Issue: October 2020
Disclosures: Marley and Tang report no relevant financial disclosures.
September 01, 2020
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HIV, STI testing outside of clinics increases uptake with minimal risks

Issue: October 2020
Disclosures: Marley and Tang report no relevant financial disclosures.
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HIV and STI testing outside of clinics increases uptake with minimal risks, a systematic review and meta-analysis showed.

Moreover, it “provide[s] an opportunity to expand access and empower patients,” researchers wrote in Open Forum Infectious Diseases.

Weiming Tang

“As our findings showed linkage-to-care success rate through decentralized testing approaches and in-clinic testing to be relatively similar, patient care post out-of-clinic testing is still evidently highly dependent on health care providers’ initiated follow-ups,” Gifty Marley, MMed, BSc, of the University of North Carolina at Chapel Hill’s Project-China in Guangzhou, China, and Weiming Tang, PhD, MS, MD, of Southern Medical University’s Institute of Global Health and STI Research in Guangzhou, China, told Healio.

“As such, clinicians should consider the adoption of out-of-clinic treatment options — such as mobile drug stores for treatment initiation and drug delivery, as well as online platforms for checkups and vitals monitoring — for people who may not have easy access to treatment centers or may be deterred from visiting clinics for reasons such as fear of stigma.”

Marley, Tang and colleagues reviewed various delivery models for infectious disease testing outside of clinics to determine their impact on test uptake and their linkage to care. They performed a systematic review of six databases, and included research manuscripts to compare testing outside clinics with conventional methods. The study’s primary outcomes included testing uptake, linkage to care, delivery models and adverse outcomes.

A total of 76 studies were included for final analysis, 48 of which focused on HIV, eight of which focused on chlamydia and 20 of which focused on multiple diseases. The researchers found that HIV self-testing boosted test uptake when compared with facility testing (OR = 2.59; 95% CI, 1.06-6.29). Self-sampling for STIs also increased testing uptake (OR = 1.74; 95% CI, 0.97-3.12).

“For clinicians, exploring out-of-clinic patient care would be more important, given that decentralized strategies can identify a large number of patients that may not show up in the clinic,” Marley and Tang said. “Therefore, clinicians implementing the use of some decentralized treatment and patient care such as home treatment initiation, online routine monitoring and ‘one-stop’ checkup service points would be useful.”

The authors noted that variance may have been underestimated in studies with multiple intervention arms.

“Future analysis should look at alternative means of pooling such data to ensure the overall variance effect is presented,” Marley and Tang said. “We also observed that very few studies”— just three, which showed adverse events to be low — “examined the risks and adverse outcomes associated with testing outside of clinics; thus, further post-trial research is needed to fully understand the risks associated with testing outside of clinics. Also, future pilot studies should assess out-of-clinic testing among persons living with disabilities, as this is another opportunity for expanding the impact of out-of-clinic testing.”