BACKGROUND: Since 2016, HIV self-testing (HIVST) has been implemented globally across various settings and approaches. In high-burden settings, distribution and use of HIVST at facilities has the potential to increase testing uptake and improve efficiency. HIVST at facilities can also replace screening tools to prioritize testing for certain individuals. We conducted a systematic review to evaluate the benefits and harms of facility-based HIVST (FB-HIVST).
METHODS: The systematic review was conducted across nine databases through February 1, 2022. We searched for randomized controlled trials (RCTs) comparing FB-HIVST to any other HIV testing service, offered at facilities or at home, or no intervention. Pair-wise meta-analyses was conducted for studies reporting on comparable dichotomous outcomes, using random-effects model for relative risks (RR). Other outcomes were summarized descriptively. Risk of bias was assessed using Cochrane’s Risk of Bias (ROB) tool. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
RESULTS: Of the 2203 references identified, we included four RCTs comparing FB-HIVST to facility-based provider-administered rapid HIV testing among 4,811 people from Malawi and Kenya. FB-HIVST may improve HIV testing uptake (RR = 2.47; 95% CI: 0.96, 6.33; low certainty) and lead to higher HIV-positivity (RR= 3.77; 95% CI: 0.81,17.44; low certainty). In a single trial, a 3-fold increase in linkage to care was observed in FB-HIVST compared to SOC (RR= 3.26; 95% CI: 0.68, 15.62; low certainty). All trials found FB-HIVST acceptable and there was no evidence of social harm.
CONCLUSIONS: FB-HIVST is a safe and effective approach which can be used to improve HIV testing coverage in clinics and should especially be considered as a way to replace risk-based screening tools.

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