Social Network-Based Strategies for HIV Testing Among Women: A Systematic Review.

Social network-based HIV testing (SNHT) is an evidence-informed strategy for expanding HIV testing coverage. This systematic review evaluated the effectiveness of SNHT strategies in improving HIV testing uptake, diagnosis of new HIV cases, and linkage to care among women and their at-risk social networks and examined key strategies for effective implementation. We systematically reviewed studies assessing social network-based approaches for HIV testing uptake, HIV diagnosis, linkage to HIV care and treatment after diagnosis, and related barriers and adverse effects among women. We searched PubMed, Web of Science, Scopus, Embase, and Google Scholar for English-language articles published up to February 2023, following PRISMA guidelines. Due to heterogeneity in study designs and incomplete data, with some studies lacking either the numerator or the denominator, we conducted a qualitative synthesis to summarize patterns in HIV testing uptake, diagnosis, linkage to HIV care and treatment after diagnosis, and adverse events. In addition, where data were available, we extracted and presented reported effect sizes for HIV testing uptake and HIV test results. Out of 1,282 screened publications, 19 met the inclusion criteria. Findings were categorized based on HIV testing uptake, diagnosis, linkage to care, the types of social network members, recruitment strategies, and adverse event. Our review found a high acceptance rate of HIV testing regardless of the type of network members. Evidence regarding new HIV case diagnoses and linkage to HIV care after diagnosis was mixed. Implementation strategies varied across studies, including differences in the types of social network members targeted, recruitment approaches, and use of incentives. Adverse events, including intimate partner violence, were infrequently reported. This review highlights that SNHT strategies can effectively increase HIV testing uptake among women and their at-risk network members. Women, through roles such as peer educators or recruiters, can actively engage peers, sexual partners, and other network members to promote HIV testing. Effective SNHT programs require robust monitoring systems to track how many network members are approached, tested, and successfully linked to confirmatory testing and treatment.