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BMJ Open. 2014 Dec 15;4(12):e006859. doi: 10.1136/bmjopen-2014-006859.

Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review.

Author information

1
Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care Ottawa Hospital Research Institute, The Ottawa Hospital.
2
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
3
Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
4
Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada Canada Foundation for Nepal, Ottawa, Ontario, Canada.
5
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Bruyere Research Institute, Bruyere Continuing Care.
6
Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
7
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, The Ottawa Hospital.

Abstract

OBJECTIVE:

To assess the effects of rapid voluntary counselling and testing (VCT) for HIV on HIV incidence and uptake of HIV/AIDS services in people at high risk for HIV exposure.

DESIGN:

Cochrane systematic review and meta-analysis.

DATA SOURCES:

We searched PubMed, EMBASE, AIDSearch, LILACS, Global Health, Medline Africa, PsychInfo, CINAHL, Cochrane CENTRAL, Cochrane HIV/AIDS Group Specialized Register and grey literature from 1 January 2001 to 5 June 2014 without language restriction.

DATA SELECTION:

We included controlled studies that compared rapid VCT with conventional testing among people at risk for HIV exposure.

DATA EXTRACTION:

Two reviewers extracted data. We used Cochrane risk of bias tool and GRADE criteria: risk of bias, inconsistency, indirectness, imprecision and publication bias. For observational studies we used the Newcastle-Ottawa Scale. We used the PRISMA-Equity reporting guideline.

RESULTS:

From 2441 articles, we included 8 randomised controlled trials and 5 observational studies. Rapid VCT was associated with a threefold increase in HIV-testing uptake (relative risk (RR)=2.95 95% CI 1.69 to 5.16) and a twofold increase in the receipt of test results (RR=2.14, 95% CI 1.08 to 4.24). Women accepted testing more often than men in rapid VCT arm, but no differences in effect for age or socioeconomic status. Observational studies also showed rapid VCT led to higher rates of uptake of testing. Heterogeneity was high. A cluster-randomised trial reported an 11% reduction in HIV incidence in intervention communities (RR=0.89, 95% CI=0.63 to 1.24) over 3 years trial.

CONCLUSIONS:

Rapid VCT in health facilities and communities was associated with a large increase in HIV-testing uptake and receipt of results. This has implications for WHO guidelines. The routine use of rapid VCT may also help avoid human rights violations among marginalised populations where testing may occur without informed consent and where existing stigma may create barriers to testing.

KEYWORDS:

HIV Services; HIV Testing; Rapid VCT

PMID:
25510889
PMCID:
PMC4267075
DOI:
10.1136/bmjopen-2014-006859
[Indexed for MEDLINE]
Free PMC Article

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