Digital Intervention Services to Promote Hiv Self-testing and Linkage to Care Services: a Bibliometric Analysis, Global Trends and Future Directions

doi:10.21203/rs.3.rs-2648800/v1

Background: It is imperative to identify and treat HIV-positive individuals that are unaware of their status to achieve the UNAIDS goal of eliminating HIV worldwide by 2030. The use of digital tools such as website-based systems, social media, mobile apps, Short Message/Messaging Service (SMS), and vending machines (VM) could expand access to HIV self-testing (HIVST) and enhance post-test linkage to care services. This study aims to analyze the progress of digital interventions in HIVST and linkage to care services, assess the impact of scholarly work in the context of scientific production, and compare the relative scientific contributions of scholars, countries, research groups or institutions.

Methods: We searched the literature in the Web of Science (WoS) database within a period of 2011 to 2022 and conducted a bibliometric analysis. The search was conducted on 10th December 2022. The key words used were mobile health, HIV self-testing and Linkage to care. This paper uses VOS viewer and bibliometrix to perform bibliometric analysis.

Results: For the keyword search, a total of 117 documents were gathered of which only 91 documents have been considered for the analysis. Among 91 documents, 79 were articles and 12 were reviews. The United States, South Africa, United Kingdom and China are the most productive and influential countries, with the widest range of collaborative partners. Other key findings are presented and discussed, followed by some potential future research avenues.

Conclusion: Based on the data collected from the WoS, digital transformation and HIV self-testing is a relatively new field, as the first paper published on the topic only dates to 2011 however, the trend of production kept increasing every year which is eloquent proof that the field is attracting a great number of researchers and scholars.

Technology-delivered

mobile health

Linkage to care

HIV

HIV self-testing

linkage to care

Bibliometric

According to the World Health Organization (WHO), at the end of 2021 there were approximately 38.4 million HIV-positive individuals worldwide (1). Moreover, the burden of the HIV epidemic continues to disproportionately affect sub-Saharan Africa wherein more than two-thirds of people living with HIV globally reside in the region (1). HIV self-testing (HIVST) is recommended by the WHO as an innovative approach for attaining the Joint United Nations Programme on HIV/AIDS (UNAIDS) objectives of eliminating HIV by 2030 (2). HIVST has received a lot of attention in the HIV testing field in recent years as a last-mile solution for meeting the UNAIDS 95-95-95 goals by 2030 (3). In the interest of both individual and societal health, identifying HIV-positive people who are unaware of their status and connecting them to care are critical steps on the continuum leading to viral suppression. People who are aware of their status are generally less likely to engage in risky sexual behaviors and successful treatment adherence improves individual health outcomes and diminishes the risk of infecting others (4). HIVST allows people to test at home and receive a preliminary result in private. It is particularly useful in settings with limited medical resources and low testing uptake among key populations to help facilitate earlier diagnosis and prevent further transmission (5). These key populations in which HIV incidence has become more concentrated include men who have sex with men (MSM), people who inject drugs, and sex workers (6). Moreover, HIVST has been shown to be cost-effective and widely accepted among those who may not otherwise get tested (5). However, follow-up services to connect self-testers to care and treatment in the event of a positive result are lacking. Here, we define linkage to care as having a confirmatory HIV test after an HIVST positive result and completing a medical visit at a Care and Treatment Center if confirmed to have an HIV positive diagnosis (7, 8).

Self-testers who receive positive HIV results may benefit from innovative strategies that use digital technologies to help them access counseling and treatment. Digital tools such as chatbots, blockchain technologies, website-based, social media, mobile HIVST applications (apps), Short Message/Messaging Service (SMS), and digital vending machines (digital VMs) are examples of digital interventions used to improve HIV testing (1, 4). Personalized, theory-based health material can be delivered with high fidelity and acceptability using mobile technologies and social media as an effective strategy to reach, engage, and retain key populations in HIV prevention and care initiatives (9). The ubiquity and variety of technology use among younger people also offers several channels for practitioners to connect people to digital health interventions that increase HIV testing and linkage to care. Likewise, the COVID-19 pandemic has created additional obstacles for facility-based and in-person health services, emphasizing the value of virtual channels for facilitating flexible access to health care and conserving health system resources (10).

