(P342) Understanding Reach, Efficacy, Adoption, Implementation, and Maintenance of home-based sexual health care including HIV testing outside a clinic: a Realist Review

Background. Home-based sexual health care, including testing, is a strategy that increases autonomy and decreases some barriers. It could improve regular testing and timely treatment of STIs and HIV. Recently, home-based sexual healthcare offers have been increasingly implemented. Key concepts that define the maintenance of this type of care are (1) reach of at-risk populations (2) impact of the innovation and (3) adoption by care providers. This review aims to identify which types of home-based sexual health care offer work for whom, under what circumstances, and why.

Methods. A realist review was conducted by searching and appraising the relevant evidence, synthesizing, and disseminating findings. The review was restricted to home-based sexual health care interventions with at least a self-managed HIV testing component. The search was conducted within PubMed, Embase, Cochrane Register of Controlled Trials and PsycInfo. Global peer-reviewed published quantitative and qualitative literature and reports published from February 2012 to November 2022 were examined. The RE-AIM framework was applied to systematically assess (R) reach of key populations, (E) impact on desired outcomes (i.e., increased HIV testing and timely treatment), and (AIM) effects on adoption and implementation in current sexual health care.
Results. Of 730 unique identified records, 93 studies were selected for extraction. Of these studies, 62% reported actual interventions, 38% solely described intention and acceptability. Most studies (67%) focused on reaching men who have sex with men (MSM). Mixed communication and recruitment strategies were used to reach key populations (e.g., online, peer-to-peer, and outreach). The impact of home-based testing was mainly increased HIV testing. Adoption by care providers was acceptable when linkage to care and additional care services would be available. In addition, the maintenance of home-based testing was mostly advised as complimentary to clinic-based testing.

Conclusion. Although multiple key populations were assessed, impact for key populations was largely restricted to MSM. Results of adoption by implementers and levels of fidelity seem inadequate. There is a great variety in reporting and analytic approaches to home-based sexual health care programs. Accordingly, more comparative standardized research is needed to examine universal success factors of home-based sexual health care.