HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

Croxford, Sara; Tavoschi, Lara; Sullivan, Ann; Combs, Lauren; Raben, Dorthe; Delpech, Valérie; Jakobsen, Stine Finne; Amato‐Gauci, Andrew J.; Desai, Sarika

doi:10.1111/hiv.12807

Cited by 27 publications

(30 citation statements)

References 64 publications

(353 reference statements)

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“…Expanding access to treatment among homeless PWID should be prioritised given the unique barriers faced by this group, 95 , 96 despite the availability of effective and cost-effective HIV and HCV testing and treatment interventions. 97 , 98 , 99…”

Section: Discussionmentioning

confidence: 99%

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Arum

Fraser

Artenie

et al. 2021

The Lancet Public Health

123

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Summary Background People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. Methods In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I 2 statistic and p value for heterogeneity. Findings We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23–1·95; p=0·0002]; I 2 = 62·7%; n=17) and HCV (1·65 [1·44–1·90; p<0·0001]; I 2 = 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06–1·84; p=0·019]; I 2 = 65·5%; n=9; and for HCV: 1·64 [1·43–1·89; p<0·0001]; I 2 = 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13–2·95; p=0·014...

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Section: Discussionmentioning

confidence: 99%

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Arum

Fraser

Artenie

et al. 2021

The Lancet Public Health

123

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“…This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement for the reporting of systematic reviews . A full description of the methodology is described elsewhere . Briefly, five electronic databases (OVID Medline, Embase, PsycINFO, Scopus and the Cochrane Library of Systematic Reviews) (January 2010 to March 2017) and the proceedings of six conferences (2014–2017) were searched using key search terms covering concepts including ‘HIV’, ‘HIV testing’ and ‘Europe’ (Tables ).…”

Section: Methodsmentioning

confidence: 99%

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

et al. 2019

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Objectives Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). Methods Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal. Results One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%). Conclusions This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.

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“…Between 2009 and 2017 a total of 25,916 persons accessed services at BCN Checkpoint with a total of 49,630 visits ( Table 2). The number of persons varied between 2009 and 2011 (9768), 2012-2014 (8750), and 2015-2017 (11,369). The mean number of visits per person per year increased from 1.69 to 1.87 to 2.07, respectively, over the three periods (Supplemental Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, subsequent studies have consistently supported community PoC testing to be equivalent to standard testing using parameters such as linkage to care (and time to undetectable HIV VL), 9 feasibility, 10 and acceptability and its ability to reach persons who had not previously tested. 11 HIV (and STI testing) at BCN Checkpoint was groundbreaking not only for Spain but also for Europe as a whole. Since then, it has become a model that has been implemented in a number of cities in Spain and across Europe.…”

Section: Discussionmentioning

confidence: 99%

Falling HIV incidence in a community clinic cohort of men who have sex with men and transgender women in Barcelona, Spain

Meulbroek¹,

Dalmau-Bueno²,

Saz³

et al. 2020

Int J STD AIDS

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In Barcelona, Spain prior to 2006, HIV testing was mostly limited to formal healthcare facilities with no incidence data reported. A community-based organization (BCN Checkpoint) was established to increase HIV testing in a peer-led community location to generate incidence data in men who have sex with men and transgender women. Three community engagement interventions were conducted between 2009 and 2017 as follows: 2009–2011 (peer-led point-of-care testing for HIV), 2012–2014 (12-monthly HIV testing with an emphasis on testing in partnerships), 2015–2017 (three-monthly HIV testing with rapid referral for antiretroviral initiation). Between 2009 and 2017 a predominantly cisgender male (99.4%) and Spanish national (62.4%) population with mean age of 34.8 years had 49,630 visits. Mean visit number increased from 1.69 in the first to 2.07 in the last three-year period. HIV incidence fell from 4.17 (95% confidence interval [CI]: 3.53–4.93) per 100 person-years in 2009–2011 to 1.57 (95% CI: 1.30–1.89) per 100 person-years in 2015–2017. This represents a 62% reduction (incidence rate ratio: 0.38, 95% CI: 0.29–0.48) between the first and third study period (p < 0.001). These early interventions may have contributed to the reduction seen in HIV incidence in this cohort.

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HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

Cited by 27 publications

References 64 publications

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

Falling HIV incidence in a community clinic cohort of men who have sex with men and transgender women in Barcelona, Spain

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