HIV self-testing and partner notification strategies for key populations in low- to upper-middle-income countries: A mixed-methods systematic review

Abstract

Background HIV self-testing (HIVST) enhances case diagnosis, but information on its integration for index testing to partner notification is limited. Assessing the acceptability and feasibility of index HIVST and partner testing among people living with HIV (PLHIV) and undiagnosed key populations is critical to ending the AIDS epidemic. Methods A mixed-methods systematic review using a convergent segregated approach was conducted using the Joanna Briggs Institute’s methodology. Four databases were used to conduct a literature review from October 2023 to March 2024, which included studies published between 2016 and 2023. Rayyan software was used for full-text screening. Meta-analysis was deemed infeasible; however, a qualitative meta-aggregation approach was conducted. Results A total of 4076 studies were retrieved, and 76 studies met the inclusion criteria after a full review. Most of these studies were from the African region, with only one from South Asia and a few from East Asia. Index HIVST and partner testing were found acceptable and feasible among PLHIV and key populations. Despite low partner elicitation ratios through assisted partner notification, a higher positivity rate was noted among notified individuals. Preferences for index HIVST and partner testing varied, with more inclination for assisted and passive partner referrals to overcome the risk of HIV status disclosure. Assisted partner notification (aPN) showed a low cost per infection averted, indicating it’s a cost-effective intervention. Available evidence was skewed towards married couples, with less evidence on unmarried and undiagnosed key populations. Conclusion The index HIVST was found to be acceptable and feasible in reaching index partners, including untested and undiagnosed partners of key populations, when various testing approaches are used. Understanding the index HIVST among unmarried HIV index cases, and partner testing of undiagnosed key populations is important, particularly in the Southeast Asian region, to bridge the current HIV case detection gaps. Although no specific cost-effectiveness studies were found for the index HIVST, the aPN was found to be cost-effective. Study registration PROSPERO Number: CRD42023475417 dated 2023. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023475417 .