Facility-based HIV self-testing as an additional testing option in health facilities: A systematic review and meta-analysis

Facility-based HIV self-testing (FB-HIVST) has been used across settings to improve testing accessibility and achieve global testing and treatment targets by 2030. The effectiveness of FB-HIVST remains uncertain; thus, we conducted a review to assess the risk and benefits of FB-HIVST to inform global guidance. We searched across nine electronic databases covering the period up to February 01, 2022, and included publications that directly compared FB-HIVST to standard HIV testing services (SOC) or no intervention. Meta-analysis was conducted on comparable outcomes using random-effects model for relative risks (RR) and 95% confidence intervals. Other outcomes were summarized descriptively. Risk of bias was assessed using Cochranes Risk of Bias tool. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). After screening 2,203 articles, 11 studies were found eligible, including 4 randomized controlled trials (RCT), 2 cohort studies, 3 economic evaluations, and 2 qualitative studies. Meta-analyses of four RCTs demonstrated that FB-HIVST may increase testing uptake (RR=2.47; 95% CI= 0.96, 6.33) and may lead to greater HIV diagnosis (RR=3.77; 95% CI=0.81, 17.44). Overall GRADE certainty was low. Trials found FB-HIVST as acceptable and feasible to many users, with minimal risk of social harm. A single RCT reported on linkage to care and observed that, among total enrolled, FB-HIVST compared to SOC may increase linkage to care threefold (RR= 3.26; 95% CI: 0.68, 15.62; low-certainty evidence). FB-HIVST was found to be cost-effective in a high-burden outpatient department, but determined to be quite variable. FB-HIVST is safe and may be an effective method to increase testing coverage and the diagnoses, particularly in high-burden HIV settings or sites with limited staff and resources. Findings from this review informed WHOS guideline development process and its recommendation that FB-HIVST be offered as an additional testing option at facilities. PROSPERO Number: CRD42022302619