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The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses.
JBI Database System Rev Implement Rep. 2015 Jul 17; 13(6):318-72.JD

Abstract

BACKGROUND

Human immunodeficiency virus counselling and testing is a critical and essential gateway to Human immunodeficiency virus prevention, treatment, care and support services. Though some primary studies indicate that home-based counselling and testing is more effective than facility based counselling and testing to reduce stigma and risky sexual behavior, to the best of the author's knowledge, no systematic review has tried to establish consistency in the findings across populations.

OBJECTIVES

The objective of this review was to determine the effectiveness of home-based Human immunodeficiency virus counselling and testing in reducing Human immunodeficiency virus-related stigma and risky sexual behavior among adults and adolescents.

TYPES OF PARTICIPANTS

All adults and adolescents aged 13 years or above. TYPE OF INTERVENTION: This review considered any studies that evaluated home-based Human immunodeficiency virus counseling and testing as an intervention. TYPES OF STUDIES: This review considered quantitative (experimental and observational) studies. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: stigma, violence, sexual behavior and clinical outcomes.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies reported in English Language from 2001 to 2014 in MEDLINE, Web of Science, EMBASE, Scopus and CINAHL. The search for unpublished studies included: WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, Mednar, Google Scholar, AIDSinfo and ProQuest Dissertations and Theses Database.

METHODOLOGICAL QUALITY

Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA EXTRACTION

Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

DATA SYNTHESIS

Quantitative data were pooled using the meta-analysis software provided by Joanna Briggs Institute. Effect sizes were calculated using fixed effects model. Where the findings could not be pooled using meta-analyses, results were presented in a narrative form.

RESULTS

Nine studies were included in this review, five of them reporting on stigma and related outcomes, three of them on sexual behavior and four of them on clinical outcomes. Meta-analysis indicated that the risk of observing any stigmatizing behavior in the community was 16% (RR=0.84, 95% CI 0.79 to 0.89] lower among the participants exposed to home-based HCT when compared to the risk among those participants not exposed to home-based HCT. The risk of experiencing any stigmatizing behavior by HIV positive patients was 37% (RR 0.63, 95% CI 0.45 to 0.88) lower among the intervention population compared to the risk among the control population. The risk of intimate partner violence was 34% (RR 0.66, 95% CI 0.49 to 0.89) lower among participants exposed to home-based HCT when compared to the risk among participants in the control arm. Compared to the control arm, the risk of reporting more than one sexual partner was 58% (RR 0.42, 95% CI 0.31 to 0.58) lower among participants exposed to home-based HCT. The risk of having any casual sexual partner in the past three months was 51% (RR 0.49, 95% CI 0.40 to 0.59) lower among the population exposed to home-based HCT when compared to the risk among those participants not exposed to home-based HCT. The risk of having ever been forced for sex among participants exposed to home-based HCT was 20% (RR 0.8, 0.56 to 1.14) lower when compared to the risk among the control arm; however this result was not statistically significant and the wide confidence interval indicates that the risk estimate was imprecise.

CONCLUSIONS

Home-based HCT is protective against intimate partner violence, stigmatizing behavior, having multiple sexual partners, and having casual sexual partners.

IMPLICATIONS FOR PRACTICE

The low quality of studies included makes it difficult to formulate clear recommendations regarding the effectiveness of home-based HCT on the above outcomes as compared to other models of HCT. However, the current findings may help in designing HIV prevention programs, especially in high prevalence settings and where stigma is higher and there is limited access or barriers to utilizing facility-based services.

IMPLICATIONS FOR RESEARCH

Randomized controlled trials that assess the effectiveness of home-based HCT on stigma, sexual behavior, viral load and viral suppression are needed.

Authors+Show Affiliations

Jimma University, College of Public Health and Medical Science, Department of Health Education and Behavioral Sciences.Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26455755

