Assessing the Impact of use of HIV self-testing on the incidence of HIV Infection in Nigeria: a systematic review and meta-analysis

BackgroundHuman immunodeficiency virus (HIV) self-testing tool is a widely adopted tool in Nigeria. However, there is little known about its impact in reducing HIV infection rates in Nigeria. This review aims to assess the impact of the use of HIV self-testing on the incidence of HIV infections in the country. MethodsThis was a systematic review and meta-analysis. Studies conducted in Nigeria on HIV self- testing with or without comparison to other HIV tests were included. The primary outcomes considered were the detection rate of new HIV cases and the acceptability (uptake) rate for HIV self-testing. Secondary outcomes were the usability rate, repeat testing rate, willingness rate, awareness rate, incidence of social harm, and incidence of high-risk behaviour. Electronic databases (PubMed/Medline, Web of Science, Scopus, CINAHL, and Cochrane Library) and Google Scholar were searched for relevant studies. Searches were conducted till December 2, 2023. Pooled estimates were calculated using a random-effects model with the DerSimonian Laird method. Heterogeneity was analyzed using the I2 test, and risk of bias was assessed with the Hoy and colleagues scale. Meta-analysis was conducted where possible. The protocol was registered with PROSPERO (CRD42023479752). ResultsEight studies, encompassing 7,556 participants, met the inclusion criteria. The overall risk of bias for the included studies was adjudged low. The detection rate of HIV self-testing for new HIV cases was 25.78% (95% CI: 0.90-50.66, I2:100.0), acceptability (uptake) rate was 56.92% (95% CI: 26.54-87.30, I2:100.0), and repeat testing rate was 20.10% (95% CI: -11.44-51.65, I2:100.0). Usability rate, willingness rate, awareness rate, and incidence of high-risk behaviour were reported in one study respectively, with no information on the incidence of social harm. Sensitivity analysis was done, and subgroup analyses could not be estimated due to insufficient data. ConclusionsThe use of HIV self-testing test kits in Nigeria showed a high detection rate of new HIV cases, moderate acceptability, but low repeat testing rates. However, the evidence is limited. Larger, higher-quality studies are essential to explore the broader impact of HIV self-testing on reducing HIV incidence in Nigeria.