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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis

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Abstract

This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran’s Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.

Resumen

Esta revisión sistemática y metaanálisis tuvo como objetivo investigar la efectividad de las estrategias y los tipos de pruebas para la realización de la prueba del VIH entre hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MT), y su alcance a personas que viven con el VIH (PVV). Los artículos publicados hasta julio de 2020 fueron identificados utilizando base de datos y literatura gris; se extrajeron los datos de los artículos y se evaluó el riesgo de sesgo. Las estimaciones se agruparon mediante un metaanálisis de efectos aleatorios, mientras que la heterogeneidad fue evaluada utilizando la prueba Q de Cochran y la prueba I2. Este estudio está registrado en PROSPERO (CRD42020192740). De 6820 títulos, fueron incluidos 263 estudios (n = 67,288 participantes). En la mayoría, las estrategias reportadas fueron comunitarias (71.2%) y en establecimientos de salud (28.8%). Las pruebas realizadas en establecimientos de salud tuvieron mayor captación y mayor alcance de PVV mientras que con las pruebas de laboratorio estándar se detectó una mayor prevalencia del VIH entre los HSH. Sin embargo, la prueba de orina mostró una tasa más elevada de nuevas infecciones por el VIH. La combinación de múltiples pruebas tuvo mayor captación y tuvo alcance a PVV entre MT. Es necesario considerar las diferentes estrategias, tomando en cuenta las barreras y diferencias regionales, así como los diferentes tipos de pruebas, para incrementar la realización de pruebas del VIH entre HSH y MT.

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Data Availability

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Acknowledgements

The authors wish to thank the Department of Chronic Diseases and Sexually Transmitted Infections (in Portuguese: Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis—DCCI) in the Brazilian Ministry of Health and the National Council for Scientific and Technological Development (in Portuguese: Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPQ) for the financial support of this Project (#443116/2019-9), and Dr. Robin Schaefer for his valuable comments and advice on this manuscript.

Funding

This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq/Brazil (#443116/2019-9). The funders had no role in study design, study selection and data extraction, data analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Life Sciences, State University of Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, Bahia, 41150-000, Brazil

    Laio Magno, Thais Aranha Rossi & Nathalia Sernizon Guimarães

  2. Institute of Collective Health, Federal University of Bahia, Salvador, Brazil

    Laio Magno, Marcos Pereira, Caroline Tianeze de Castro, Nathalia Sernizon Guimarães & Ines Dourado

  3. Federal University of Western Bahia, Barreiras, Brazil

    Laylla Mirella Galvão Azevedo

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  3. Caroline Tianeze de Castro
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Contributions

LM conceived the study and assisted in the funding acquisition. MP, CTC and NSG contributed to the data analysis. CTC and LMGA contributed to the data collection and extraction. LM and CTC were involved in the writing of the original draft. LM, MP, CTC, TAR, LMGA, NSG and ID were involved in the manuscript's final review. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laio Magno.

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All analyses were based on previously published studies; no ethical approval or patient consent was required.

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Magno, L., Pereira, M., de Castro, C.T. et al. HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 27, 678–707 (2023). https://doi.org/10.1007/s10461-022-03803-5

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