# Effect of human immunodeficiency virus self-testing (HIVST) on HIV and STI testing uptake among men who have sex with men (MSM): A systematic review and meta-analysis of randomized controlled trials

## TL;DR

This study finds that HIV self-testing increases HIV testing and detection among men who have sex with men but reduces STI testing compared to traditional methods.

## Contribution

The study provides the first meta-analysis of RCTs comparing HIV self-testing to traditional testing among MSM.

## Key findings

- HIVST increased HIV test uptake and detection compared to traditional testing.
- HIVST led to a higher mean number of HIV tests among MSM.
- STI testing uptake was lower in the HIVST group compared to traditional testing.

## Abstract

The objective of this review was to assess the effectiveness of HIVST in terms of increasing HIV testing, early detection of HIV, and sexually transmitted infections among MSM via HIVST.

We conducted a systematic review and meta-analysis of randomized controlled trials. We searched PubMed/MEDLINE, EMBASE, Cochrane Central, and clinicaltrials.gov. Data were extracted from May 2013- May 2024. RCTs comparing HIVST with traditional HIV testing among MSM were included in the review. Data was analyzed using Review Manager version five.

A total of fifteen randomized controlled trials (RCTs) were identified and included in the qualitative synthesis, and thirteen were included in the meta-analysis. The mean difference in HIV test results between the HIVST group and the traditional HIV testing group was 2.07 (95% confidence interval (CI) 1.54--2.60). The odds ratio for the detection of incident HIV in the HIVST group was 1.55 (95% confidence interval 1.02–2.37). The odds ratio of HIV test uptake from eleven RCTs was 5.17 (95% confidence interval 1.90—14.06) for HIVST compared with traditional HIV testing. Pooled analysis revealed that the odd ratio of STI test uptake was 0.86 among the HIVST group compared with the traditional HIV testing group (P <.02).

HIVST is associated with increased uptake of HIV testing and an increased mean number of HIV tests among MSM. It also leads to increased detection of HIV. However, STI testing decreases with HIVST, likely because of facility-based HIV testing in the control arm.