In a systematic review of digital innovations for HIV and STI control interventions from 1996–2017, all digital innovations were highly accepted and feasible with combination innovations significantly impacting antiretroviral therapy (ART) adherence, clinic attendance, partner notifications, and self-care (11). Likewise, investigators examining the utility of social media interventions aimed at promoting HIV testing found that these interventions could be used to create online interactive communities to encourage HIV testing and treatment adherence, offer HIV testing services, generate further intervention materials, and provide a channel for participants to request HIVST kits (12). For example, a randomized controlled trial evaluating a digital intervention on ART among MSM living with HIV in China found that those in the intervention arm receiving ART medication information and reminders, peer education, and support had a higher proportion of participants achieving optimal adherence than in the control arm (13).

Similarly, the first pilot HIV testing combination intervention in Nigeria targeting young MSM including social media outreach and virtual peer navigation demonstrated success with identifying new HIV cases by increasing uptake of HIV testing (14). Within the iCare Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents) intervention, creating closed groups on various social media platforms (i.e., Grindr, WhatsApp, Facebook) enabled peer navigators to engage young MSM with posts and discussions on health topics including sexual orientation and gender identity, correct condom use, pre exposure prophylaxis, and the importance of HIV testing and early ART. Additionally, investigators examining the effects of mobile health (online and smartphone apps) to encourage HIV-preventative behaviors among MSM found increased HIV testing and decreased condomless anal intercourse with the use of messaging, social media, and combined technology modalities (15). HIVST innovations with digital support also offer a great opportunity to reduce stigma and confidentiality difficulties among hard-to-reach populations, and improve connectivity to care (7).

Considering the importance of HIV testing to prevent transmission and achieving UNAIDS goals, the literature concerning HIV testing and linkage to care has been increasing over the past several years. However, the trend of collaboration and growth of HIVST literature with digital intervention have not been explored in a bibliometric analysis. Previous bibliometric studies(11, 12, 16, 17) have explored the trend and the growth of the HIV/AIDS literature in general. Still, unfortunately, there is a scarcity of bibliometric studies investigating and reporting advances of HIVST with digital supports to enhance linkage to care.

Reflecting the global scientific effort to address the epidemic, bibliometric studies of research output in international settings documenting the productivity and collaboration is needed. The current study aims to contribute to the debate on HIV/AIDS more specifically, our study builds on HIVST. self – testing, and digital support interventions to enhance linkage to care following HIV self-testing. The study intends to answer the following questions:

What is the current level of research in the digital intervention on HIV self-testing and linkage to care?
Who are the most productive authors in digital transformation, HIV self-testing and linkage to care?
Who are the most global cited authors?
Which are the most productive institutions, countries, and journal outlets?
Which are the potential research avenues on digital transformation, HIV self-testing and linkage to care?

Since the main aim of this study is to assess the current level of knowledge development on mobile health intervention, HIVST and linkage to care, we opted for a bibliometric approach which can be defined as “the measurement of all aspects related to the public and reading of books and documents'' (18). This approach is suitable when assessing the status of a discipline using various indicators, such as countries' scientific production, the most influential and cited publications, most relevant affiliations, journals, and authors (19). It also allows the assessment of the level of collaboration network between authors, institutions, and countries. More broadly, this research approach enables the analysis of a vast number of publications at the macroscopic level (18). This study builds on prior studies to investigate digital technologies, mobile health on HIVST and linkage to care. For the selected 91 articles identified and selected for further analysis we used a bibliometric tool called Bibliometrix (20). More precisely, we used the shiny interface for bibliometrix called biblioshiny (20). Bibliometrix is an R-tool that provides comprehensive science mapping analysis (20).

