背景:支持HIV自我检测(HIVST)的咨询有助于促进与护理的联系,并促进男男性行为者(MSM)的行为改变。对MSMHIVST用户的不同程度的咨询支持可能会导致与护理联系的差异。
目的:本研究旨在综合支持MSMHIVST使用者的咨询证据,并进行荟萃分析以量化与护理相关的MSMHIVST使用者的比例。
方法:使用预定义的资格标准和相关关键词进行系统搜索,以从MEDLINE检索研究。全球卫生,WebofScience,Embase,APAPsycINFO,和Scopus数据库。此搜索包含2012年7月3日至2022年6月30日之间发表的论文和预印本。如果研究报告了支持HIVST的咨询或与MSM之间的护理联系的定量结果,并且以英文发表,则研究合格。筛选过程和数据提取遵循PRISMA(系统审查和荟萃分析的首选报告项目)指南。纳入研究的质量由美国国立卫生研究院质量评估工具进行评估。使用随机效应模型提取数据,以结合与护理相关的HIVST用户的比例。进行了亚组分析和回归分析,以评估与护理的联系是否根据研究特征而有所不同。所有分析均使用metafor软件包用R(4.2.1版;R统计计算基金会)进行。
结果:2014年至2021年共发表55项研究,包括43项观察性研究和12项随机对照试验,已确定。在这些研究中,50(91%)提供了主动咨询支持,5(9%)提供了被动咨询支持。在提供积极咨询支持的研究中,大多数MSMHIVST用户都与各种形式的护理有关,包括报告测试结果(97.2%,95%CI74.3%-99.8%),实验室确认(92.6%,95%CI86.1%-96.2%),开始抗逆转录病毒治疗(90.8%,95%CI86.7%-93.7%),和转诊给医生(96.3%,95%CI85%-99.2%)。在提供被动咨询支持的研究中,与实验室确认相关的MSMHIVST用户较少(78.7%,95%CI17.8%-98.4%),开始抗逆转录病毒治疗(79.1%,95%CI48.8%-93.7%),和转诊医生(79.1%,95%CI0%-100%)。多变量回归表明,更多的基本咨询成分,样本量较小(<300),使用移动健康技术提供咨询支持与更好的护理联系相关。研究的质量从一般到良好,从低到高的偏倚风险。
结论:主动为所有用户提供咨询支持,在咨询支持中涉及更多的基本组成部分,使用移动健康技术可以增加MSMHIVST用户与护理的联系。
背景:PROSPEROCRD42022346247;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=346247。
BACKGROUND: Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care.
OBJECTIVE: This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care.
METHODS: A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package.
RESULTS: A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias.
CONCLUSIONS: Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users.
BACKGROUND: PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.