Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men

MacGowan, Robin J.; Chavez, Pollyanna R; Borkowf, Craig B.; Owen, S. Michele; Purcell, David W.; Mermin, Jonathan; Sullivan, Patrick S.

doi:10.1001/jamainternmed.2019.5222

Cited by 111 publications

(182 citation statements)

References 24 publications

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“…Second, all HIV self‐testing and clinic based testing information was based on participants' reporting their HIV test results online or by phone to study staff. We assumed the reported HIV‐positive test result was a new diagnosis unless subsequent, confirmatory testing indicated a false‐positive result . We were unable to confirm all reported positive test results; thus the number of new HIV diagnoses in our analysis could be lower and the ICER higher than those reported in the base case (Figure ).…”

Section: Discussionmentioning

confidence: 88%

“…The participants could report their self‐test results online through the study website or by phone. A participant who reported a preliminary positive self‐test result was considered to have a new diagnosis unless subsequent, confirmatory testing indicated a false‐positive result . All study participants and social network associates who used the study HIV self‐tests were able to call a toll‐free hotline to talk with a counsellor from 9 AM to 5 PM Eastern Time, Monday–Friday, and a toll‐free crisis line after‐hours and on weekends.…”

Section: Methodsmentioning

confidence: 99%

“…Participants assigned to the control arm were given access to the eSTAMP website with a link to AIDSVu.org, and they were not given self‐tests by the eSTAMP study. Details on the trial protocol are reported elsewhere .…”

Section: Methodsmentioning

confidence: 99%

“…The World Health Organization strongly recommended that HIV self‐testing be offered as an additional approach to clinical and targeted HIV testing services . In the United States, MSM reported a high willingness to use HIV self‐tests , and using self‐tests results in increased screening and awareness of HIV status . However, the cost‐effectiveness of this strategy for MSM has not been established.…”

Section: Introductionmentioning

confidence: 99%

“…To assess the feasibility and potential benefits of HIV self‐testing among MSM, CDC sponsored a nationwide randomized controlled trial (RCT), Evaluation of Rapid HIV Self‐Testing among MSM Project (eSTAMP: NCT02067039), in the United States . In this analysis, we use trial expenditure data to estimate the cost and cost‐effectiveness of delivering a self‐testing programme, potentially by a health department or community‐based organization, in a non‐research setting .…”

Section: Introductionmentioning

confidence: 99%

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Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Shrestha

Chavez

Noble³

et al. 2020

J Intern AIDS Soc

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Introduction HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre‐exposure prophylaxis. Internet distribution of HIV self‐tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost‐effectiveness of a self‐testing programme. Methods Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12‐month trial of HIV self‐testing in the United States. Participants were randomly assigned either to the self‐testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self‐testing participants received up to four self‐tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow‐up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self‐testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self‐test completed, cost per person tested, cost per new HIV diagnosis among those self‐tested and cost per quality adjusted life year (QALY) saved. Results A total of 2665 men were assigned either to the self‐testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self‐testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self‐testing participants additionally distributed 2864 self‐tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self‐testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self‐testing programme was $449,510. The cost per self‐test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self‐testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. Conclusions The HIV self‐testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving.

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Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Shrestha

Chavez

Noble³

et al. 2020

J Intern AIDS Soc

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Ending the HIV Epidemic in the United States—The Roles of Increased Testing and Preexposure Prophylaxis

Janssen

Katz

2020

JAMA Intern Med

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Implementation of HIV Self-Testing Program in New York City—Reply

2020

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To the Editor In their recently published Original Investigation, McGowan and colleagues 1 reported findings from a randomized clinical trial that demonstrated that provision of HIV self-tests to internet-recruited men who have sex with men (MSM) increases HIV testing and diagnosis of infection. The authors recommend that HIV programs incorporate HIV selftest distribution to increase HIV diagnosis.Their findings align with the New York City (NYC) Health Department's programmatic experiences since 2015. HIV self-tests offer the opportunity to increase HIV status awareness by providing convenience, privacy, and the ability to access HIV testing in an environment free from stigma and discrimination. Building on evidence that NYC populations who might benefit from HIV self-tests would have challenges with the cost, 2 paired with concerns about availability and accessibility of HIV self-tests in local pharmacies, 3 we developed 2 programs to reach priority populations through distinct strategies: an online home test giveaway 4 and a community home test giveaway. 5 With community involvement, these 2 HIV self-test giveaway programs have engaged NYC priority populations: MSM, including black and/or Latino MSM; cisgender women, especially those who identify as black and/or Latina and live in high-poverty neighborhoods; transgender and gender-nonconforming individuals; and individuals who are unstably housed, experience transactional sex, experience intimate partner violence, share needles, or have HIVpositive partners. These programs distribute HIV self-tests through complementary mechanisms: online for MSM and transgender and gender-nonconforming individuals, and through community-based organization partnerships for all priority populations. Participants, community members, and health care providers express high levels of enthusiasm for these strategies.These NYC Health Department programs combined have distributed thousands of HIV self-tests to individuals in priority populations, many of whom reported never testing previously and some of whom reported receiving a positive test result that was subsequently confirmed. 4,5 Our experience suggests that by removing the barrier of cost and tailoring recruitment methods with community input, HIV self-test programs can engage individuals not reached by other testing programs. These strategies may be adapted to other jurisdictions to supplement routine testing and traditional outreach testing, thus further extending the findings presented by McGowan and colleagues 1 in support of national, state, and local efforts to end the HIV epidemic.

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Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men

Cited by 111 publications

References 24 publications

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Estimating the costs and cost‐effectiveness of HIV self‐testing among men who have sex with men, United States

Ending the HIV Epidemic in the United States—The Roles of Increased Testing and Preexposure Prophylaxis

Implementation of HIV Self-Testing Program in New York City—Reply

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