Search Strategy

The search strategy was developed by consulting a professional librarian from George Washington University, Ms. Stacy Brody and was modified and applied for use in the Web of Science database. The search was conducted on 10th December 2022. Search terms involved three topics which were digital technologies (mobile health), HIV self-testing and linkage to care and were combined using Boolean operators’ ‘OR’ and ‘AND’. There was no restriction on language or published date, however, we only found documents written in English. The search string: ALL= (technology-delivered intervention* OR digital intervention OR mHealth OR mobile health OR text messaging OR digital health OR SMS intervention OR text messaging) AND ALL= (linkage to care* OR link to care OR connect to care OR connect to services OR connect to care OR connect4care OR link to treat OR connect to treat OR follow up to services OR follow-up to care) AND ALL= (HIV* OR Human immunodeficiency virus) AND ALL= (HIV self-testing* OR self-test OR home testing OR home test)

Study selection

All initially identified articles from the Web of Science (WoS) database were exported in excel file for initial cleaning. Title and abstract screening were conducted to make sure each article was double-checked. After the title and abstract screening, the remaining articles were subject to full text screening for eligibility based on the inclusion criteria.

Eligibility criteria, Data extraction, and presentation

The criteria for including and excluding research papers for the reviews are presented in Table 1. The research studies have only been included if those conditions are met. A data extraction tabula form was used to abstract and record data from the eligible documents. The author conducted data extraction and double-checked the entered data to ensure completeness and accuracy.

Table 1

Condition for selecting research paper.
Access type	Subject Area	Publication Year	Language
Open access	Infectious Diseases	2011	English
Others	Public Environmental Occupational Health	2012
	Health Care Sciences Services	2013
	Immunology	2014
	Medical Informatics	2015
	Multidisciplinary Sciences	2016
	Medicine General Internal	2017
	Medicine Research Experimental	2018
	Social Sciences Biomedical	2019
	Virology	2020
	Respiratory System	2021
	Health Policy Services	2022
	Psychology Multidisciplinary
	Substance Abuse
	Tropical Medicine
	Audiology Speech Language Pathology
	Education Educational Research
	Microbiology
	Oncology
	Otorhinolaryngology
	Pediatrics
	Psychiatry

Sampling

Figure 1 presents the PRISMA diagram which depicts the flow of information recorded through difference phase of this systematic review. It shows the records identified through the database searching, the records excluded, and the records included for analysis.

The publications on digital intervention (mHealth, eHealth, mobile health, text messages, text messaging, online, digital health), HIV self-testing (self-testers, home testers) and linkage to care (connect to care, connect4care, link to treat, linkage to treatment, follow-up services) analyzed in this study were 91 published between 2011 to 2022. In the sections below, the key findings from the bibliometric analysis are presented and discussed. Presentation and discussion are provided by considering different aspects which includes; the main information, article production, authors, sources, affiliation, documents and word cloud. The results of the analysis are shown below.

Main Information

Table 2 shows the primary information about the dataset extracted from WoS containing papers dealing with digital intervention, HIVST and linkage to care. The table shows a range of interesting information. For example, we can see that the most documents are articles (91, in which 79 are articles and 12 are reviews), that is, 86.8% of all documents identified. We can also see that the first paper published on digital intervention, HIV self-testing and linkage to care dates to 2011. Table 2also shows that the annual growth rate is 24.36% and a total of 718 authors contributed in the production of documents, however, there was no authors of single-authored docs.

Table 2

Main information of document published in the WoS database
Description	Results
Timespan	2011–2022
Sources (Journals, Books, etc.)	41
Documents	91
Annual Growth Rate %	24.36
Document Average Age	3.56
Average citations per doc	25.73
References	1
DOCUMENT CONTENTS
Keywords Plus (ID)	256
Author's Keywords (DE)	239
AUTHORS
Authors	718
Authors of single-authored docs	0
AUTHORS COLLABORATION
Single-authored docs	0
Co-Authors per Doc	9.46
International co-authorships %	62.64
DOCUMENT TYPES
article	79
review	12

Scientific production

Table 3 and Fig. 2presents the yearly scientific production of documents on digital intervention, HIV self-testing, and linkage to care. From the table we can see that the first paper published on the area in the WoS database dates to 2011 with only 1 published article. The year 2021 recorded the highest number of published articles with 17 published articles. However, by the 10th of December 2022, the WoS database had already recorded 11 documents published on digital intervention, HIV self-testing and linkage to care accounting for this year.

