CRD summary

The authors concluded that there is strong evidence that rapid testing considerably increases the proportion of patients who receive their human immunodeficiency virus test results. These conclusions appear to be supported by the data presented. However, details of review methods and a validity assessment were not reported, which makes it difficult to assess the reliability of the evidence.

Authors' objectives

To evaluate the effects of alternatives to conventional human immunodeficiency virus (HIV) counselling and testing (CT) on the receipt of HIV test results.

Searching

MEDLINE, EMBASE and AIDSLINE were searched from 1990 to March 2005 for English language reports. In addition, abstracts from the International AIDS Conferences (2000, 2002 and 2004) and National HIV Prevention Conferences (2003 and 2005) and reference lists from retrieved studies were screened, and experts were contacted. Abstracts and unpublished studies were eligible.

Study selection

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Two reviewers independently extracted the data using a form and resolved any disagreements through discussion. For each study, the relative risk (RR) with 95% confidence interval (CI) was calculated. For studies in which the event rate was zero, 0.5 was added to each cell to enable the calculation of an RR. Where required, authors were contacted for sufficient data to calculate an effect size. Studies that reported data for separate populations or study settings were treated as separate independent studies.

Methods of synthesis

Results of the review

Fifteen studies reported in 13 articles were included in the review (n=21,096). These studies provided 17 measures of effect. Four studies reporting 8 measures of effect were randomised controlled trials (RCTs). Nine studies reporting 14 measures of effect were non-randomised studies with either concurrent or historical control groups.

The participants were significantly more likely to receive HIV test results after alternative testing compared with conventional testing (RR 1.61, 95% CI: 1.36, 1.90, p<0.0001). There was strong evidence of heterogeneity (p<0.0001). The results were similar after adjusting for over-representation of control groups. Intervention effects were largest for rapid testing (RR 1.80, 95% CI: 1.46, 2.22, p<0.0001; 12 studies; strong evidence of heterogeneity, p<0.0001), followed by use of the telephone to deliver results (RR 1.38, 95% CI: 1.24, 1.47, p<0.0001; 2 studies; no evidence of heterogeneity) and home collection testing (RR 1.28, 95% CI: 1.07, 1.53, p<0.01; 1 study).

Rapid testing interventions showed higher rates of receipt of HIV tests when set in emergency departments (compared with sexually transmitted disease clinics and outreach settings), for HIV-negative participants (compared with HIV-positive participants), in non randomised trials (compared with randomised trials), and among studies using historical controls (compared with concurrent controls). Of these meta-analyses, only analyses involving HIV-positive participants and RCTs showed no significant heterogeneity.

Authors' conclusions

There is strong evidence that rapid testing considerably increases the proportion of patients who receive their HIV test results.

CRD commentary

The review addressed a clear question that was defined in terms of the intervention, outcomes and study design. Several relevant sources were searched and attempts were made to minimise publication bias. The inclusion of only English language reports appears reasonable in view of the restriction to studies conducted in the USA. Study validity was not assessed, thus the results from these studies and any synthesis might not be reliable. The methods used to select studies and extract the data were not described, so it is not known whether any efforts were made to reduce reviewer errors and bias.

The studies were combined in a meta-analysis regardless of study design. However, statistical heterogeneity was assessed and various potential sources of heterogeneity (including study design) were examined and discussed. The forest plot indicated that although heterogeneity was present all studies showed a similar direction of treatment effect; the authors discussed the implications of this. The authors' conclusions appear to be supported by data in the review, but the absence of reporting of review methods and validity assessment means it is difficult to assess the reliability of the evidence.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated the need for further research to record the frequency of false-positive rapid test results and the effect of false-positive results on patients, and a need to assess other outcomes including test acceptance and linkage to care and preventive services.

Bibliographic details

Hutchinson A B, Branson B M, Kim A, Farnham P G. A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS 2006; 20(12): 1597-1604. [PubMed: 16868440]

Original Paper URL

http://www.aidsonline.com/pt/re/aids/issuelist.htm

Indexing Status

Subject indexing assigned by NLM

MeSH

AIDS Serodiagnosis /methods; Counseling /methods; Enzyme-Linked Immunosorbent Assay /methods; HIV Infections /diagnosis; HIV-1 /isolation & purification; Humans; Randomized Controlled Trials as Topic; Research Design; Self Care; Telephone

AccessionNumber

12006002879

Database entry date

31/12/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.