Attitudes and Preferences Regarding the Use of Rapid Self-Testing for Sexually Transmitted Infections and HIV in San Diego Area Men Who Have Sex With Men

Abstract

Background Sexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake. Methods MSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test. Results HIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age <45 years more frequently citing inconvenience as a barrier to testing (HIV: 50.9% vs 17.4%, P = .010; STI: 58.3% vs 31.8%, P = .070). Conclusions Although additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach.

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

“…Many studies explored preference for HIVST compared with other testing modes. [54][55][56][57][58][59][60][61][62][63] Huang et al (2016) provided In a 2016 study of Black and Latino MSM who completed surveys before and after HIVST home delivery, 77% of respondents preferred or somewhat preferred HIVST compared to traditional clinic-based testing. 57 However, Freeman et al (2018) found that many participants saw HIVST mainly as an option to supplement but not replace their regular testing in clinics and overall preferred facility-based testing, and another study found social mediausing YMSM did not prefer HIVST over other testing options despite being generally favorable toward HIVST.…”

“…The convenience of HIVST compared to testing in facilities was a value described by participants of many studies included in this review. 55,56,[58][59][60][61][62][63][64][65][66][67][68][69][70] Through focus groups and qualitative interviews of MSM, Freeman et al 2018found that the convenience of purchasing an HIV test and having the test available when needed was valuable to participants. Hubbard et al (2020) also reported that 52% of participants in their study liked that using HIVST allowed them to test at their own convenience.…”

“…Several articles assessed participants' preferences for oral swab versus blood-based HIVST rapid tests among MSM. [60][61][62]71 These studies found mixed results when assessing preferences for oral swab versus fingerstick selftests should that form of testing become available for at-home rapid use. One study found participants favored oral-swab testing, but that reluctance to use blood-based HIVST was reduced if tests for other sexually transmitted infection could be included in the test.…”

“…56,58,59,61,69 One study observed that some participants preferred to test in a clinic if they thought they might be positive, although 64% of participants preferred to read test results alone. 56 Similarly, Cushman et al (2019) found that most MSM preferred HIVST to traditional clinic HIV testing but that while they preferred to receive negative results via website, text, or email, they want to receive positive results from a provider via phone or in person. 60 However, more self-control over testing, for some, meant being able to test more often which provides the opportunity for earlier detection and care initiation.…”

“…56 Similarly, Cushman et al (2019) found that most MSM preferred HIVST to traditional clinic HIV testing but that while they preferred to receive negative results via website, text, or email, they want to receive positive results from a provider via phone or in person. 60 However, more self-control over testing, for some, meant being able to test more often which provides the opportunity for earlier detection and care initiation. 61,66 Explicit access to post-HIVST counseling, support, and direct linkage to care was seen as essential for HIVST to work.…”