Table 3

Annual scientific production
Year	Articles
2011	1
2012	2
2013	5
2014	3
2015	9
2016	5
2017	4
2018	6
2019	14
2020	14
2021	17
2022	11

Countries scientific production

Table 4 and Fig. 3shows the countries scientific production on digital intervention, HIV self-testing and linkage to care published in the WoS database. We can see that the United States is leading with 197 documents, followed by South Africa with 63 documents. The United Kingdom (UK) is in third position with 52 documents and CHINA is in fourth with 37 documents published. East African countries, Kenya and Uganda are in the top 10 list of countries top scientific production with 16 and 14 published articles respectively.

Table 4

Countries top scientific production
SN	Region	Freq
1	USA	197
2	SOUTH AFRICA	63
3	UK	52
4	CHINA	37
5	CANADA	26
6	SWITZERLAND	22
7	KENYA	16
8	UGANDA	14
9	BRAZIL	10
10	ZIMBABWE	9

Authors

Top authors

Regarding the top authors in relation to numbers of articles, Table 5shows the classification of the 10 most relevant authors on digital intervention, HIV self-testing and linkage to care published in the WoS database. We can see that Tang W, M lead the race with 5 published articles. Other authors produced less than 5 articles by 10th December, 2022.

Table 5

Most relevant authors
SN	Authors	Articles	Articles Fractionalized
1	TANG WM	5	0.38
2	FORD N	4	0.50
3	OPERARIO D	4	0.47
4	SHAHMANESH M	4	0.37
5	THIRUMURTHY H	4	0.37
6	TUCKER JD	4	0.39
7	BACHANAS P	3	0.24
8	BUKUSI EA	3	0.22
9	CHARLEBOIS ED	3	0.22
10	CHIDARIKIRE T	3	0.20

Authors local impact

Regarding the author's local impact, Table 6shows that FORD N is leading the race with 554 Total Citation (TC) and 4 articles that have received 4 citations. SHAHMANESH M is in the second position with 72 total citations with 4 articles that have received 4 citations. EGGEL N is in the third position with 70 total citations and 3 articles that have received 3 citations.

Table 6

Author Local Impact
SN	Element	h_index	g_index	m_index	TC	NP	PY_start
1	FORD N	4	4	0.4	554	4	2013
2	SHAHMANESH M	4	4	0.571	72	4	2016
3	ENGEL N	3	3	0.3	70	3	2013
4	GOVINDASAMY D	3	3	0.273	288	3	2012
5	HIGHTOW-WEIDMAN L	3	3	0.333	73	3	2014
6	KLAUSNER JD	3	3	1	18	3	2020
7	KRANZER K	3	3	0.273	288	3	2012
8	OPERARIO D	3	4	0.5	79	4	2017
9	PAI NP	3	3	0.3	81	3	2013
10	SEELEY J	3	3	0.75	43	3	2019

Affiliations

Top most affiliations

Regarding the topmost relevant affiliations Table 7 and Fig. 4shows that London School of Hygiene and Tropical Medicine is leading with 20 articles published followed by University of Washington with 19 and University of California is in the third position with 15 articles published. The most relevant affiliations in Africa are the University of Witwatersrand with 14 articles in the fourth position and University of Cape Town with 12 articles in the firth position.

Table 7

Most relevant affiliations
SN	Affiliation	Articles
1	LONDON SCH HYG AND TROP MED	20
2	UNIV WASHINGTON	19
3	UNIV CALIF SAN FRANCISCO	15
4	UNIV WITWATERSRAND	14
5	UNIV CAPE TOWN	12
6	UNIV N CAROLINA	12
7	MCGILL UNIV	11
8	BROWN UNIV	9
9	EMORY UNIV	8
10	YALE UNIV	8

Top 10 cited countries

Regarding the top 10 most cited countries, Table 8 and Fig. 5points out that the USA comes first with the highest total citations count (1089 and average article citation of 26.56), followed by Switzerland with 399 TC and 99.75 average article citation and South Africa in the third position with 378 TC and 31.50 average article citation. The United Kingdom is in fourth position with 160 TC and 20.00 average article citations followed by Canada with 152 TC and 25.33 average article citations. Other countries have less than 100 TC.

