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.

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.

INCLUSION CRITERIA:

None

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The search strategy aimed to find both published and unpublished studies reported in English Language from 2001 to 2014 in MEDLINE, Web of Science, EMBASE, Scopus and CINAHL. The search for unpublished studies included: WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, Mednar, Google Scholar, AIDSinfo and ProQuest Dissertations and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% (relative risk =0.84, 95% Confidence interval 0.79 to 0.89] lower among the participants exposed to home-based counselling and testing when compared to the risk among those participants not exposed to home-based counselling and testing. The risk of experiencing any stigmatizing behavior by Human immunodeficiency virus positive patients was 37% (relative risk 0.63, 95% Confidence interval 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% (relative risk 0.66, 95% Confidence interval 0.49 to 0.89) lower among participants exposed to home-based counselling and testing 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% (relative risk 0.42, 95% Confidence TRUNCATED AT 500 WORDS.