Globally, men who have sex with men (MSM) are disproportionally affected by HIV infection. Incidence of HIV among MSM remains steadily high, despite declines in the general population and increasing benefits of antiretroviral therapy (ART) for the management of HIV. In addition, rates of HIV testing among MSM have stayed low worldwide, as have their rates of access to HIV prevention and care services. Engagement in HIV care has the potential to improve health outcomes and greatly reduce onward transmission of infection. To benefit fully from treatment however, individuals need to first be aware of their HIV status. Unfortunately, HIV testing and treatment programs often fail to reach MSM despite being disproportionally affected by the infection. Peer-led interventions to promote HIV testing can potentially increase testing rates among MSM. Peer-led HIV interventions typically involve enlisting members of a specific at-risk group to influence and support members to maintain healthy sexual behaviors and change risky sexual behaviors.
[Photo: Ms. Sylvia Shangani]
The purpose of this systematic review and meta-analysis, led by Ms. Sylvia Shangani, doctoral student in the Department of Behavioral and Social Sciences, was to summarize evidence on the effectiveness of peer-led interventions to increase the uptake of HIV testing among MSM. Seven studies including a total of 6,205 participants met eligibility criteria; four studies were from high-income countries, two were from Asia and only one was from sub-Saharan Africa. Two studies were quasi-experimental, three were non-randomized pre- and post-intervention studies, one was a cluster randomized trial, and one was a randomized controlled trial. Meta-analysis of the seven studies found HIV testing rates were significantly higher in the peer-led intervention groups versus control groups, however there was significant heterogeneity among non-randomized pre- and post-intervention studies.
This is the first systematic review and meta-analysis of the effect of peer-led interventions on the rate of HIV testing among MSM. Overall, peer-led interventions increased HIV testing among MSM. However, this review also revealed the paucity of research in this area, particularly in low- and middle-income countries. More data from high-quality studies are needed to evaluate effects of peer-led interventions on HIV testing among MSM.
This study was published in AIDS Care, 2017 (ahead of print).
For more information: https://www.ncbi.nlm.nih.gov/pubmed/28150501