Effective facility-based interventions could compliment frontline efforts in reaching the UNAIDS 90-90-90 targets by 2020; however, a rigorous evaluation is yet to be done. We systematically reviewed evidence on all facility-based—including provider-initiated testing and counseling (PITC)—initiatives through the lens of the UNAIDS targets (first 90, second 90, third 90).
We searched 11 databases from 2007-2017 and classified eligible studies by country income level (low [LIC], medium [MIC], high [HIC]), with outcomes (i.e., test attendance, linkages to care, and viral suppression/CD4 rates) stratified by UNAIDS targets. We considered interventions as highly successful at >86%, moderately successful at 71-85%, and unsuccessful at 55-70%.
Of 28 studies, 12 (42%) were from MIC, 8 (29%) from HIC, and 8 (29%) from LIC. Reporting of outcomes by targets was: first 90- 14/28 (50%); second 90- 13/28 (46%); third 90- 10/28 (36%). Interventions meeting targets were based in: MIC-4/12 (33%); LIC-2/8 (25%); HIC-3/14 (21%). Less than half of the studies (32%) reported successful initiatives. Initiatives in MIC highlighted the importance of support and care-based initiatives to test, treat, and maintain viral suppression. HIC initiatives presented poor success rates, with low attendance rates in primary and outpatient care settings. In HIC, testing and treatment services lacked adaptation to language and health literacy needs of at-risk populations. As only 2/28 (7%) studies reported data by UNAIDS targets, new interventions must report progress by UNAIDS targets for standardization and applicability.
Results revealed resource-level adapted interventions to test and treat at risk populations may be successful if applied innovatively. Interventions stratified by country income level show successful application of similar methods to reach target populations, and reveal gaps in the evaluated interventions to be addressed in future facility-based initiatives. Few studies (7%) reported success as per UNAIDS targets, and some care-based initiatives required context adaptations to demonstrate success. Standardized reporting as per targets will aid comparability of data from countries and facilitate scale up.
N. P. Pai,
N. Karatzas, None
S. Dave, None
T. Peter, None
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