Mapping evidence of intervention strategies to improving men’s uptake to HIV testing services in sub-Saharan Africa: A systematic scoping review

Abstract

Background: HIV testing serves as a critical gateway for linkage and retention to care services, particularly in sub-Saharan African countries with high burden of HIV infections. However, the current progress towards addressing the first cascade of the 90-90-90 programme is largely contributed by women. This study aimed to map evidence on the intervention strategies to improve HIV uptake among men in sub-Saharan Africa. Methods: We conducted a scoping review guided by Arksey and O'Malley's (2005) framework and Levac et al. (2010) recommendation for methodological enhancement for scoping review studies. We searched for eligible articles from electronic databases such as PubMed/MEDLINE; American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations (UCTD); SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; and Google Scholar. We included studies from January 1990 to August 2018. We used the PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. The Mixed Method Appraisal Tool version 2018 was used to determine the methodological quality of the included studies. We further used NVivo version 11 to aid with content thematic analysis. Results: This study revealed that teaching men about HIV; Community-Based HIV testing; Home-Based HIV testing; Antenatal Care HIV testing; HIV testing incentives and HIV Self-testing are important strategies to improving HIV testing among men in sub-Saharan Africa. The need for improving programmes aimed at giving more information to men about HIV that are specifically tailored for men, especially given their poor uptake of HIV testing services was also found. This study further revealed the need for implementing Universal Test and Treat among HIV positive men found through community-based testing strategies, while suggesting the importance of restructuring home-based HIV testing visits to address the gap posed by mobile populations. Conclusion: The community HIV testing, as well as, HIV self-testing strategies showed great potential to increase HIV uptake among men in sub-Saharan Africa. However, to address poor linkage to care, ART should be initiated soon after HIV diagnosis is concluded during community testing services. We also recommend more research aimed at addressing the quality of HIV self-testing kits, as well as, improving the monitoring systems of the distributed HIV self-testing kits.

Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

“…The findings of this study, consistent with the findings of other studies conducted in resource-limited settings, revealed that, given the many barriers associated with HIV testing in a clinic setting, more men preferred to engage themselves with HIV testing services that were conducted outside this setting [16,[46][47][48][49][50][51]. In addition to that, the HIVST model further empowers young people and sexually active individuals to be independent and have the option to choose the location and timing of the test and to control the disclosure of their results [36].…”

“…While several studies have documented the high acceptance of HIVST among populations [16,[38][39][40] and its convenience [41,42], this, to our knowledge, is the first systematic review and meta-synthesis to assess men's perspectives on HIVST in SSA. While education is key to changing men's perspectives and improving HIV knowledge, this study further revealed that HIV self-testing is critical to addressing issues of confidentiality and convenience [9,16,43,44]. Therefore, this strategy is key to supporting the UNAIDS plans aimed at addressing masculinity issues, one of which is men's engagement in HIV testing [45].…”

“…Some of the notable arguments against HIVST involve its high costs, insufficient counselling, and missed opportunities for STI screening [15]. Despite these arguments, HIVST has been shown to be widely acceptable in SSA [11,12,16], as well as among key population groups [13]. However, this acceptability has not seemed to have translated into an increase in the uptake of HIVST, especially among men in SSA.…”

Prevalence, associated factors and perspectives of HIV testing among men in Uganda

“…In the first stage of sampling, we used the latest update of the National Population and Housing Census for Mpigi district as the sampling frame from which we selected villages using probability proportionateto-size. We generated cumulative frequency of the total population of Mpigi district (at the time estimated to be 251512), computed the sampling interval by dividing the total population by the desired number of villages [30]. We used simple random sampling to select the first village (from a total of 339 villages) and the subsequent ones by adding the sampling interval to the population in the listing until we selected 30 villages in total.…”

Outcomes of and factors associated with partner notification and HIV testing in Northeastern Tanzania.

“…The success across the Human Immunodeficiency Virus (HIV) care continuum highly depends on effective HIV testing services (HTS) as a critical gateway to prevention and support services, accessing HIV care and antiretroviral treatment (ART) [1][2][3]. In recognition of the need for effective HTS, major steps have been taken to improve the testing strategies over the past two decades.…”