Table 8

Top 10 most cited countries
SN	Country	TC	Average Article Citations
1	USA	1089	26.56
2	SWITZERLAND	399	99.75
3	SOUTH AFRICA	378	31.50
4	UNITED KINGDOM	160	20.00
5	CANADA	152	25.33
6	CHINA	66	7.33
7	ZAMBIA	40	20.00
8	KAZAKHSTAN	23	23.00
9	FRANCE	19	19.00
10	GHANA	10	10.00

Documents

Most global cited documents

Regarding the most global cited documents, Table 9shows that SHARMA M, 2015, NATURE is leading with 328 Total citations, 41.00 TC /yr and 4.69 normalized TC, followed by SUTHAR AB, 2013, PLOS MED with 274 TC, 27.40 TC/yr and 2.82 normalized TC. GOVUBDASAMY D, 2014, J INT AIDS SOC is in the third position with 179 TC, 19.89 TC/yr and 1.93 normalized TC followed by CHAMIE G, 2016, LANCET HIV in the fourth place with 108 TC, 15.43 TC/yr and 2.21 normalized TC. Other documents have received less than 100 TC.

Table 9

Most Global Cited Documents
SN	Paper	DOI	Total Citations	TC per Year	Normalized TC
1	SHARMA M, 2015, NATURE	10.1038/nature16044	328	41.00	4.69
2	SUTHAR AB, 2013, PLOS MED	10.1371/journal.pmed.1001496	274	27.40	2.82
3	GOVINDASAMY D, 2014, J INT AIDS SOC	10.7448/IAS.17.1.19032	179	19.89	1.93
4	CHAMIE G, 2016, LANCET HIV	10.1016/S2352-3018(15)00251-9	108	15.43	2.21
5	SCANLON ML, 2013, HIV AIDS-RES PALLIAT	10.2147/HIV.S28912	96	9.60	0.99
6	GOVINDASAMY D, 2015, J INT AIDS SOC	10.7448/IAS.18.1.20182	82	10.25	1.17
7	LABHARDT ND, 2014, PLOS MED	10.1371/journal.pmed.1001768	69	7.67	0.74
8	RICE E, 2011, J URBAN HEALTH	10.1007/s11524-011-9624-z	65	5.42	1.00
9	MBUAGBAW L, 2015, AIDS PATIENT CARE ST	10.1089/apc.2014.0308	63	7.88	0.90
10	PAI NP, 2013, PLOS ONE	10.1371/journal.pone.0079772	54	5.40	0.56

Keywords analysis

Keyword analysis contributes to the identification of topics in a particular field. This section performs co-occurrence analysis, burst detection of most frequent words and identification of research hotspots, frontier and trends.

Most Frequent Word

Regarding the most frequent words Table 10 and Fig. 6 presents the word cloud related to digital intervention, HIV self-testing and linkage to care. The figures highlight the most frequent keywords used by authors in their publications, the word with the highest number of occurrences being men (21), followed by antiretroviral therapy (16) and care (16). This illustrates the importance of care and antiretroviral therapy in the field of HIV testing. It is surprising to notice that “linkage” is only ranked 10th with 9 occurrences. This shows how linkage to care is problematic in the HIV prevention field.

Table 10

Most frequent word
SN	Terms	Frequency
1	men	20
2	antiretroviral therapy	19
3	care	19
4	prevention	16
5	infection	15
6	sex	14
7	risk	11
8	South-Africa	10
9	acceptability	9
10	linkage	9

Trend Topics

Regarding the trend topics, Fig. 7 shows the top 5 trend topics as the most frequent keywords are antiretroviral therapy, care, men, prevention, infection and sex.

Co - Occurrence Analysis

The co-occurrence analysis facilitates understanding of research hotspots in a particular field. The co-occurrence network of key words is shown in Fig. 8 (a & b). The nodes represent keywords, and two nodes connected means that both keywords appear in the same publication. The larger the node the more frequent the keyword appears. The wider the link, the higher the number of keyword co-occurrences. The 47 keywords are divided into 4 clusters distinguished by different colors. It can be seen that “antiretroviral therapy”, “adherence” and “care”, etc. belong to cluster 1 (Red). Cluster 2 (Green) has “hiv”, “intervention”, “mhealth”, “mobile phone”, and “technology”. Cluster 3 (Blue) has “acceptability”, “health”, “prevalence” and “risk”. Cluster 4 (Yellow) has “feasibility”, “sex”, “self-testing”, “home” and “men”. The co-occurrence overlay of keywords in different clusters, and average publication year of the keyword determines its color shade. The darker the color, the earlier the year of publication.

