The effect of universal voluntary HIV counseling and testing on epidemiological, behavioral, and psychosocial outcomes: An umbrella review of systematic reviews and meta-analyses.

Background: Despite progress in reducing global HIV-related mortality, the decrease in the rate of HIV incidence remains slow. As such, HIV testing remains crucial to the prevention of HIV and its treatment.

Objective: This review aims to examine the credibility and strength of evidence arising from systematic reviews of psychosocial, behavioral, and epidemiological outcomes associated with different delivery models of voluntary HIV counseling and testing.

Design: Overviews of systematic reviews.

Methods: We conducted the umbrella review by searching PubMed, EMBASE, CINAHL, the Cochrane Library, Web of Science, ProQuest, Scopus, PsycINFO, and the reference lists of relevant reviews. Eligible reviews published in English between 1 January 2000 and 9 February 2021, and different reported models of voluntary HIV counseling and testing were considered. Two independent reviewers assessed the reviews for methodological quality, employing the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research syntheses. Evidence from meta-analyses of observational and interventional studies were graded as conclusive, highly suggestive, suggestive, or weak. The extracted data were tabulated and narratively synthesized.

Results: A total of 17 review papers were identified, most of which focused on home-based, community-based, and facility-based voluntary HIV counseling and testing. The most studied epidemiological outcomes include uptake of HIV testing, linkage to care and access to treatment. The most frequently reported behavioral outcomes were safe sexual practices of use of contraceptive and frequency of casual sex, while the most studied psychosocial outcome was social norms. Community-based voluntary HIV counseling and testing approaches achieved high uptake rates, linkage to care, improvement in behavioral outcomes of lower frequency of casual sex, fewer multiple sexual partners, and users experienced fewer stigmatizing behavior through the normalization of HIV testing. Facility-based voluntary HIV counseling and testing was found to be acceptable when offered as part of antenatal care. Using the evidence classification criteria, most of the outcomes were presented with suggestive evidence (Class III).

Conclusion: The integration of facility-based and home-based voluntary HIV counseling and testing services could potentially increase linkage to care. However, there is scope for further high-quality reviews and meta-analyses to provide greater insights into the impacts of different voluntary HIV counseling and testing models on behavioral and psychosocial outcomes in middle-high-income countries. The provision of a combination of these voluntary HIV counseling and testing models is needed to achieve and surpass the 95-95-95 goals by 2030.

Registration: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020183577).