Public Health Nursing Vol. 31 No. 1, pp. 58–59 0737-1209/© 2013 Wiley Periodicals, Inc. doi: 10.1111/phn.12092
REVIEW SUMMARIES Summaries of systematic reviews on public health nursing-related issues from the Cochrane Library, Cochrane Nursing Care Field, and other evidence review organizations A FIELD OF
THE COCHRANE COLLABORATION®
Telephone Communication of HIV Testing Results for Improving Knowledge of HIV Infection Status Ai hua Zhang, Ph.D., R.N. and Liping Chen, Ph.D. (c) School of Nursing, TaiShan Medical University, China Correspondence to: Ai hua Zhang, School of Nursing, TaiShan Medical University, TaiAn City, Shandong Province, China. E-mail:[email protected]
Review Question What is the effectiveness of using the telephone for delivering human immunodeficiency virus (HIV) test results and posttest counseling compared with face-to-face notification?
Keywords: HIV infection, systematic review, Telephone notification, test result.
Type of Review This synopsis is of a Cochrane systematic review by Tudor Car, Gentry, van-Velthoven, and Car (2013) containing one randomized controlled trial (RCT) evaluating the effectiveness of telephone versus face-to-face notification of HIV results in high-risk persons. No meta-analysis was possible, and a narrative summary is presented.
Relevance for Public Health Nursing More than 34 million people were living with HIV in 2010 (World Health Organization, 2011), and this number is expected to increase significantly over the next few decades (The AIDS 2031 Consortium, 2011). A large proportion of people do not
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know that they are infected with HIV, and knowledge of one’s own HIV serostatus is important to access treatment, care, and to prevent acquisition or further transmission of HIV. Testing and counseling for HIV help a person get informed about his/her HIV status and can reduce stigma by increasing HIV knowledge through counseling. Following testing (commonly one to 2 weeks), patients often need to return to the testing site to receive their test results and get postcounseling. However, many people do not return for their HIV test results for various reasons, such as barriers to health care (lack of money, transportation problems) and the stigma sometimes associated with HIV-positive serostatus. Given the recent rise in mobile phone use in both developed and developing countries, HIV test results could be delivered by a phone call. Either the telephone or a mobile phone can be used for this purpose. Using telephones to communicate HIV test results compared to face-to-face notification may improve access, reduce costs, and save time. Nurses and other health care professionals are often involved in the care and counseling for HIV/AIDS testing; therefore, it is important to know effective ways to deliver results.
Zhang and Chen: Telephone Communication of HIV Testing Results
Characteristics of the Evidence To be included in the review, participants could be from any populations regardless of their demographic characteristics or setting. One RCT involving 351 participants met inclusion criteria. Participants were homeless youths and youth at high risk for contracting HIV infection. Participants were offered counseling and oral HIV testing and were randomized into face-to face (n = 184) and telephone (n = 167) notification groups. The face-to face group had to collect their results from the HIV test clinic. The telephone notification group had the option of receiving HIV test results either by telephone or face-to- face. The outcome of interest was the proportion of participants who were notified about their HIV test results and received posttest counseling. The included RCT had a high risk of bias due to inadequate random sequence generation and baseline imbalance between the intervention and control group. Blinding of the participants and personnel in the study was not possible. The risk of detection bias, attrition bias, and reporting bias was unclear. Results were as follows: ● Of the 351 participants who were tested, 48% (n = 168) followed up to receive test results and posttest counseling. Significantly more participants received their HIV test results in the telephone notification group: 58% (n = 106) compared to 37% (n = 62) in the face-to-face notification group (p < .001). In the telephone notification group, the majority of participants who received their HIV test results did so by telephone (88%, n = 93). ● The study could not provide information about the effectiveness of telephone HIV test notification with HIV-positive participants because only two youths tested positive and both were assigned to the face-to-face notification group and therefore no HIV-positive results were given by telephone. ● The included study did not provide any information about patients’ and providers’ satisfaction with the intervention, its cost-effectiveness, or potential adverse outcomes.
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Implications for Population-Based Practice Although the included study in this review showed that telephone for HIV test result notification was more effective than face-to-face delivery, the study was performed in a specific group of participants from an upper-income country with a low HIV prevalence. The study also had a high-risk bias. The existing evidence does not offer sufficient information on the effects of telephone use of HIV test result notification and counseling either in developed or in developing countries.
Implications for Public Health Nursing Research There is a need for more studies conducted in various settings and contexts comparing the effectiveness of telephone use with other ways of HIV test delivery and providing other relevant information, such as potential harmful effects of the intervention, its economic and adverse outcomes. Policymakers should ensure urgent prioritization of high-quality research on the effectiveness of telephone use for HIV test result delivery in the future.
Acknowledgment Both authors are members of the Cochrane Nursing Care Field (CNCF).
