Methods
Study Design
We performed a systematic literature review using the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We included all studies in which HST was offered to and performed by study participants. Utilised HIV test devices included home sample collection tests with performance of standard Western blot and real self-tests based on blood or saliva rapid tests. We included the two HST methods, as our main interest was acceptability of HIV testing in privacy, which is central to both testing strategies. In the absence of international recommendations about HST, no standardised procedure for HST was required.
Search Strategy and Restrictions
Pubmed, Embase, ScienceDirect, The Cochrane Library and the Global Health Database were systematically searched for matching manuscripts and a comprehensive Google search was performed for grey literature. Search terms included 'HIV` AND 'self-test` OR 'self-test` OR 'self-testing` or 'home test` OR 'home sample collection test`. Preferably peer-reviewed studies published in English between 1998 and October 2012 were included. Conference abstracts were eligible but no comments, editorials and unpublished reports. Because of the limited number of published studies, the search was not restricted to a specific study type. The different phases of the study selection process are presented in a flow diagram (Figure 1).
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Figure 1.
Selection process of HIV self-testing studies following the PRISMA methodology
Data Analysis
The study focussed on the outcome 'acceptability of HST`. The acceptability rate was defined as the proportion of all people approached to participate in a study, who eventually performed HST. Insights around the following topics were also extracted whenever possible: accuracy of HST, here defined as the proportion of self-test results in agreement with confirmatory test results performed and interpreted by trained health staff (invalid test results have been included as discordant test results), referral rate of those who tested seropositive into medical care, disclosure rate of self-test results, rate of first-time self-testers and utilisation rate of a telephone counselling hotline. Besides extraction of these rates, each study was reviewed for various qualitative aspects of HST. Because of the heterogeneity of included studies regarding study design and study populations, no meta-analysis has been performed. Study characteristics as well as outcomes are presented in tabular form ( Table 1 , Table 2 , and Table 3 respectively).