Social Media Interventions to Promote HIV Testing, Linkage, Adherence, and Retention: Systematic Review and Meta-Analysis

Abstract

BackgroundSocial media is increasingly used to deliver HIV interventions for key populations worldwide. However, little is known about the specific uses and effects of social media on human immunodeficiency virus (HIV) interventions.ObjectiveThis systematic review examines the effectiveness of social media interventions to promote HIV testing, linkage, adherence, and retention among key populations.MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane guidelines for this review and registered it on the International Prospective Register of Systematic Reviews, PROSPERO. We systematically searched six databases and three conference websites using search terms related to HIV, social media, and key populations. We included studies where (1) the intervention was created or implemented on social media platforms, (2) study population included men who have sex with men (MSM), transgender individuals, people who inject drugs (PWID), and/or sex workers, and (3) outcomes included promoting HIV testing, linkage, adherence, and/or retention. Meta-analyses were conducted by Review Manager, version 5.3. Pooled relative risk (RR) and 95% confidence intervals were calculated by random-effects models.ResultsAmong 981 manuscripts identified, 26 studies met the inclusion criteria. We found 18 studies from high-income countries, 8 in middle-income countries, and 0 in low-income countries. Eight were randomized controlled trials, and 18 were observational studies. All studies (n=26) included MSM; five studies also included transgender individuals. The focus of 21 studies was HIV testing, four on HIV testing and linkage to care, and one on antiretroviral therapy adherence. Social media interventions were used to do the following: build online interactive communities to encourage HIV testing/adherence (10 studies), provide HIV testing services (9 studies), disseminate HIV information (9 studies), and develop intervention materials (1 study). Of the studies providing HIV self-testing, 16% of participants requested HIV testing kits from social media platforms. Existing social media platforms such as Facebook (n=15) and the gay dating app Grindr (n=10) were used most frequently. Data from four studies show that HIV testing uptake increased after social media interventions (n=1283, RR 1.50, 95% CI 1.28-1.76). In the studies where social media interventions were participatory, HIV testing uptake was higher in the intervention arm than the comparison arm (n=1023, RR 1.64, 95% CI 1.19-2.26).ConclusionsSocial media interventions are effective in promoting HIV testing among MSM in many settings. Social media interventions to improve HIV services beyond HIV testing in low- and middle-income countries and among other key populations need to be considered.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO): CRD42016048073; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016048073 (Archived by WebCite at http://www. webcitation.org/6usLCJK3v)

Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China (Preprint)

“…Influencers could also serve as leaders in network-based, social media interventions to allow health messages to reach more MSM [37]. We found among influencers a higher rate of social media engagement about HIV testing and a higher likelihood of having used social media for HIV testing than other MSM, suggesting influencers may be readily incorporated into social media HIV interventions [37]. Influencers additionally contribute by being well positioned in social networks to spread behavior change.…”

“…For example, influencers could serve as steering committee members of crowdsourcing contests that aim to promote testing [30,46]. Influencers could also serve as leaders in network-based, social media interventions to allow health messages to reach more MSM [37]. We found among influencers a higher rate of social media engagement about HIV testing and a higher likelihood of having used social media for HIV testing than other MSM, suggesting influencers may be readily incorporated into social media HIV interventions [37].…”

“…Their higher HIV testing may be related to increased community engagement in sexual health [35] and HIV testing-related social media use. [37] The higher rates of HIV testing among influencers may also be related to lower HIV stigma and higher testing self-efficacy which are two important contributors to test uptake [32,38].…”

The Web-Based Physician is Ready to See You: A Nationwide Cross-Sectional Survey of Physicians Using a Mobile Medical App to Evaluate Patients With Sexually Transmitted Diseases in China (Preprint)

“…Studies in high-, middle-, and low-income countries have demonstrated that social media experiences can promote STD testing [23,24]. A study in the United Kingdom found that offering internet-accessed STD testing increased test uptake and decreased the time to get tested, however, it did not reduce time to treatment [25].…”

Use of geosocial networking applications to reach men who have sex with men: progress and opportunities for improvement

“…Examples of novel interventions include the use of vending machines to offer HIV tests,11 home specimen collection for STI testing12 and using GSN app pop-up messages to refer users to a website to order home-delivered HIV self-test kits 5. Ultimately, GSN apps are just one method of reaching MSM who may be at high risk for HIV and STIs, but multiple methods, including other social media platforms13 and traditional outreach, are needed to curb the HIV and STI epidemics among MSM.…”