SNA a feasible HIV testing approach

Social network testing approaches (SNA) for HIV testing may be an effective and acceptable approach to improve HIV testing in all populations, a systematic review and meta-analysis suggests.

“The engagement of HIV testing services is a fundamental step to establish one’s HIV status and subsequent provision of appropriate prevention or treatment and care,” said Dr Jason Ong from Monash University, Melbourne, Australia, during his presentation at IAS 2023.

SNA involves individuals who act as ‘test promoters’ (otherwise called ‘seeds’) who recruit and encourage sexual or injecting partners and/or those in their social networks who may benefit from HIV testing to participate. Seeds are individuals who are either newly diagnosed with HIV, those with established infection, or high-risk HIV-negative individuals.

As part of a comprehensive care and prevention package, the WHO recommends SNA for key populations as an additional approach to optimize HIV testing services. However, this is a conditional recommendation with low-certainty evidence. “[We sought to determine whether] SNA-based approaches can be offered as an additional HIV testing approach,” said Ong.

Ong and his team searched five databases from January 2010 to July 2022. The analysis included 47 trials that compared SNA against non-SNA or compared different models of SNA, or were qualitative studies. The predominant population type was MSM/TGW* (29 studies). [IAS 2023, abstract 5688]

“We found that compared with non-SNA approaches, SNA improved the uptake of HIV testing and increased the proportion of first-time testers and case finding of people with HIV,” Ong said.

Based on six studies, the uptake of HIV testing may be higher among partners/social contacts of seeds using SNA vs non-SNA. The relative effect was 2.04 (95 percent confidence interval [CI], 1.06–3.95).

Using data from eight studies, the proportion of first-time testers also appeared higher among partners/social contacts of seeds with SNA compared with non-SNA approaches, corresponding to a relative effect of 1.49 (95 percent CI, 1.22–1.81). Despite the large heterogeneity, Ong attributed this to the population type and the comparator.

“SNA approaches probably increase the proportion of first-time testers for MSM and may increase the proportion of first-time testers for the general population. However, compared with peer-testing, SNA approaches for persons who inject drugs may decrease the proportion of first-time testers,” he explained.

There were also more people who newly tested positive for HIV among partners/social contacts of seeds using SNA compared with non-SNA. An analysis based on 13 trials yielded a relative effect of 1.84 (95 percent CI, 1.01–3.35).

“No studies reported serious adverse events (eg, suicide, abuse) or ‘pressure to test’,” said Ong.

SNA was also deemed empowering and considered an approach that could open opportunities for discussing sexual health and facilitate joint testing. This was based on data from the qualitative studies.

Identifying the undiagnosed is essential

Some of the barriers to SNA were the uncertainty of partners/social contacts to react/respond to the invitation for HIV testing, the lack of support, and the challenges in locating partners/social contacts who could benefit from HIV testing.

“Reaching undiagnosed people with HIV is critical … Providing SNA as an additional approach for delivering HIV testing services could improve patients’ choices and contribute to global goals to eliminate HIV/AIDS as a public threat,” Ong underlined.

The benefits of SNA likely outweigh its risks and there is good acceptability among users. SNA should be further scaled up to strengthen global efforts to achieve the goal by 2030, he continued. The type of SNA to implement should also be based on the setting, epidemiology, client preferences, and available resources.