Promoting the uptake of HIV testing among men who have sex with men: systematic review of effectiveness and cost-effectiveness
- Theo Lorenc1,
- Isaac Marrero-Guillamón2,
- Peter Aggleton3,
- Chris Cooper4,
- Alexis Llewellyn5,
- Angela Lehmann5,
- Catriona Lindsay5
- 1Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
- 2Department of Iberian and Latin American Studies, Birkbeck College, London, UK
- 3School of Education and Social Work, University of Sussex, Brighton, UK
- 4Centre for Evidence and Policy, King's College London, London, UK
- 5Matrix Evidence, London, UK
- Correspondence to Dr Theo Lorenc, Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK;
Contributors TL led the design and conduct of the review. Literature searches were conceived and executed by CC. Screening was carried out by TL, IMG, AL (Alexis Llewellyn), AL (Angela Lehmann) and CL. Quality assessment and data extraction were carried out by TL and IMG. Data analysis and interpretation were carried out by TL, IMG and PA. TL wrote the first draft of the paper with input from IMG and PA.
- Accepted 2 March 2011
- Published Online First 25 March 2011
What interventions are effective and cost-effective in increasing the uptake of HIV testing among men who have sex with men (MSM)? A systematic review was conducted of the following databases: AEGIS, ASSIA, BL Direct, BNI, Centre for Reviews and Dissemination, Cochrane Database of Systematic Reviews, CINAHL, Current Contents Connect, EconLit, EMBASE, ERIC, HMIC, Medline, Medline In-Process, NRR, PsychINFO, Scopus, SIGLE, Social Policy and Practice, Web of Science, websites, journal hand-searching, citation chasing and expert recommendations. Prospective studies of the effectiveness or cost-effectiveness of interventions (randomised controlled trial (RCT), controlled trial, one-group or any economic analysis) were included if the intervention aimed to increase the uptake of HIV testing among MSM in a high-income (Organization for Economic Co-operation and Development) country. Quality was assessed and data were extracted using standardised tools. Results were synthesised narratively. Twelve effectiveness studies and one cost-effectiveness study were located, covering a range of intervention types. There is evidence that rapid testing and counselling in community settings (one RCT), and intensive peer counselling (one RCT), can increase the uptake of HIV testing among MSM. There are promising results regarding the introduction of opt-out testing in sexually transmitted infection clinics (two one-group studies). Findings regarding other interventions, including bundling HIV tests with other tests, peer outreach in community settings, and media campaigns, are inconclusive. Findings indicate several promising approaches to increasing HIV testing among MSM. However, there is limited evidence overall, and evidence for the effectiveness of key intervention types (particularly peer outreach and media campaigns) remains lacking.
- AIDS serodiagnosis/psychology
- health behaviour
- health promotion
- HIV infections/diagnosis
- HIV testing
- systematic review
Funding This review was funded by the National Institute for Health and Clinical Excellence (NICE). The authors would like to thank the NICE project team (Chris Carmona, Catherine Swann, Daniel Tuvey and Linda Sheppard) for their invaluable support and guidance throughout the review. The views and opinions expressed are those of the authors alone and do not reflect the official opinion of NICE, or any guidance issued by NICE.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.