The Use of Patient Self-Testing in Low- and Middle-Income Countries: A Systematic Scoping Review

Abstract

Background Improving access to health through use of innovative health technologies such as points-of-care testing is 1 global health priority. Patient self-testing (PST) is one of the point-of-care testing strategies that was shown to have an ability to improve access to diagnostic testing, autonomy and allow access to health care for hard-to-reach populations in resource-limited settings. However, the level of evidence on the use of PST for diagnosis and management of diseases in low- and middle-income countries (LMICs) is unknown. We mapped literature on evidence of the use of PST in LMICs. Methods Data were sourced from the following databases: PubMed; EBSCOhost (Medline, health source: Nursing), WEB of Science; Science Direct; and Google Scholar. Eligibility criteria for this study included: studies that focused on PST, reported on evidence on use of PST, conducted in LMICs, comparing PST with facility-based testing. Thematic analysis was performed to identify the patterns of use of PST. The mixed method quality appraisal tool version 2011 was used to assess the quality of the included primary studies. Results Eight studies met the inclusion criteria. Studies included populations from the following LMICs: Kenya; South Africa; Uganda; Bulgaria; and Malawi. Of the 18,816 total participants in all included primary studies, 57% were males. Overall, 7 (87.5%) of the 8 included studies reported on human immunodeficiency virus (HIV) self-testing using the following: oral fluid HIV self-test (HIVST), OraQuick in Home Rapid HIV-1/2 Antibody Test, OraQuick O-HIVST, oral fluid, and Fingerstick HIV self-tests. One (12.5%) of the 8 included studies reported on colorectal carcinoma using rapid immunochemical fecal occult blood tests. Although the findings of this study shows high usage of HIVST, it also demonstrates poor level of use of PST for other communicable and noncommunicable diseases in LMICs. We extracted the following themes; use of PST, feasibility of PST, and linkage to care from the included studies. Of the 8 included studies, 5 scored the highest quality (76–100%) from the methodological quality assessment. Conclusions The findings of the review revealed a high level of research evidence on the use of HIV self-testing compared to other communicable diseases and noncommunicable diseases in LMICs. Increased implementation of PST for communicable diseases is recommended, particularly for high-risk and hard-to-reach populations.