Collaboration

As it clearly appears in Figs. 9 and 10 below, the strongest collaboration is being nurtured by USA scholars, who establish links with their counterparts in various countries in the world (see also “appendix"). Besides, we recognize that countries from Sub-Saharan Africa have few international collaborations.

Sources

Top 10 most relevant sources

The distribution of the top 10 most relevant sources and sources growth dynamics on the area is displayed in Table 11. It is clearly appearing that the PLOS ONE is topping the list with 7 publications followed by BMC Public health and Journal of Medical Internet Research with 6 publications each. JAIDS -Journal of Acquired Immune Deficiency Syndromes and TRIALS both published 5 articles followed by JMIR Research Protocols in sixth position with 4 publications.

Table 11

Top 10 most relevant sources
SN	Sources	Articles
1	PLOS ONE	7
2	BMC PUBLIC HEALTH	6
3	JOURNAL OF MEDICAL INTERNET RESEARCH	6
4	JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES	5
5	TRIALS	5
6	JMIR RESEARCH PROTOCOLS	4
7	AIDS AND BEHAVIOR	3
8	AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV	3
9	BMJ GLOBAL HEALTH	3
10	CURRENT HIV/AIDS REPORTS	3

Source Local Impact

Table 12 shows the sources impacts on digital intervention, HIV self-testing and linkage to care publications. The source impact is measured by h-index frequencies which measures quantity with quality by comparing publication to citations. JMIR Research Protocols is leading with h-index of 4, and 49 Total citations, followed by the Journal of Medical Internet Research with h-index of 4, and 87 TC and PLOS ONE in the third position with h-index of 4 and 115 TC.

Table 12

Source Impact
SN	Element	h_index	g_index	m_index	TC	NP	PY_start
1	JMIR RESEARCH PROTOCOLS	4	4	0.667	49	4	2017
2	JOURNAL OF MEDICAL INTERNET RESEARCH	4	5	0.4	87	5	2013
3	PLOS ONE	4	5	0.4	115	5	2013
4	AIDS AND BEHAVIOR	3	3	0.375	85	3	2015
5	AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV	3	3	0.375	50	3	2015
6	BMC PUBLIC HEALTH	3	6	0.429	70	6	2016
7	JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES	3	4	0.273	66	4	2012
8	JOURNAL OF THE INTERNATIONAL AIDS SOCIETY	3	3	0.333	266	3	2014
9	TRIALS	3	4	0.75	22	4	2019
10	BMJ GLOBAL HEALTH	2	3	1	9	3	2021

Sources growth and dynamics

Table 13 presents the sources growth and dynamics on digital intervention, HIV self-testing and linkage to care published in the WoS database. A list of 5 journals were identified with the most important growth, namely: PLOS ONE, BMC Public Health, JMIR, JAIDS and TRIALS. A total of 63 articles were published in the listed journals for the last 10 years. A significant growth is observed for the PLOS ONE with a total of 18 articles (28.6% growth rate), followed by JAIDS with 15 articles (23.8% growth rate) by 10th December 2022.

Table 13

Source growth impact
Year	PLOS ONE	BMC PUBLIC HEALTH	JOURNAL OF MEDICAL INTERNET RESEARCH	JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES	TRIALS
2011	0	0	0	0	0
2012	0	0	0	1	0
2013	1	0	1	1	0
2014	1	0	1	1	0
2015	1	0	1	1	0
2016	1	1	1	2	0
2017	2	1	1	2	0
2018	3	2	2	2	0
2019	4	3	3	2	1
2020	5	4	4	3	4

The use of digital platforms in enhancing HIV testing and prevention witnessed considerable attention in recent years. As a result, growth in literature on the topic is evident. To consolidate the disjoined knowledge base, explore knowledge trajectories, key research clusters and opportunities for future research, we applied a bibliometric analysis. In this study, bibliometric indicators of literature in digital intervention, HIVST and linkage to care services were sought. Literature in digital intervention, m-health, HIVST and linkage to care were dominated by multi-authored publications. Data presented in this study indicated that patterns of authorship showed an increasing pattern of number of authors per document with time. This might be due to the nature of digital intervention, m-health and technology field which included two disciplines, digital intervention and health, and therefore, might require authors from different disciplines. Furthermore, the availability of diverse means of communication among researchers in different world regions made team research and collaboration easier and more practical which reflected positively on the prevalence of multi-authored publications seen in our study.

