Effectiveness of peer-led interventions to increase HIV testing among men who have sex with men: a systematic review and meta-analysis

ABSTRACT

HIV testing constitutes a key step along the continuum of HIV care. Men who have sex with men (MSM) have low HIV testing rates and delayed diagnosis, especially in low-resource settings. Peer-led interventions offer a strategy to increase testing rates in this population. This systematic review and meta-analysis summarizes evidence on the effectiveness of peer-led interventions to increase the uptake of HIV testing among MSM. Using a systematic review protocol that was developed a priori, we searched PubMed, PsycINFO and CINAHL for articles reporting original results of randomized or non-randomized controlled trials (RCTs), quasi-experimental interventions, and pre- and post-intervention studies. Studies were eligible if they targeted MSM and utilized peers to increase HIV testing. We included studies published in or after 1996 to focus on HIV testing during the era of combination antiretroviral therapy. Seven studies encompassing a total of 6205 participants met eligibility criteria, including two quasi-experimental studies, four non-randomized pre- and-post intervention studies, and one cluster randomized trial. Four studies were from high-income countries, two were from Asia and only one from sub-Saharan Africa. We assigned four studies a “moderate” methodological rigor rating and three a “strong” rating. Meta-analysis of the seven studies found HIV testing rates were statistically significantly higher in the peer-led intervention groups versus control groups (pooled OR 2.00, 95% CI 1.74–2.31). Among randomized trials, HIV testing rates were significantly higher in the peer-led intervention versus control groups (pooled OR: 2.48, 95% CI 1.99–3.08). Among the non-randomized pre- and post-intervention studies, the overall pooled OR for intervention versus control groups was 1.71 (95% CI 1.42–2.06), with substantial heterogeneity among studies (I²= 70%, p < 0.02). Overall, peer-led interventions increased HIV testing among MSM but more data from high-quality studies are needed to evaluate effects of peer-led interventions on HIV testing among MSM in low- and middle-income countries.

KEYWORDS:

• Peers
• interventions
• HIV testing
• MSM
• systematic review
• meta-analysis

Acknowledgement

SS generated the idea, planned and carried out the systematic review, and wrote the initial draft. All authors contributed to the interpretation of the findings and article revisions. All authors approved the final version of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Fellowship or the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Brandon Marshall http://orcid.org/0000-0002-0134-7052

Additional information

Funding

This work was supported by the Brown/Tufts Fogarty AIDS International Training and Research program grant [grant number D43-TW000237] from the NIH-Fogarty International Center, National Institute of Health (NIH) [grant number NICHD R24-HD077976], [grant number NIMH R34-MH106349], and [grant number NIAAA U24-AA022000].