The use of telephone for the delivery of HIV testing results

A large proportion of people do not know they are infected with HIV. Knowledge of one’s own HIV serostatus is necessary to access HIV support, care and treatment and to prevent acquisition or further transmission of HIV. Patients often need to return to the testing site to receive HIV test results and post-test counselling one to two weeks later after being tested. Frequently, people do not return for their HIV test results, particularly in developing countries. In this setting, barriers such as lack of money, transportation or stigma attached to HIV positive serostatus prevent people from collecting their HIV test results. However, the HIV test results could also be delivered by a single phone call, either by a fixed line or a mobile phone. Given the recent rise in mobile phone use in both developed and developing countries, telephone HIV test result notification could be an effective and feasible method for increasing the number of people receiving HIV test results. The aim of this review was to assess effectiveness of the telephone for HIV test result delivery, compared with face-to-face or other methods of HIV test result notification. After a comprehensive search of various scientific databases and other resources, we found only one relevant study. This study was performed in 1998-1999 in the United States on high-risk and homeless youth. The participants were offered an HIV test and told that their HIV test results would be available in two weeks. They were then divided into two groups; one that had to return to the testing site to get their HIV test results, and another that had the option of receiving HIV test results either by telephone or face-to-face at the testing site. Overall, less than half of participants received their HIV test results. Most participants in the telephone notification group opted for telephone rather than in person delivery of HIV test results.The proportion of youth receiving their HIV test results in the telephone group was significantly higher compared to the face-to-face group. However, since none of the participants in the telephone group were HIV positive, the study could not provide information about the effectiveness of telephone HIV test result delivery in people with HIV. In addition, we could not find any information about other relevant outcomes such as participants’ and providers’ satisfaction with the telephone HIV test results delivery, cost or potential harmful effects of this intervention. We urgently need more studies conducted in various settings comparing the effectiveness of telephone to other ways of HIV test result delivery and providing other relevant information in addition to the proportion of people receiving their HIV test results.

  

Authors' conclusions: 

We found only one eligible study. Although this study showed the use of the telephone for HIV test results notification was more effective than face-to-face delivery, it had a high-risk of bias. The study was conducted about 13 years ago in a high-income country, on a high-risk population, with low HIV prevalence, and the applicability of its results to other settings and contexts is unclear. The study did not provide information about telephone HIV test results notification of HIV positive people since none of the intervention group participants were HIV positive. We found no information about the acceptability of the intervention to patients’ and providers’, its economic outcomes or potential adverse effects. There is a need for robust evidence from various settings on the effectiveness of telephone use for HIV test results notification.

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Background: 

This is one of three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Both in developed and developing countries there is a large proportion of people who do not know they are infected with HIV. Knowledge of one's own HIV serostatus is necessary to access HIV support, care and treatment and to prevent acquisition or further transmission of HIV. Using telephones instead of face-to-face or other means of HIV test results delivery could lead to more people receiving their HIV test results.

Objectives: 

To assess the effectiveness of telephone use for delivery of HIV test results and post-test counselling.

To evaluate the effectiveness of delivering HIV test results by telephone, we were interested in whether they can increase the proportion of people who receive their HIV test results and the number of people knowing their HIV status.

Search strategy: 

We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health (CINAHL), WHOs The Global Health Library and Current Controlled Trials from 1980 to June 2011. We also searched grey literature sources such as Dissertation Abstracts International,CAB Direct Global Health, OpenSIGLE, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society and AEGIS Education Global Information System, and reference lists of relevant studies for this review.

Selection criteria: 

Randomised controlled trials (RCTs), quasi-randomised controlled trials (qRCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) studies comparing the effectiveness of telephone HIV test results notification and post-test counselling to face-to-face or other ways of HIV test result delivery in people regardless of their demographic characteristics and in all settings.

Data collection and analysis: 

Two reviewers independently searched, screened, assessed study quality and extracted data. A third reviewer resolved any disagreement.

Main results: 

Out of 14 717 citations, only one study met the inclusion criteria; an RCT conducted on homeless and high-risk youth between September 1998 and October 1999 in Portland, United States. Participants (n=351) were offered counselling and oral HIV testing and were randomised into face-to-face (n=187 participants) and telephone (n=167) notification groups. The telephone notification group had the option of receiving HIV test results either by telephone or face-to-face. Overall, only 48% (n=168) of participants received their HIV test results and post-test counselling. Significantly more participants received their HIV test results in the telephone notification group compared to the face-to-face notification group; 58% (n=106) vs. 37% (n=62) (p < 0.001). In the telephone notification group, the majority of participants who received their HIV test results did so by telephone (88%, n=93). The study could not offer information about the effectiveness of telephone HIV test notification with HIV-positive participants because only two youth tested positive and both were assigned to the face-to-face notification group. The study had a high risk of bias.

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