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ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data
INTRODUCTION: Measuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving d...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287607/ https://www.ncbi.nlm.nih.gov/pubmed/34275871 http://dx.doi.org/10.1136/bmjgh-2021-004986 |
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author | Neuman, Melissa Fielding, Katherine L Ayles, Helen Cowan, Frances M Hensen, Bernadette Indravudh, Pitchaya P Johnson, Cheryl Sibanda, Euphemia Lindelwe Hatzold, Karin Corbett, Elizabeth Lucy |
author_facet | Neuman, Melissa Fielding, Katherine L Ayles, Helen Cowan, Frances M Hensen, Bernadette Indravudh, Pitchaya P Johnson, Cheryl Sibanda, Euphemia Lindelwe Hatzold, Karin Corbett, Elizabeth Lucy |
author_sort | Neuman, Melissa |
collection | PubMed |
description | INTRODUCTION: Measuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates. METHODS: Five STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the months of intervention at clinics in HIVST and comparison areas were presented graphically, and study effects combined using meta-analysis. Meta-regression was used to estimate associations between the impact of community-based HIVST distribution and indicators of implementation context, intensity and reach. Effect size estimates used (1) prespecified trial definitions of ART timing and comparator facilities and (2) exploratory definitions accounting for unexpected diffusion of HIVST into comparison areas and periods with less distribution of HIVST than was expected. RESULTS: Compared with arms with standard testing only, ART initiations were higher in clinics in HIVST distribution areas in 4/5 studies. The prespecified meta-analysis found positive but variable effects of HIVST on facility ART initiations (RR: 1.14, 95% CI 0.93 to 1.40; p=0.21). The exploratory meta-analysis found a stronger impact of HIVST distribution on ART initiations (RR: 1.29, 95% CI 1.08 to 1.55, p=0.02). ART initiations were higher in studies with greater self-reported population-level intensity of HIVST use (RR: 1.12; 95% CI 1.04 to 1.21; p=0.02.), but did not differ by national-level indicators of ART use among people living with HIV, number of HIVST kits distributed per 1000 population, or self-reported knowledge of how to link to care after a reactive HIVST. CONCLUSION: Community-based HIVST distribution has variable effect on ART initiations compared with standard testing service alone. Optimising both support for and approach to measurement of effective and timely linkage or relinkage to HIV care and prevention following HIVST is needed to maximise impact and guide implementation strategies. |
format | Online Article Text |
id | pubmed-8287607 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-82876072021-07-30 ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data Neuman, Melissa Fielding, Katherine L Ayles, Helen Cowan, Frances M Hensen, Bernadette Indravudh, Pitchaya P Johnson, Cheryl Sibanda, Euphemia Lindelwe Hatzold, Karin Corbett, Elizabeth Lucy BMJ Glob Health Original Research INTRODUCTION: Measuring linkage after community-based testing, particularly HIV self-testing (HIVST), is challenging. Here, we use data from studies of community-based HIVST distribution, conducted within the STAR Initiative, to assess initiation of antiretroviral therapy (ART) and factors driving differences in linkage rates. METHODS: Five STAR studies evaluated HIVST implementation in Malawi, Zambia and Zimbabwe. New ART initiations during the months of intervention at clinics in HIVST and comparison areas were presented graphically, and study effects combined using meta-analysis. Meta-regression was used to estimate associations between the impact of community-based HIVST distribution and indicators of implementation context, intensity and reach. Effect size estimates used (1) prespecified trial definitions of ART timing and comparator facilities and (2) exploratory definitions accounting for unexpected diffusion of HIVST into comparison areas and periods with less distribution of HIVST than was expected. RESULTS: Compared with arms with standard testing only, ART initiations were higher in clinics in HIVST distribution areas in 4/5 studies. The prespecified meta-analysis found positive but variable effects of HIVST on facility ART initiations (RR: 1.14, 95% CI 0.93 to 1.40; p=0.21). The exploratory meta-analysis found a stronger impact of HIVST distribution on ART initiations (RR: 1.29, 95% CI 1.08 to 1.55, p=0.02). ART initiations were higher in studies with greater self-reported population-level intensity of HIVST use (RR: 1.12; 95% CI 1.04 to 1.21; p=0.02.), but did not differ by national-level indicators of ART use among people living with HIV, number of HIVST kits distributed per 1000 population, or self-reported knowledge of how to link to care after a reactive HIVST. CONCLUSION: Community-based HIVST distribution has variable effect on ART initiations compared with standard testing service alone. Optimising both support for and approach to measurement of effective and timely linkage or relinkage to HIV care and prevention following HIVST is needed to maximise impact and guide implementation strategies. BMJ Publishing Group 2021-07-14 /pmc/articles/PMC8287607/ /pubmed/34275871 http://dx.doi.org/10.1136/bmjgh-2021-004986 Text en © World Health Organization 2023. Licensee BMJ. https://creativecommons.org/licenses/by-nc/3.0/igo/This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY NC 3.0 IGO (https://creativecommons.org/licenses/by-nc/3.0/igo/) ), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL. Disclaimer: The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization. |
spellingShingle | Original Research Neuman, Melissa Fielding, Katherine L Ayles, Helen Cowan, Frances M Hensen, Bernadette Indravudh, Pitchaya P Johnson, Cheryl Sibanda, Euphemia Lindelwe Hatzold, Karin Corbett, Elizabeth Lucy ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title | ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title_full | ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title_fullStr | ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title_full_unstemmed | ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title_short | ART initiations following community-based distribution of HIV self-tests: meta-analysis and meta-regression of STAR Initiative data |
title_sort | art initiations following community-based distribution of hiv self-tests: meta-analysis and meta-regression of star initiative data |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287607/ https://www.ncbi.nlm.nih.gov/pubmed/34275871 http://dx.doi.org/10.1136/bmjgh-2021-004986 |
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