What Are the Implications of the Review for HIV and STI Testing in Canada?
This systematic review found that incentives may increase the uptake of initial STI testing, especially in non-clinical settings. The results offer us another potential tool with which to address HIV and STI testing rates in Canada. For service providers interested in exploring what role an incentivized testing program could play in their organization some things to consider include:
- Assessing whether such an approach could help increase uptake of testing in the populations they serve.
- Considering potential ethical issues around incentivizing certain populations to increase HIV and STI testing.
- Organizations that don't offer testing can still play a role in the planning and promotion of an incentivized testing strategy through partnerships with other organizations.
However, it's important to remember that:
- Although four of the seven studies in the review took place in the United States, more Canadian research is needed to help us further understand how effective HIV and STI testing incentives would be in Canada.
- With the exception of one study, the interventions did not look at whether incentives of different sizes would have different effects on testing rates. The studies also did not explore whether there was a difference between using monetary or non-monetary incentives. More research is needed to help us understand what the optimal type of incentive would be to achieve the greatest increase in HIV and STI testing.
- The interventions involved different populations, but they did not evaluate the impact of incentives on different populations. Additional research could help us determine whether incentives work the same across all populations, or whether there are some groups of people who would benefit more from this test promotion strategy than others.
- The authors noted several limitations to the systematic review. Not all studies included in the review were able to ensure that the comparison and intervention conditions were comparable. This means that differences found in the test uptake rates may have been due to another factor that differed between the two conditions. The authors also noted that increases in the availability of HIV treatment over time may have decreased some of the barriers to testing. Finally, there was no economic data on the financial background of the study participants. One limitation of the study not noted by the authors is the issue of publication bias. This may be an issue as there is a tendency among researchers to publish positive results more often than negative results. This can result in drawing the wrong conclusions because not all the studies completed are available for the review.
What Is a Systematic Review?
Systematic reviews are important tools for informing evidence-based programming. A systematic review is a critical summary of the available evidence on a specific topic. It uses a rigorous process to identify all the studies related to a specific research question. Relevant studies can then be assessed for quality and their results summarized to identify and present key findings and limitations. If studies within a systematic review contain numerical data, this data can be combined in strategic ways to calculate pooled estimates. Combining data to produce pooled estimates can provide a better overall picture of the topic being studied.
Anonymous HIV Testing Program -- Options Clinic, London InterCommunity Health Centre
Peer HIV Testing -- PHS Community Services Society, Vancouver, British Columbia
Erica Lee is the Information Specialist at CATIE. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).
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