Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis.

Area of Science:

• Public Health
• Infectious Disease Diagnostics
• Health Services Research

Background:

• Limited access to facility-based diagnostic testing is a global public health challenge.
• Decentralized testing models like self-testing and self-sampling are transforming infectious disease diagnostics in low- and middle-income countries (LMICs).
• Understanding the impact of these models on test uptake and linkage to care is crucial.

Purpose of the Study:

• To systematically review and analyze delivery models of infectious disease diagnostic testing outside conventional clinical settings.
• To assess the impact of these models on test uptake and linkage to care.
• To evaluate adverse outcomes associated with testing outside clinics.

Main Methods:

• A systematic review and meta-analysis of 76 studies comparing testing outside clinics with conventional facility-based testing.
• Searched 6 databases, including 18 studies in meta-analyses focusing on HIV, chlamydia, and multiple diseases.
• Assessed evidence quality using GRADE and registered the study in PROSPERO (CRD42019140828).

Main Results:

• HIV self-testing significantly increased test uptake compared to facility-based testing (pooled OR, 2.59; moderate quality evidence).
• Self-sampling for sexually transmitted infections also increased test uptake (pooled OR, 1.74; moderate quality evidence).
• Testing outside clinics improved test uptake without significant adverse outcomes.

Conclusions:

• Decentralized testing approaches effectively increase test uptake for infectious diseases.
• These models offer a promising strategy to expand access to diagnostics and empower patients in LMICs.
• Further implementation research, scale-up of effective models, and supportive policies are needed to optimize these services.