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Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: an equity-focused systematic review
  1. Kevin Pottie1,2,3,4,5,
  2. Olanrewaju Medu3,
  3. Vivian Welch2,4,6,7,
  4. Govinda P Dahal2,8,
  5. Mark Tyndall3,4,
  6. Tamara Rader2,
  7. George Wells3,5
  1. 1Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Bruyere Research Institute, Bruyere Continuing Care
  5. 5Ottawa Hospital Research Institute, The Ottawa Hospital
  6. 6Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  7. 7University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
  8. 8Canada Foundation for Nepal, Ottawa, Ontario, Canada
  1. Correspondence to Dr Kevin Pottie; kpottie{at}uottawa.ca

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.

  • HIV Testing
  • Rapid VCT
  • HIV Services

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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