Study results
| Citation | Study design | Comparison (C) | Intervention (I) | Seroconversions/person years; incidence rate per 100 person years | Unadjusted and adjusted results (I vs C) (95% CIs) | Interpretation |
|---|---|---|---|---|---|---|
| (A) Sites receiving HCT vs sites not receiving HCT | ||||||
| Corbett et al21 | Cluster randomised controlled trial | Pretest counselling, risk assessment and a voucher for results and post-test counselling at a free-standing clinic; uptake 5.2% | Pretest counselling, risk assessment, testing, results, post-test counselling and risk reduction planning in workplace; uptake 70.7% | C: 25/2462; 0.95 (mean/cluster) I: 36/2560; 1.37 (mean/cluster) | IRR: 1.44 (0.79 to 2.80), p=0.4 aIRR: 1.49 (0.77 to 2.71), p=0.5 | No effect of HCT on HIV acquisition |
| (B) Individuals receiving HCT vs individuals not receiving HCT | ||||||
| Machekano et al26 | Pre/post cohort | Pretest counselling, tested for HIV but did not receive HIV test results or post-test counselling | Pretest counselling, tested for HIV and received results and post-test counselling | C:16/332; 4.82 I: 20/657; 3.04 | IRR: 0.63 (0.31 to 1.30), p=0.2 | Trend towards HCT leading to lower HIV acquisition |
| Matovu et al24 | Exposed/unexposed cohort | Participants who provided blood but did not receive HIV test results and post-test counselling at the first household survey | Participants who provided blood and received HIV test results and post-test counselling at the first household survey | C: 35/2441; 1.4 (overall) I: 42/2631; 1.6 (overall) C: 11/1001; 1.1 (males) I: 18/1166 1.5 (males) C: 24/1439; 1.7 (females) I: 24/1464; 1.6 (females) | IRR:1.11 (0.71 to 1.75), p=0.6 (overall)* IRR: 1.40 (0.67 to 3.08), p=0.4 (males)* IRR: 0.98 (0.55 to 1.74), p>0.9 (females)* | No effect of HCT on HIV acquisition |
| Matovu et al22 | Exposed/unexposed cohort | Participants who did not accept home-based HCT results (entire population) | Participants who received home-based HCT results once or more than once (entire population) | C: 66/4038; 1.6 (never) I:76/4658; 1.6 (once); I: 48/3488; 1.4 (repeat) | IRR: 1.00 (0.72 to 1.39), p>0.9 (once vs never)* aIRR: 1.00 (0.72 to 1.39) (once vs never) IRR: 0.84 (0.58 to 1.22), p=0.4 (repeat vs never)* aIRR: 0.85 (0.58 to 1.23) (repeat vs never) | No effect of HCT on HIV acquisition |
| Participants who did not accept home-based HCT results (those with ≥2 partners) | Participants who received home-based HCT results once or more than once (those with >2 partners) | C: 16/560; 2.9 (never) I: 9/631; 1.4 (once) I: 7/641; 1.1 (repeat) | IRR: 0.50, (0.21 to 1.12), p=0.1 (once vs never)* aIRR: 0.58 (0.25 to 1.37) (once vs never) IRR: 0.38, (0.15 to 0.91), p=0.03 (repeat vs never)* aIRR: 0.49 (0.21 to 1.17) (repeat vs never) | Trend towards HCT leading to lower HIV acquisition | ||
| Participants who did not accept home-based HCT results (those with only one partner) | Participants who received home-based HCT results once or more than once (those with only one partner) | C: 50/3478; 1.4 (never) I: 67/4027; 1.7 (once) I: 41/2846; 1.4 (repeat) | IRR: 1.16, (0.80 to 1.67), p=0.4 (once vs never)* aIRR: 1.15, (0.79 to 1.67) (once vs never) IRR: 1.00, (0.66 to 1.51), p>0.9 (repeat vs never)* aIRR: 1.00 (0.66 to 1.51) (repeat vs never) | No effect of HCT on HIV acquisition | ||
| Sherr et al25 | Exposed/unexposed cohort | Persons who had never been tested or counselled | Participants who received pretest counselling, testing and post-test counselling | C: 147/8401; 1.75 (overall) I: 18/801; 2.25 (overall) C: 61/2950; 2.07 (males) I: 10/462; 2.16 (males) C: 86/5451; 1.58 (females) I: 8/339; 2.36 (females) | IRR: 1.28 (0.77 to 2.05), p=0.3 (overall)* aIRR: 1.30 (0.79 to 2.14) (overall) IRR: 1.05 (0.51 to 1.98), p=0.9 (males)* aIRR: 1.08 (0.62 to 1.82) (males) IRR: 1.50 (0.68 to 2.95), p=0.3 (females)* aIRR: 1.55 (0.63 to 3.84) (females) | No effect of HCT on HIV acquisition |
| Rosenberg et al23 | Exposed/unexposed and pre/post cohort | Participants who had not been tested for HIV and learnt their results | Participants who had been tested for HIV and learnt their results | C: 131/4702; 2.79 I: 117/3834; 3.05 | HR: 1.02 (95% CI 0.79 to 1.31), p=0.5 aHR: 0.65 (95% CI 0.50 to 0.86), p<0.01 ipwHR: 0.59 (95% CI 0.45 to 0.78), p<0.01 | HCT leads to lower HIV acquisition, but only after adjustment |
| (C) Individuals receiving HCT alone vs individuals receiving HCT as a couple | ||||||
| Allen et al28 32 | Pre/post cohort | HIV-uninfected women before undergoing cHCT | HIV-uninfected women after undergoing cHCT | HCT: 12/293 4.1† cHCT: 5/278; 1.8† | IRR: 0.44 (0.14 to 1.22), p=0.1* | Trend towards cHCT being more protective than no HCT |
| Exposed/unexposed cohort | HIV-uninfected women who underwent individual HCT | HIV-uninfected women who underwent cHCT | HCT: 24/706; 3.4† cHCT: 5/278; 1.8 | IRR: 0.53 (0.18 to 1.32), p=0.2* | Trend towards cHCT being more protective than individual HCT | |
| Okiria et al27 | Exposed/unexposed cohort | Individual pretest and post-test counselling | Couple pretest and post-test counselling | HCT: 82/NA; 0.81 cHCT: 24NA; 0.25 HCT: 27/NA; 0.85 (women) cHCT: 3/NA; 0.14 (women)‡ HCT: 11/NA; 0.76 (men) cHCT: 7/NA; 0.38 (men) | IRR: 0.31 (0.19 to 0.48), p<0.01* IRR: 0.4 (0.22 to 0.75), p=<0.01 (women) aIRR: 0.4 (0.22 to 0.75) (women) IRR: 0.5 (0.24 to 1.05), p=0.07 (men) | cHCT was more protective than individual HCT |
*CIs calculated by review authors using Open Epi.
†Based on hand calculations by the review authors.
‡Review authors believe original article may not have correctly reported this strata as the hand-calculated IRR does not equal the reported rate ratio and the person years seem insufficient.
a, adjusted; C, comparison; cHCT, couple HIV counselling and testing; HCT, HIV counselling and testing; I, intervention; ipw, inverse probability weighted; IRR, incidence rate ratio; NA, not available.