Distributing HIV self-tests online increases testing frequency in MSM
Distributing free HIV self-tests may be an effective way to increase testing frequency among men who have sex with men, according to results from a randomized clinical trial published in JAMA Internal Medicine.
“Getting an HIV test has never been quicker or easier than it is today,” Robin J. MacGowan, MPH, a research officer in the division of HIV/AIDS prevention at the CDC, told Healio Primary Care. “Yet, approximately 14% of people living with HIV in America don’t know they have it.”
“Self-testing is an important option for some people and in some situations — it saves time, offers privacy and reaches people who may not be able to or willing to access existing testing services,” he continued.
Researchers recruited participants through advertisements on social media, dating and music websites. The participants were directed to the study website and an eligibility screening survey. Men who indicated that they lived in the United States, had anal sex with a man in the last year, and were either HIV-negative or unaware of their HIV status were included in the study. Participants were required to create an online account with their contact information.
All men who were eligible for the study could receive up to $90 if they completed surveys at baseline, 3, 6, 9 and 12 months, returned a dried blood spot card and reported self-test results after the 12-month survey. Participants were randomly assigned in a 1:1 ratio to a control group or intervention group. Those in the intervention group were mailed two oral fluid HIV self-tests and two finger-stick whole blood HIV self-tests. After completing the surveys, participants in the intervention group had the option to order more HIV self-tests to replace any they used or gave away.
A total of 2,665 participants with a mean age of 30 years were included in analyses. Of those, 1,325 were randomly assigned to the self-test group and 1,340 were assigned to the control group.
Researchers mailed 8,654 self-tests to the intervention group, 52% of which were used by participants and 33.1% of which were given away and used by participants’ family, friends or other members of their social circles.
Participants in the intervention group reported more frequent HIV testing during the study period compared with those in the control group (mean number of tests, 5.3 vs. 1.5; P < .001). In addition, more participants in the intervention group reported that they were tested at least three times during the study period (76.6%) compared with those in the control group (22%).
More new cases of HIV were identified among participants who received self-tests compared with those who did not (25 of 1,325 [1.9%] vs. 11 of 1,340 [0.8%]; P = .02). The largest difference between new HIV cases in the groups was noted at 3 months (12 of 1,325 [0.9%] vs. 2 of 1,340 [0.1%]; P < .01).
Additionally, 34 new cases of HIV were identified in members of participants’ social circles who were given HIV self-tests by study participants.
“Our study found that gay and bisexual men who have never been tested will use HIV self-tests provided via the internet at no cost,” MacGowan said. “More than 16% of the participants in our study had never been tested for HIV before enrolling in the study. At the end of the 12-month trial, our analysis found that only 4% of those who received HIV self-tests and responded to a follow-up survey had not been tested.”
Julia M. Janssen, MD, a resident in the department of medicine at the University of California, San Francisco, and Mitchell H. Katz, MD, president and CEO of NYC Health and Hospitals, explained in an editor’s note that the findings demonstrated that “self-testing facilitates HIV testing in a high-risk population when tests are free and convenient; distribution of self-testing kits to social contacts via social networks provides another avenue for making testing more accessible and acceptable.”
"The self-testing kits targeting individuals at high risk of acquiring HIV complement the use of [pre-exposure prophylaxis], and are another way to accelerate the end of the epidemic,” they wrote – by Erin Michael
Disclosures: Katz reports receiving royalties for a chapter on HIV in Lange's Current Medicine and Diagnostic Testing. MacGowan reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.