Digital intervention in health had witnessed rapid spread in developed countries where technology and a prosperous economy helped in developing healthcare services though most -up-to date technology. The advancement in technology and introduction of health applications through smartphones and other mobile technologies will increase the burden on healthcare providers. The power of technology in advancing health service should encourage governments, organizations, and individuals to invest in technology for better health services.

Contributions

This work provides essential insights for practitioners, scholars, decision-makers, and policy makers involved in the digital transformation and HIV self-testing and linkage to care fields, by carefully investigating the literature, insights into the research dynamics the fields of digital transformation, HIV self-testing and linkage to care over the years were identified. Regarding the contribution for practice, this analysis showed that the ten most relevant affiliations on the digital transformation, HIV self-testing and linkage to care very few are from the most disaster-prone regions and most less developed countries. From the academic contributions, the study results showed that digital intervention, HIV self-testing and linkage to care keeps as a hot topic, and the needs of more works from emerging economies like Africa countries is fundamental to an in-depth understanding of the particularities of each country. Besides, by the identification of two clusters, this study gives powerful insights to scholars about the most promising areas in the digital transformation and HIV self-testing.

The main objective of this paper was to provide a holistic view of the development of the digital transformation in HIV self-testing and linkage to care field. To achieve this aim, bibliometric analysis of digital intervention, HIV self-testing and linkage to care related data were extracted from the Web of Science (WoS) database. The key insights presented included the following: (1) the most productive authors, institutions, and countries in digital intervention and HIV self-testing (2) the most cited authors, countries and journals outlets in the area. For example, the study found that most of digital transformation and HIV self-testing documents extracted from WoS were (79 articles, 12 reviews). Therefore, future research may consider diversifying the nature and portfolio of documents dealing with digital intervention, HIV self-testing, and linkage to care by including case studies and teaching cases for example.

Compared to other fields, and based on the data collected from the WoS, digital transformation and HIV self-testing is a relatively new field, as the first paper published on the topic only dates to 2011, as shown by the WoS database. However, the number of relevant documents published since then (17 documents in 2021 and only 11 by 10th December 2022) in the WoS database is eloquent proof that the field is very new and attracting a great number of researchers and scholars.

HIV Human Immune Virus

HIVST Human Immune Virus Self Testing

WoS Web of Science

WHO World Health Organization

MSM Men Sex with Men

UNAIDS The Joint United Nations Programme on HIV/AIDS

AIDS Acquired Immune Deficiency Syndrome

UN United Nations

Ethics approval and consent to participate

As a bibliometric study, no patients were involved in this type of analysis. Therefore, there was no need for institutional Review Boards approval, and it was exempted based upon the design of this study.

Consent for publication

Not applicable

Availability of data and materials

Data can be retrieved from Web of Science using search query presented in methodology.

Competing interests

The author declares that he has no competing interests.

Funding

D.F.C. was supported by the National Institute of Mental Health Grant (R00MH110343:PI Conserve) and the HIV Dissemination Science Training Program for Underrepresented Investigators from the National Institute on Drug Abuse of the National Institutes of Health under Award Number R25MH080665. G.H. was supported by the Minority Health International Research Training (MHIRT; Grant T37-MD001448) from the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD, USA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Authors contributions

F.M. and D.F.C. led the study design, data collection, statistical analysis, and drafting of the manuscript, G.H., M.N., L.I., K.O., and M.H. participate in the study design, and revised the article for important intellectual content. All authors read and approved the final manuscript and agreed on its submission.

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No competing interests reported.

AppendixCollaborationbetweencountries.docx