(288) Self-test as a strategy to promote HIV testing among men who have sex with men and transgender women - overview of systematic reviews and meta-analyses

Background: HIV self-testing (HIVST) is one of the strategies used to achieve people who do not know their HIV status. Due to the advantages in the use (e.g. privacy, convenience), HIVST is potentially effective in reaching hidden key-populations, such as men who have sex with men (MSM) and transgender women (TGW).

Objectives: To assess whether HIVST combined or not with other strategies is effective in increasing uptake and frequency of HIV testing among MSM and TGW.

Methods: Overview of systematic reviews and meta-analyses (SR-MA) including randomized clinical trials (RCTs) and observational studies that evaluated HIVST as a strategy to increase HIV testing among MSM and TGW. The search was performed electronically on eight databases, without language restriction. Data selection and extraction were both performed independently by pairs and disagreements were solved by a third reviewer. The screening of SR-MA was carried out through the selection of titles/abstracts and the reading of full texts of the pre-selected reviews. Data extraction was conducted using a structured form. The estimates of effect size from meta-analyses were expressed as odds ratios (OR) and relative risks (RR) followed by 95% confidence intervals (CIs). Disagreements were resolved by consensus supported by a third reviewer (PROSPERO CRD42023410822).

Results: In total, five SR-MA met eligibility criteria (n=3 of RCTs; being one an update of a previous systematic review and meta-analysis, and n=2 of RCTs and observational studies). They evaluated oral fluid-based, blood-based, or both HIVST types. The target population evaluated were MSM exclusively (n=1), MSM and other key-populations (n=2) and MSM and TGW (n=2; SR-MA analyzed pooled data concerning both populations). SR-MA compared HIVST distribution with other HIV testing interventions: facility-based, online/mail and peer distribution. The frequency and uptake of testing among MSM and TGW increased in the HIVST arm compared with all the investigated interventions. Results of meta-analyses of RCTs showed that the mean number of tests increased by 0.88, 2.34, and 2.56. The increase in the uptake of testing in the HIVST arm varied from 1.12 (RR; 95%CI= 1.05, 1.20) to 1.61 (RR; 95%CI= 1.33, 1.94). One systematic review reported increased testing uptake in first-time testers and non-recent testers.

Conclusions: HIVST seems to be effective in increasing uptake and frequency of HIV testing among MSM and TGW. However, data on TGW are still scarce and further studies are needed to address trans-specific prevention actions toward the achievement of the 95-95-95 treatment targets to end AIDS by 2030.