The United Nations has set ambitious targets to increase the number of people living with HIV (PLWH) who are aware of their status, on antiretroviral therapy (ART), and virally suppressed. However, despite significant progress, gaps remain, particularly among marginalized populations. Demand-creation interventions are crucial for increasing the uptake of HIV testing services (HTS) among these populations, but with declining resources, it is essential to prioritize practical approaches.
The systematic review and meta-analysis published in PLOS Medicine assessed various strategies to increase demand for HIV testing services (HTS). The results showed that several interventions significantly increased the uptake of HTS. These included mobilization, couple-oriented counseling, peer-led interventions, motivation-oriented counseling, SMS, and conditional fixed-value incentives.
Mobilization efforts effectively increased HTS uptake, especially in settings where the overall coverage of testing is low. Mobilization involves motivating large groups within a community to take up testing and can be particularly effective in motivating individuals who may have previously been hesitant or resistant to testing.
However, the effectiveness of mobilization may decrease over time as the remaining untested individuals become systematically different from those who have already been tested. As a result, it may be necessary to tailor demand-creation interventions to subpopulations, such as key populations, to continue increasing HTS uptake.
Couples counseling and motivation-oriented counseling approaches were also effective in increasing HTS uptake. Couples counseling is widely used in many contexts, while motivation-oriented counseling may merit further expansion. Economic empowerment interventions were also found to have broad-reaching effects beyond HTS. Incentives, such as conditional fixed value incentives, effectively increased HTS uptake.
However, concerns exist about the affordability and long-term sustainability of such incentives and the potential for erosion of intrinsic motivation for testing. While the limited data available do not support concerns about the erosion of intrinsic motivation, policymakers and implementers may still hesitate to invest in incentives.
The review also highlighted a range of digital interventions, with older technology, such as videos and SMS, having more evidence supporting effectiveness than newer technology, such as websites, social media, and gamification. SMS was effective in enhancing the uptake of HTS and promoting frequent retesting. However, reminder SMS messages were found to be relatively ineffective, and SMS platforms that offered interactive instead of one-way communication were more effective.
Overall, the findings of this review are similar to other systematic reviews of demand creation interventions for VMMC and family planning, supporting the use of incentives, mobilization, and interpersonal communication with or without peer involvement. However, the review also highlights the need for tailoring demand creation strategies to specific subpopulations and the potential for digital interventions to enhance HTS uptake.