Can digital HIV self-testing (HIVST) be the next paradigm for self-testing? A systematic review of global evidence


BACKGROUND: In line with UNAIDS targets to end HIV by 2030 and WHO HIV self-testing (HIVST) recommendations, HIVST deployment and integration in health services is an emerging priority. Digital HIVST is defined as use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging, digital vending machines) to improve the efficiency and impact of HIVST. Following COCHRANE methodology, we conducted a systematic review to inform policy recommendations and close the knowledge gap.
METHODS: We searched all literature on PubMed and Embase for the period February 1, 2010 to December 1, 2020. We assessed all outcomes (i.e., uptake, acceptability, HIVST, kit return rate, linkages to care, etc.) across at-risk populations. Data were narratively synthesized as heterogeneity of interventions and diversity of outcomes precluded a meta-analysis.
RESULTS: Of 39 studies reviewed, 28% (11/39) were RCTs and 72% (28/39) were observational studies. About 49% of studies (19/39) evaluated websites (e.g., study websites, videos, chatbots), followed by social media (31%, 12/39), text messaging (10%, 4/39), apps (5%, 2/39), and vending machines (5%, 2/39). A significant proportion of HIVST users (range: 30%-51%) were first-time HIV testers. High uptake (up to 95%) was reported for websites and apps. Acceptability, defined as willingness to use digital HIVST, was high (77%-97%). HIVST kit return rates (54%-94%) increased with text messaging reminders/prompts. Most importantly, linkage to care was high (53%-100%). Linkages to care were initiated for HIV positive and negative self-testers.
CONCLUSIONS: In the context of the current COVID-19 pandemic, digital HIVST is a timely and convenient strategy for hard-to-reach and at-risk populations. Mobile apps and website-based counselling were effective in reaching populations in diverse settings. Digital HIVST reported successes in increasing uptake, acceptability, participant preference, kit return rates, and in linking participants to care. The overall evidence suggests that digital HIVST is well poised to become the new paradigm for HIVST.