HIV Self-testing in Africa: adoption, barriers, and health outcomes: a systematic review and Meta-Analysis

Abstract

Background: HIV testing is an essential pathway to HIV prevention and management services. However, HIV testing has remained low in resource-constrained settings in Africa owing to certain barriers such as stigma and confidentiality issues. HIV self-testing (HIVST) is an alternative preventive measure for HIV that can address these constraints. This study examined HIVST adoption/ uptake, health outcomes and barriers among adults in Africa.
Methods: This was a systematic review and meta-analysis that surveyed published literature from January 2018 to August 2024 using five electronic databases (PsycINFO, MEDLINE in PubMed, Web of Science, CINAHL, and EMBASE) and bibliographic search. Studies were included if they were peer-reviewed, published in the English language, and examined HIVST uptake, barriers and health outcomes following HIVST uptake within Africa. The Joanna Briggs Institute Critical Appraisal Checklist was used for critical appraisal of the quantitative articles while the qualitative articles were appraised using the Critical Appraisal Skills Program. Narrative synthesis and effect size computations were used to analyze findings. The review was registered with PROSPERO under registration number 600021.
Results: Twenty-two articles related to HIVST were included in the final synthesis. Of the included articles, 13 measured HIVST adoption/ uptake/ acceptability, 6 reported the outcomes of HIVST, and 18 reported barriers to HIVST. The meta-analysis revealed a pooled HIVST uptake estimate of 67% among adults in Africa. Early diagnosis and linkage to care were the most commonly reported health outcomes following HIVST by adults within Africa. The barriers to HIVST uptake were participants’ lack of expertise in interpreting results, cost of the kits, social stigma and discrimination, lack of professional help, not having enough time to test or get a self-test kit, and differing spousal opinions regarding self-testing were significant barriers to the use of HIVST.
Conclusion: Continued health education, promotion, and healthcare provider-assisted services should be encouraged to foster uptake rates within Africa. Also, HIVST should be made available, free of charge particularly in resource-limited settings to ensure cost is not a barrier to access. Nevertheless, caution should still be taken when generalizing these results since high heterogeneity was observed within this analysis