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Demand creation for HIV testing services: A systematic review and meta-analysis
Anjuli D Wagner1, Irene N Njuguna1,2, Jillian Neary3
1Department of Global Health, University of Washington, Seattle, Washington, United States of America.
Plos Medicine
|March 21, 2023
Summary
Effective HIV testing services (HTS) are crucial for UNAIDS goals. Demand creation strategies like mobilization, counseling, and incentives significantly increase HTS uptake, guiding global health programs.
Area of Science:
- Public Health
- Global Health
- Epidemiology
Background:
- HIV testing services (HTS) are foundational to achieving UNAIDS 95-95-95 goals and reducing HIV incidence.
- Evaluating demand creation interventions is vital for optimizing HTS uptake and resource allocation.
- This review informed the World Health Organization's 2019 HIV testing guidelines, focusing on effective HTS demand creation strategies globally.
Approach:
- Systematic review and meta-analysis of 124 randomized controlled trials (RCTs) published up to September 28, 2021.
- Searched multiple electronic databases and conference proceedings for interventions including incentives, mobilization, counseling, tailoring, and digital methods.
- Assessed study quality using Cochrane's risk of bias tool, with a focus on HTS uptake as the primary outcome.
Key Points:
- Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS significantly increased HTS uptake (≥50% relative increase).
- Lottery-based incentives and audio-based interventions showed a smaller, non-significant increase in HTS uptake.
- Reduced duration counseling and video-based interventions demonstrated comparable or improved effectiveness to standard methods.
Conclusions:
- High-impact demand creation interventions (mobilization, counseling, peer-led, incentives, SMS) should be prioritized for HTS programs.
- Efficient alternatives like reduced duration counseling and video-based interventions can address staffing needs.
- Intervention selection requires careful consideration of risks, benefits, context, feasibility, sustainability, and universal health coverage principles.
