Background: Targeting HIV testing services, as the World Health Organization (WHO) recommended in ۲۰۱۵, fast-tracks the identification of individuals with HIV and addresses the persisting HIV testing gap which might delay epidemic control. Following this recommendation, different models of targeted testing have been implemented, exposing varied interpretations by different countries. This study identifies, aggregates, and synthesizes targeted HIV testing models to develop a concise targeted testing package which can increase the identification of people with HIV.
Methods: A systematic literature search in PubMed, Scopus and Web of Science databases identified cross-sectional studies of people (۱۸ years and above) from
Southern Africa published between ۲۰۱۶ and ۲۰۲۱. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied, and the quality of studies was evaluated using the Joanna Brigs Institute tool (JBI). Data were extracted using a guided matrix to identify the target population, testing models, description, and positivity ratio. Conclusions and methodological suggestions were narratively synthesized.
Results: The authors identified ۵۷۴ studies; ۴۲ full-text articles were screened which yielded ۲۹ studies of moderate quality (۷۱%) meeting the eligibility criteria. Of these, ۲۵ studies (۸۶.۲%) were quantitative. From the included studies, similar models were synthesized, and ۱۲ targeted testing models emerged. Prioritized models were Index testing, described in ۳ (۱۰.۳%) of the studies, scoring the highest positivity ratio of >۳۰%. Six studies (۲۰.۷%) described male-targeted models with yields influenced by age, economic status, and educational level, with a positivity ratio of ۱۰% among first-time testers. In contrast, four (۱۳.۸%) described Key and Vulnerable Populations (KVP) focused models (positivity ratio of ۳۷.۵%) and recency-informed targeted testing (۱۳.۱% positivity ratio).
Conclusion: This review provides a critical overview and insights into the targeted testing models implemented in Southern Africa. Synthesizing comparable models can meet the various needs of unique populations comprehensively and increase positivity ratio. The recommended models can improve the efficiency of programs in targeting HIV testing services.