# Motivations, Facilitators, and Barriers of Donation-Based Interventions in HIV and Sexually Transmitted Infection Research: A Systematic Review

## TL;DR

This review explores what motivates people to donate health services in HIV and STI research, how it helps, and what challenges exist.

## Contribution

The study systematically identifies prosocial motivations and barriers in donation-based HIV/STI interventions using qualitative data.

## Key findings

- Givers are motivated by altruism and a prosocial identity, which can improve health service distribution.
- Social proximity between givers and recipients facilitates effective service distribution and peer relationships.
- Secondary syringe distribution poses legal risks and may lead to unsupervised care.

## Abstract

What are the motivations, facilitators, and barriers of prosocial behavior in donation-based interventions in HIV and sexually transmitted infection research?

This systematic review of 27 qualitative studies of donation-based interventions, which included 1543 participants, found that givers leveraged altruism, agency, and relationality with recipients to improve distribution and use of health services in their social networks. Distributing or donating services to others could foster a prosocial identity that increased givers’ concern and responsibility for others’ health needs.

Findings suggested that donation-based interventions could improve service uptake among marginalized populations using psychosocial assets already within those networks.

This systematic review uses data from qualitative studies to identify motivations, facilitators, and barriers of prosocial behavior for donation-based interventions in HIV and sexually transmitted infection research.

Donation-based prosocial interventions involve someone receiving a free health service and then distributing or donating to support health services for others; examples within the HIV and sexually transmitted infection (STI) literature include secondary distribution of HIV self-tests, secondary syringe exchange, and pay it forward for STI testing. These interventions answer research and policy recommendations to incorporate prosocial behaviors into HIV/STI services.

To describe motivations, facilitators, and barriers of donation-based interventions in HIV and STI research using data from qualitative studies.

In this systematic review, 5 databases (PubMed, CINAHL, Embase, PsycInfo, and Scopus) and references were searched up to January 23, 2024, for qualitative studies of donation-based interventions. Thematic synthesis was used to summarize findings, the Critical Appraisal Skills Programme Qualitative Studies Checklist was used to assess risk of bias among studies, and GRADE-CERQual (Confidence in the Evidence From Reviews of Qualitative Research) was used to assess confidence in review findings.

Of 374 studies screened, 27 were included, which included 1543 participants, assessing secondary distribution of HIV self-tests (15 studies), secondary syringe exchange among people who inject drugs (10 studies), and pay it forward for STI testing (2 studies). Studies were from low-income (5 studies), middle-income (13 studies), and high-income (12 studies) countries. Givers who distributed health services were motivated by a selfless concern to benefit others (20 studies, moderate confidence) and by the cultivation of a prosocial identity (20 studies, moderate confidence). Social proximity between givers and recipients facilitated distribution (22 studies, moderate confidence), allowing for recipient-tailored strategies to introduce the service, strengthen peer relationships, and promote reciprocal giving. However, secondary syringe distribution could subject people who use drugs to legal harms and encourage them to provide unsupervised clinical care (7 studies, low confidence).

This systematic review identified motivations, facilitators, and barriers of donation-based interventions for HIV/STI services that could enhance implementation. Donation-based interventions may foster prosocial motivation and responsibility among socially marginalized populations to increase access to HIV/STI services.