title: Active recall to increase HIV and STI testing: a systematic review.
abstract: BACKGROUND
  Active recall can improve reattendance rates and could increase retesting rates and detection of HIV and sexually transmitted infections (STIs), but the best strategy remains uncertain.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of active recall for HIV and/or STI testing. We searched six electronic databases using terms for HIV, STIs, tests and active recall (defined as a reminder to retest for HIV/STIs) for randomised, non-randomised and observational English-language studies published between 1983 and 2013. Outcomes included reattendance/retesting rate and STI diagnosis at follow-up.
  
  
  RESULTS
  Of 5634 papers identified, 17 met the inclusion criteria. Of the 14 comparative studies, all but one demonstrated higher reattendance/retesting rates in the intervention group, but the range was wide (17.5-89%). Meta-analysis of nine RCTs found reattendance/retesting rates were significantly higher in the intervention versus control groups (pooled OR 2.42 (95% CI 1.84 to 3.19)). In a subgroup analysis, home sampling increased retesting compared with clinic testing (pooled OR 2.20 (95% CI 1.65 to 2.94)). In observational studies SMS reminders increased retesting compared with standard clinic care (pooled OR 2.19 (95% CI 1.46 to 3.29)), but study estimates were highly heterogeneous (I(2)=94%, p<0.001).
  
  
  CONCLUSIONS
  Active recall interventions are associated with higher reattendance/retesting rates for HIV/STI. Although home sampling and SMS reminders were associated with higher reattendance/retesting rates in most studies, evidence is limited by the heterogeneity of interventions and control groups and the quality of studies. Further work is needed to explore which active recall modality is clinically cost-effective and acceptable for HIV/STI screening.
authors.affiliation: HIV & STI Department, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Desai
authors.affiliation: HIV & STI Department, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Woodhall
authors.affiliation: HIV & STI Department, Public Health England, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Nardone
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Burns
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mercey
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D002690:Chlamydia Infections / Q000175:diagnosis / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D006069:Gonorrhea / Q000175:diagnosis / Q000517:prevention & control*; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006302:Health Services Research; D006801:Humans; D008403:Mass Screening; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems; D013587:Syphilis / Q000175:diagnosis / Q000517:prevention & control*; D060145:Text Messaging; D064887:Observational Studies as Topic
keywords: HEALTH SERV RESEARCH; HIV; SEXUAL HEALTH; TESTING