Compiled by: Kate Shiells, Alesha Wale, Amy Hookway & Hannah Shaw; Public Health Wales Evidence Service
Date published:
Background: Human Immunodeficiency Virus (HIV) continues to be a global health issue. In Wales, improving access to prevention and testing has contributed towards a 75% reduction in new diagnoses between 2015 and 2021, and the Welsh Government aim to have no new cases of HIV by 2030. HIV self-testing kits, which have been available on the market across the UK since 2015, allow individuals to test for HIV in the privacy of their own home, and may help to reduce new infections. Given that self-testing is a relatively novel method of testing for HIV, it is important to understand which behaviours could impact its uptake, and the effectiveness of interventions to promote self-testing.
Aims: The aims of this review were twofold. Firstly, to explore which behavioural determinants influence uptake of self-testing for HIV. Secondly, to assess the effectiveness of interventions to increase the uptake of HIV self-testing.
Methods: Two scoping reviews of the secondary literature were undertaken. Searches were conducted across multiple databases including Medline, PsycInfo, Scopus, Epistemonikos and Google scholar in May 2024. Only secondary sources focused on adults, published since 2014 and written in English were included in the reviews. All included reviews were quality appraised by two reviewers. Behavioural determinants were synthesised using the Theoretical Domains Framework and the findings were summarised under the associated components of the COM-B model. The effectiveness of interventions to increase uptake were synthesised narratively.
Results: Fourteen systematic reviews were included in the first scoping review which explored behavioural determinants for HIV self testing. The decision to self-test was found to be influenced by various behavioural domains linked to capability, opportunity, and motivation. Self-testing was widely seen as convenient, easy to use, empowering, private and as a way in which to reduce stigma. However, barriers included a lack of awareness about self-testing, difficulties in carrying out the test, concerns around accuracy, and fears about receiving a positive test without post-test support. Concerns around privacy and stigma were also raised.
Six systematic reviews were included in the second scoping review which examined the impact of interventions to increase HIV testing uptake. Providing people with a choice of testing methods, or information on self-testing and how to use self-testing kits increased uptake. Various distribution strategies increased uptake including, partner or peer distribution, social network strategies and providing self-test kits in emergency departments. Digital interventions including websites or apps, social media interventions, text message interventions, and digital vending machines were found to increase uptake. Lastly, the cost of self-testing kits was seen to impact uptake.
Conclusions: Capability, opportunity and motivation appear to all act as behavioural determinants which influence the decision to self-test for HIV, and the evidence suggests that a range of interventions can be used to address some of these behavioural determinants and increase the uptake of self-testing. Interventions to increase awareness of and knowledge around how to conduct self-testing could address the lack of awareness or the lack of confidence to perform self-testing that was seen to reduce uptake. Interventions that incorporate counselling and linkage to care could address people’s concerns around not being able to access support if they received a positive result.
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ISBN: 978-1-83766-495-5