer educators for facilitating HIV care cascade progression. |
| Ortblad et al., 2017[@161904] |
Uganda |
FSW |
RCT |
Peer educators HIVST delivery
Peer educators distributed HIVST kits, referred participants to standard of care HIV testing services, and screened for potential adverse events and provided HIV self-test training, including self-test use, results interpretation, and linkage to care to participants.
3 arms
(1) direct provision of HIV self-tests by peer educators
(2) provision of coupons for free collection of HIVST in a health care facility
(3) routine HIV testing |
Linkage to care/ATR initiation at 1 month:
SOC: 25(8.3%)/13 (4.3%)
Direct provison of HIVST: 17 (5.9%)/13 (4.5%)
Coupons for free collection of HIV self-tests: 13 (4.2%)/10 (3.2%)
Linkage to care/ATR initiation at 4 month:
SOC: 37 (12.6%)/24 (8.2%)
peer educator HIVST delivery: 27 (10.4%)/19 (7.3%)
coupon clinic/pharmacy collection of HIVST kits: 37 (12.8%)/27 (9.3%) |
Although all participants received the peer educator intervention, the overall degree of linkage to care and treatment was low. HIVST policies for FSWs should be accompanied by stronger linkage interventions. |
| Dijkstra et al., 2021[@161905] |
Kenya |
MSM, TGW |
Implementation study |
Peer mobilisation followed by PN service
Mobilisers distributed HIV oral self-test kits within their networks and gave clients with acute early HIV infection symptoms a symptom referral card and immediately referred them to further testing. The mobilised participants who were diagnosed with HIV were assisted to engage their partners in HIV testing through the PN service. |
Among the 26 participants who were newly diagnosed with HIV, 24 (92.3%) immediately initiated ART, and PrEP was initiated among 24.0% (103/429) mobilised participants and 28.6% (4/14) partners without HIV. |
HIV PN provider referral effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP services. |
| Nguyen, et al., 2019[@161906] |
Vietnam |
MSM, PWID, FSW |
Implementation study |
Community-led HIV self-testing combined with assisted PN
Clients with a reactive result were counselled and supported by a peer educator and referred for confirmatory testing. Those confirmed to have HIV positive received additional post-test counselling by staff at the site of confirmatory testing. Peer educators then assisted them with enrolment in ART at an outpatient clinic. |
Among participants who self-tested, 5.1% (103/2009) was confirmed HIV positive and 98.1% (101/103) initiated ART.
Note: Linkage time was not reported. |
The dedication of peer educators in supporting clients with reactive results to access confirmatory testing and ART services contributed to the
linkage results. |
| Mirzazadeh, 2017[@161908] |
Iran |
FSW |
RCT
(Registered clinical trial) |
Monetary incentives
Monetary incentives for returning their test results, and for every successful invitation of clients, partners, and peers, and for successful linkage to care. |
Confirmatory HIV test among FSW.
ART initiation among FSW.
ART initiation among clients, partners and peers.
Confirmatory HIV test among clients, partners and peers.
Note: Linkage time was not specified. |
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