References The AIDS 2031 Consortium. (2011). AIDS: Taking a long-term view. New York, NY: FT Press Science. Tudor Car, L., Gentry, S., van-Velthoven, M. H., & Car, J. (2013). Telephone communication of HIV testing results for improving knowledge of HIV infection status. Cochrane Database of Systematic Reviews, 1, CD009192. doi:10. 1002/14651858.CD009192.pub2. World Health Organization. (2011). Progress report 2011: Global HIV/AIDS response: epidemic update and health sector progress towards universal access. Retrieved from http://www. who.int/hiv/pub/progress_report2011/en/
REVIEW SUMMARIES Summaries of systematic reviews on public health nursing-related issues from the Cochrane Library, Cochrane Nursing Care Field, and other evidence review organizations A FIELD OF
THE COCHRANE COLLABORATION®
Telephone Communication of HIV Testing Results for Improving Knowledge of HIV Infection Status Ai hua Zhang, Ph.D., R.N. and Liping Chen, Ph.D. (c) School of Nursing, TaiShan Medical University, China Correspondence to: Ai hua Zhang, School of Nursing, TaiShan Medical University, TaiAn City, Shandong Province, China. E-mail:[email protected]
Review Question What is the effectiveness of using the telephone for delivering human immunodeficiency virus (HIV) test results and posttest counseling compared with face-to-face notification?
Keywords: HIV infection, systematic review, Telephone notification, test result.
Type of Review This synopsis is of a Cochrane systematic review by Tudor Car, Gentry, van-Velthoven, and Car (2013) containing one randomized controlled trial (RCT) evaluating the effectiveness of telephone versus face-to-face notification of HIV results in high-risk persons. No meta-analysis was possible, and a narrative summary is presented.
Relevance for Public Health Nursing More than 34 million people were living with HIV in 2010 (World Health Organization, 2011), and this number is expected to increase significantly over the next few decades (The AIDS 2031 Consortium, 2011). A large proportion of people do not
58
know that they are infected with HIV, and knowledge of one’s own HIV serostatus is important to access treatment, care, and to prevent acquisition or further transmission of HIV. Testing and counseling for HIV help a person get informed about his/her HIV status and can reduce stigma by increasing HIV knowledge through counseling. Following testing (commonly one to 2 weeks), patients often need to return to the testing site to receive their test results and get postcounseling. However, many people do not return for their HIV test results for various reasons, such as barriers to health care (lack of money, transportation problems) and the stigma sometimes associated with HIV-positive serostatus. Given the recent rise in mobile phone use in both developed and developing countries, HIV test results could be delivered by a phone call. Either the telephone or a mobile phone can be used for this purpose. Using telephones to communicate HIV test results compared to face-to-face notification may improve access, reduce costs, and save time. Nurses and other health care professionals are often involved in the care and counseling for HIV/AIDS testing; therefore, it is important to know effective ways to deliver results.
Zhang and Chen: Telephone Communication of HIV Testing Results
Characteristics of the Evidence To be included in the review, participants could be from any populations regardless of their demographic characteristics or setting. One RCT involving 351 participants met inclusion criteria. Participants were homeless youths and youth at high risk for contracting HIV infection. Participants were offered counseling and oral HIV testing and were randomized into face-to face (n = 184) and telephone (n = 167) notification groups. The face-to face group had to collect their results from the HIV test clinic. The telephone notification group had the option of receiving HIV test results either by telephone or face-to- face. The outcome of interest was the proportion of participants who were notified about their HIV test results and received posttest counseling. The included RCT had a high risk of bias due to inadequate random sequence generation and baseline imbalance between the intervention and control group. Blinding of the participants and personnel in the study was not possible. The risk of detection bias, attrition bias, and reporting bias was unclear. Results were as follows: ● Of the 351 participants who were tested, 48% (n = 168) followed up to receive test results and posttest counseling. Significantly more participants received their HIV test results in the telephone notification group: 58% (n = 106) compared to 37% (n = 62) in the face-to-face notification group (p < .001). In the telephone notification group, the majority of participants who received their HIV test results did so by telephone (88%, n = 93). ● The study could not provide information about the effectiveness of telephone HIV test notification with HIV-positive participants because only two youths tested positive and both were assigned to the face-to-face notification group and therefore no HIV-positive results were given by telephone. ● The included study did not provide any information about patients’ and providers’ satisfaction with the intervention, its cost-effectiveness, or potential adverse outcomes.
59
Implications for Population-Based Practice Although the included study in this review showed that telephone for HIV test result notification was more effective than face-to-face delivery, the study was performed in a specific group of participants from an upper-income country with a low HIV prevalence. The study also had a high-risk bias. The existing evidence does not offer sufficient information on the effects of telephone use of HIV test result notification and counseling either in developed or in developing countries.
Implications for Public Health Nursing Research There is a need for more studies conducted in various settings and contexts comparing the effectiveness of telephone use with other ways of HIV test delivery and providing other relevant information, such as potential harmful effects of the intervention, its economic and adverse outcomes. Policymakers should ensure urgent prioritization of high-quality research on the effectiveness of telephone use for HIV test result delivery in the future.
Acknowledgment Both authors are members of the Cochrane Nursing Care Field (CNCF).
References The AIDS 2031 Consortium. (2011). AIDS: Taking a long-term view. New York, NY: FT Press Science. Tudor Car, L., Gentry, S., van-Velthoven, M. H., & Car, J. (2013). Telephone communication of HIV testing results for improving knowledge of HIV infection status. Cochrane Database of Systematic Reviews, 1, CD009192. doi:10. 1002/14651858.CD009192.pub2. World Health Organization. (2011). Progress report 2011: Global HIV/AIDS response: epidemic update and health sector progress towards universal access. Retrieved from http://www. who.int/hiv/pub/progress_report2011/en/
