SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
March, 2017 - SUPPORT Summary of a systematic review | print this article | download PDF
Low uptake of HIV testing is one of the main reasons why only one third of people who need antiretroviral medications are currently receiving treatment worldwide. Mass media are sometimes used to promote voluntary HIV counseling and testing and to sustain test seeking behavior. Mass media include television, radio, internet, newspapers, books, posters, and billboards.
Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev 2005; (3): CD004775.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
Rapid expansion of access to antiretroviral treatment in low income countries is saving lives, improving quality of life, and contributing to the rejuvenation of households and entire communities. However, low testing rates reduce the impact of HIV treatment because infected individuals who are not diagnosed do not get treatment and those who are diagnosed late in the course of infection have a poorer prognosis. Low uptake of HIV testing may result from a combination of factors, including lack of information on HIV testing services as well as stigma and discrimination against people living with HIV. Various population level interventions have been used to increase uptake of HIV testing, including messages in the media such as television, radio, newspapers, posters, and billboards.
| Review objectives: To assess the effect of mass media interventions on the uptake of HIV testing. | ||
| Type of | What the review authors searched for | What the review authors found |
|---|---|---|
| Study designs & interventions | Randomised trials, non randomised trials, and interrupted time series studies assessing multimedia interventions or interventions using one type of media. |
2 randomised trials, 3 non randomised trials, and 9 interrupted time series studies. Interventions included multimedia (9 studies), video (1), television (1), group education (1), and leaflets plus discussion with participants (2). No study compared different types of media. |
| Participants | The public or specific target groups (such as sex workers or drug users), excluding healthcare providers. |
The studies targeted the public (8 studies), pregnant women (2), men who have sex with men (1), blood transfusion recipients (1), and women (2). |
| Settings | Not specified |
Studies from the UK (7), USA (3), Australia (2), Canada (1) and Israel (1) |
| Outcomes |
Primary: rate of persons tested for HIV Secondary: improvement in detecting HIV seropositivity |
All studies reported on uptake of HIV testing and 3 reported on HIV seropositivity. |
| Date of most recent search: April 2004. | ||
| Limitations: This is a well conducted systematic review with only minor limitations. | ||
Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev 2005; (3): CD004775.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
The review included fourteen studies from high income countries.
Mass media interventions versus no intervention |
|||
| People: General public or specific target groups. Settings: Diverse settings in high income countries. Intervention: Mass media. Comparison: No intervention. |
|||
| Outcomes | Impact | No of Participants (studies) |
Quality of the evidence (GRADE) |
| Immediate up take of HIV testing |
Despite substantial heterogeneity in the populations studied, media used, duration and frequency of interventions, and study designs, each study showed that mass media increased initial uptake of HIV testing. |
14 studies |
High |
| Long term uptake of HIV testing |
4 studies had both short and long term positive impacts on uptake of HIV testing; 3 studies had initial benefits with some decay of the beneficial effect over time; and 4 studies had only an initial impact. |
11 studies |
Low |
| HIV seropositivity | 1 study showed an initial positive impact and further improvement in detecting HIV seropositivity, 1 showed an initial increase in HIV seropositivity with decay over time, and 1 showed an initial deficit with a delayed effect for detecting HIV seropositivity. | 3 studies |
Low |
| GRADE: GRADE Working Group grades of evidence (see above and last page). |
|||
| Findings | Interpretation* |
|---|---|
| APPLICABILITY | |
|
All mass media interventions used in the studies led to increases in initial uptake of HIV testing (with no appreciable effects on HIV seropositivity), but all the studies were from high income, non epidemic countries.
|
Differences in the organisation and financing of health services as well as HIV prevalence between the high income countries where these studies were conducted and low income countries such as those of sub Saharan Africa, may affect the transferability of the review findings to the latter.
|
| EQUITY | |
| The included trials did not provide data regarding differential effects of the interventions between gender or across various levels of advantage. |
Some mass media interventions may not be appropriate for reaching rural or low income households (e.g. leaflets or television). Therefore, an HIV programme that does not take such local realities into consideration may exacerbate health inequities or fail to address them adequately.
|
| ECONOMIC CONSIDERATIONS | |
| None of the studies reported economic evaluations of the interventions. |
Mass media interventions have been used extensively for health education in low income countries and their costs may vary considerably. There fore, decision makers need to use considerable judgement in the selection of appropriate mass media interventions for their communities taking available resources and competing priorities into consideration. |
| MONITORING & EVALUATION | |
|
Duration and frequency of the interventions varied considerably between studies.
|
When mass media interventions are implemented in low income countries to promote HIV testing, clearly defined process indicators for monitoring these interventions should be included in the general HIV control programme monitoring and evaluation framework.
|
|
*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods |
|
Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Syst Rev 2002; (1): CD000389.
Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010; 376:1261-71.
Charles Shey Wiysonge, Lilian Dudley, Jimmy Volmink; South African Medical Re search Council, Cape Town, South Africa.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Godfrey Woelk, Flora Kessy, and the Maputo SUPPORT Team.
Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev 2005; (3): CD004775.
Wiysonge CS, Dudley L, Volmink J. Do mass media interventions increase uptake of HIV testing. A SUPPORT Summary of a systematic review. March 2017. www.supportsummaries.org
evidence informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, mass media, radio, television, HIV testing, voluntary HIV counselling and testing, HIV/AIDS.
The South African Medical Research Council aims to improve South Africa’s health and quality of life through promoting and conducting relevant and responsive health research. www.mrc.ac.za/
Cochrane South Africa, the only centre of the global, independent Cochrane network in Africa, aims to ensure that health care decision making within Africa is informed by high quality, timely and relevant research evidence. www.mrc.ac.za/cochrane/cochrane.htm