Citation

Feyissa, Garumma Tolu, et al. "The Effectiveness of Home-based HIV Counseling and Testing On Reducing Stigma and Risky Sexual Behavior Among Adults and Adolescents: a Systematic Review and Meta-analyses." JBI Database of Systematic Reviews and Implementation Reports, vol. 13, no. 6, 2015, pp. 318-72.
Feyissa GT, Lockwood C, Munn Z. The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses. JBI Database System Rev Implement Rep. 2015;13(6):318-72.
Feyissa, G. T., Lockwood, C., & Munn, Z. (2015). The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses. JBI Database of Systematic Reviews and Implementation Reports, 13(6), 318-72. https://doi.org/10.11124/jbisrir-2015-2235
Feyissa GT, Lockwood C, Munn Z. The Effectiveness of Home-based HIV Counseling and Testing On Reducing Stigma and Risky Sexual Behavior Among Adults and Adolescents: a Systematic Review and Meta-analyses. JBI Database System Rev Implement Rep. 2015 Jul 17;13(6):318-72. PubMed PMID: 26455755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses. AU - Feyissa,Garumma Tolu, AU - Lockwood,Craig, AU - Munn,Zachary, Y1 - 2015/07/17/ PY - 2015/03/24/received PY - 2015/05/28/accepted PY - 2015/05/12/revised PY - 2015/10/13/entrez PY - 2015/10/13/pubmed PY - 2016/5/14/medline KW - HIV counseling and testing KW - Stigma KW - home-based KW - sexual behaviour KW - systematic review SP - 318 EP - 72 JF - JBI database of systematic reviews and implementation reports JO - JBI Database System Rev Implement Rep VL - 13 IS - 6 N2 - BACKGROUND: Human immunodeficiency virus counselling and testing is a critical and essential gateway to Human immunodeficiency virus prevention, treatment, care and support services. Though some primary studies indicate that home-based counselling and testing is more effective than facility based counselling and testing to reduce stigma and risky sexual behavior, to the best of the author's knowledge, no systematic review has tried to establish consistency in the findings across populations. OBJECTIVES: The objective of this review was to determine the effectiveness of home-based Human immunodeficiency virus counselling and testing in reducing Human immunodeficiency virus-related stigma and risky sexual behavior among adults and adolescents. TYPES OF PARTICIPANTS: All adults and adolescents aged 13 years or above. TYPE OF INTERVENTION: This review considered any studies that evaluated home-based Human immunodeficiency virus counseling and testing as an intervention. TYPES OF STUDIES: This review considered quantitative (experimental and observational) studies. TYPES OF OUTCOMES: This review considered studies that included the following outcome measures: stigma, violence, sexual behavior and clinical outcomes. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies reported in English Language from 2001 to 2014 in MEDLINE, Web of Science, EMBASE, Scopus and CINAHL. The search for unpublished studies included: WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, Mednar, Google Scholar, AIDSinfo and ProQuest Dissertations and Theses Database. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Quantitative data were pooled using the meta-analysis software provided by Joanna Briggs Institute. Effect sizes were calculated using fixed effects model. Where the findings could not be pooled using meta-analyses, results were presented in a narrative form. RESULTS: Nine studies were included in this review, five of them reporting on stigma and related outcomes, three of them on sexual behavior and four of them on clinical outcomes. Meta-analysis indicated that the risk of observing any stigmatizing behavior in the community was 16% (RR=0.84, 95% CI 0.79 to 0.89] lower among the participants exposed to home-based HCT when compared to the risk among those participants not exposed to home-based HCT. The risk of experiencing any stigmatizing behavior by HIV positive patients was 37% (RR 0.63, 95% CI 0.45 to 0.88) lower among the intervention population compared to the risk among the control population. The risk of intimate partner violence was 34% (RR 0.66, 95% CI 0.49 to 0.89) lower among participants exposed to home-based HCT when compared to the risk among participants in the control arm. Compared to the control arm, the risk of reporting more than one sexual partner was 58% (RR 0.42, 95% CI 0.31 to 0.58) lower among participants exposed to home-based HCT. The risk of having any casual sexual partner in the past three months was 51% (RR 0.49, 95% CI 0.40 to 0.59) lower among the population exposed to home-based HCT when compared to the risk among those participants not exposed to home-based HCT. The risk of having ever been forced for sex among participants exposed to home-based HCT was 20% (RR 0.8, 0.56 to 1.14) lower when compared to the risk among the control arm; however this result was not statistically significant and the wide confidence interval indicates that the risk estimate was imprecise. CONCLUSIONS: Home-based HCT is protective against intimate partner violence, stigmatizing behavior, having multiple sexual partners, and having casual sexual partners. IMPLICATIONS FOR PRACTICE: The low quality of studies included makes it difficult to formulate clear recommendations regarding the effectiveness of home-based HCT on the above outcomes as compared to other models of HCT. However, the current findings may help in designing HIV prevention programs, especially in high prevalence settings and where stigma is higher and there is limited access or barriers to utilizing facility-based services. IMPLICATIONS FOR RESEARCH: Randomized controlled trials that assess the effectiveness of home-based HCT on stigma, sexual behavior, viral load and viral suppression are needed. SN - 2202-4433 UR - https://www.unboundmedicine.com/medline/citation/26455755/The_effectiveness_of_home_based_HIV_counseling_and_testing_on_reducing_stigma_and_risky_sexual_behavior_among_adults_and_adolescents:_A_systematic_review_and_meta_analyses_ L2 - http://dx.doi.org/10.11124/jbisrir-2015-2235 DB - PRIME DP - Unbound Medicine ER -