Digital Counseling and Testing Services to Improve HIV Self-Testing Acceptance In Key Populations: A Systematic Review

Key populations still experience stigma, privacy concerns, and limited access to HIV testing. Digital counseling and HIV self-testing offer a safer alternative. This systematic review synthesized evidence on the effectiveness of technology-based counseling and testing services in improving self-testing acceptability, uptake among key populations and linkage to care. A literature search was conducted (July–September 2025) in five databases, including studies published between 2017 and 2024, in accordance with PRISMA guidelines. This review protocol was registered with PROSPERO (CRD420251084235). Inclusion criteria comprised adult key populations receiving technology-based interventions in randomised controlled trials, cohort, or quasi-experimental designs that reported outcomes on acceptance, uptake, and/or linkage to care. Risk of bias was evaluated using the Joanna Briggs Institute tools, and results were synthesized narratively. Twelve studies from middle and high-income countries (n = 8,328) were included. The most consistently effective interventions were models that integrated HIV self-testing with structured digital counselling, including pre-and post-test education and direct referral systems to healthcare services. These services increased HIV testing frequency compared to standard care, were well accepted, and successfully reached many first-time testers. However, challenges remain, including disparities in digital access, sustainability of self-testing kit supply, and variability in intervention components. In this context, nurses play a critical role as digital care navigators by providing digital pre- and post-test counseling through smartphone-based platforms, such as widely used applications like WeChat, while also ensuring digital health literacy, addressing technical barriers, and coordinating referrals for confirmatory testing.