Active Recall to Increase HIV and STI Testing
Active Recall to Increase HIV and STI Testing
Active recall was defined as a reminder to return for or to have a repeat test or screen. This could take the form of a text message, email, telephone call, letter, or sending out a kit for home sample collection or testing. A verbal reminder at the initial visit did not count as active recall.
We used the PICO (population, intervention, comparison, outcome) framework to guide our eligibility criteria. Studies of patients who were HIV-negative or of unknown status were eligible for inclusion. Studies from all countries were included and testing facilities included hospitals, sexual health clinics, general practice, community venues and home sampling/testing.
The intervention was active recall (as defined above) and the comparator was no active recall, a reminder at the initial visit only or no comparator (in the case of non-comparative and cohort studies). The primary outcome of interest was the proportion of those recalled who reattended or retested at least once. The secondary outcomes were additional infections among those retested (number of infections/number reattended or retested) and infections detected among those recalled (number of infections/number recalled). This gives an idea of clinical and public health benefits, since clinical benefit may be high if the number of additional infections at retest is high, but public health benefit will depend on the number of additional infections identified through active recall, in relation to the cost of the programme.
All randomised and non-randomised interventional and non-interventional study designs were included. Qualitative studies were excluded from this review.
Exclusion criteria included studies without a recall intervention, pretest and post-test counselling without a recall intervention, recall for current episodes of care including tests of cure, postexposure and pre-exposure prophylaxis studies, review articles, conference abstracts and news reviews.
We searched six databases: Medline, Pubmed, Embase, Cinahl Plus, Psychinfo and the Cochrane Database of Systematic Reviews limiting the search from 1983 up to the date of the final search on 6 December 2013, human studies and English language studies. Search keywords included HIV, terms for STIs, specific STIs including chlamydia and gonorrhoea, test, screen, terms for active recall, and the specific modes of active recall including text message and telephone. The full search strategy is provided in the online supplementary annex http://sti.bmj.com/content/91/5/314/suppl/DC1.
One reviewer (MD) searched the databases and performed a full title screen to remove obviously irrelevant articles. Shortlisted titles underwent full abstract review and full papers were shortlisted using the eligibility criteria above. Full paper review was conducted by one reviewer (MD) to generate a final list of papers included in the review. One reviewer (MD) manually searched the reference list of included papers to identify any articles missed by the search strategy. Two reviewers (MD and SW) extracted data from the selected papers.
The National Institute of Health and Care Excellence Public Health Methods Manual was used to assess the methodological quality of each study. This is a modification of the graphical appraisal tool for epidemiological studies checklist for interventional and observational studies. This tool was chosen as it is intended for use in the development of public health guidance and allows for assessment of all study types. Where the reviewers (MD and SW) felt any items on the tool were ambiguous, these reviewers agreed and applied study-specific criteria.
Outcome data for reattendance/retesting was pooled using a random effects model due to heterogeneity between studies and study samples using the Stata statistical package. Pooled ORs are presented separately for randomised controlled trials (RCTs) and observational studies, since biases inherent to observational studies may affect the RCT results. Pooled OR for each active recall intervention is presented separately and as an overall pooled estimate. Each of the studies followed up participants over different time periods; crude and pooled ORs are presented, but the heterogeneity of studies is also considered. We controlled for heterogeneity of study population as far as possible by presenting results for studies with two distinct comparison groups, such as a concurrent and historical control group or control groups from two independent populations separately.
Publication bias was assessed with a funnel plot and using the Harbord test of small study sizes.
Factors associated with reattendance/retesting are presented descriptively, with population subgroup analyses where possible (eg, by gender, sexual orientation).
Methods
Eligibility Criteria
Active recall was defined as a reminder to return for or to have a repeat test or screen. This could take the form of a text message, email, telephone call, letter, or sending out a kit for home sample collection or testing. A verbal reminder at the initial visit did not count as active recall.
We used the PICO (population, intervention, comparison, outcome) framework to guide our eligibility criteria. Studies of patients who were HIV-negative or of unknown status were eligible for inclusion. Studies from all countries were included and testing facilities included hospitals, sexual health clinics, general practice, community venues and home sampling/testing.
The intervention was active recall (as defined above) and the comparator was no active recall, a reminder at the initial visit only or no comparator (in the case of non-comparative and cohort studies). The primary outcome of interest was the proportion of those recalled who reattended or retested at least once. The secondary outcomes were additional infections among those retested (number of infections/number reattended or retested) and infections detected among those recalled (number of infections/number recalled). This gives an idea of clinical and public health benefits, since clinical benefit may be high if the number of additional infections at retest is high, but public health benefit will depend on the number of additional infections identified through active recall, in relation to the cost of the programme.
All randomised and non-randomised interventional and non-interventional study designs were included. Qualitative studies were excluded from this review.
Exclusion criteria included studies without a recall intervention, pretest and post-test counselling without a recall intervention, recall for current episodes of care including tests of cure, postexposure and pre-exposure prophylaxis studies, review articles, conference abstracts and news reviews.
Search Strategy
We searched six databases: Medline, Pubmed, Embase, Cinahl Plus, Psychinfo and the Cochrane Database of Systematic Reviews limiting the search from 1983 up to the date of the final search on 6 December 2013, human studies and English language studies. Search keywords included HIV, terms for STIs, specific STIs including chlamydia and gonorrhoea, test, screen, terms for active recall, and the specific modes of active recall including text message and telephone. The full search strategy is provided in the online supplementary annex http://sti.bmj.com/content/91/5/314/suppl/DC1.
One reviewer (MD) searched the databases and performed a full title screen to remove obviously irrelevant articles. Shortlisted titles underwent full abstract review and full papers were shortlisted using the eligibility criteria above. Full paper review was conducted by one reviewer (MD) to generate a final list of papers included in the review. One reviewer (MD) manually searched the reference list of included papers to identify any articles missed by the search strategy. Two reviewers (MD and SW) extracted data from the selected papers.
Quality Assessment
The National Institute of Health and Care Excellence Public Health Methods Manual was used to assess the methodological quality of each study. This is a modification of the graphical appraisal tool for epidemiological studies checklist for interventional and observational studies. This tool was chosen as it is intended for use in the development of public health guidance and allows for assessment of all study types. Where the reviewers (MD and SW) felt any items on the tool were ambiguous, these reviewers agreed and applied study-specific criteria.
Statistical Analysis
Outcome data for reattendance/retesting was pooled using a random effects model due to heterogeneity between studies and study samples using the Stata statistical package. Pooled ORs are presented separately for randomised controlled trials (RCTs) and observational studies, since biases inherent to observational studies may affect the RCT results. Pooled OR for each active recall intervention is presented separately and as an overall pooled estimate. Each of the studies followed up participants over different time periods; crude and pooled ORs are presented, but the heterogeneity of studies is also considered. We controlled for heterogeneity of study population as far as possible by presenting results for studies with two distinct comparison groups, such as a concurrent and historical control group or control groups from two independent populations separately.
Publication bias was assessed with a funnel plot and using the Harbord test of small study sizes.
Factors associated with reattendance/retesting are presented descriptively, with population subgroup analyses where possible (eg, by gender, sexual orientation).
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