High acceptability of HIV self-testing in a randomized trial among transgender women and men who have sex with men, Myanmar

Wirtz, Andrea L; Naing, Soe; Mon, Sandra Hsu Hnin; Paing, Aung Zayar; Mon, Ei Khine; Thu, Kaung Htet; Truong, Jasmine; Jivapong, Belinda; Clouse, Emily; Baral, Stefan; Beyrer, Chris

doi:10.1080/09540121.2021.2005763

Cited by 9 publications

(22 citation statements)

References 22 publications

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“…Peer and community led approaches for HIVST have been successfully implemented among the key population in different parts of the world. Okoboi [18], Wirtz [19] and Adeagbo [20] have used this approach for HIVST distribution in Uganda, Myanmar and South Africa. In Pakistan, with additional training they can be capacitated to distribute HIVST kits in the community and support linkage.…”

Section: Plos Onementioning

confidence: 99%

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project

Altaf

Pasha

Majeed³

et al. 2022

PLoS ONE

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Background HIV self-testing (HIVST) is an innovative HIV testing approach that effectively reaches those who do not otherwise test, including key populations (KPs). Despite potential benefits, HIVST is not currently implemented in Pakistan. The high risk of HIV among transgender (TGs) persons is among the highest risk group for HIV in Pakistan, yet knowledge of HIV status remains low in this key population group. We conducted a pilot project to assess the acceptability and feasibility of distributing HIVST to TGs in Larkana. Methods Eligible participants were 18 years or above and self-identified as transgender (“hijra”). One oral fluid HIVST kit per person was distributed free of cost in the community by trained transgender peer outreach workers (ORW). Participants could request a demonstration of the HIVST procedure before performing self-testing which was provided by the trained ORW. Demographic characteristics of participants were collected. The ORW followed up with phone calls two days later to record if HIVST kits were used, the results, and whether assistance was required. Results Between November 2020 and February 2021, 150 HIVST kits were distributed to eligible TGs. The average age of participants was 25.5 years (standard deviation: 7.0). Over a third (52, 34.7%) had no formal education, while (16, 10.6%) had attended at least five years of schooling. Over one-third (58, 38.6%) of participants were first-time testers. One hundred and thirty-nine (92.7%) participants reported their results within two days. For the remaining 11 participants, ORWs had to contact them. All participants reported using HIVST kits within three days. A majority (141, 94%) used the kit in their homes, and the remaining nine (6%) used it at the community-based organization’s office. Overall, a small proportion (11, 7.3%) of participants requested a demonstration of the test procedure before performing HIVST. Four (2.7%) participants who had performed unsupervised self-tests reported reactive HIVST results; all were linked to treatment within five working days once their HIV result was confirmed. The majority (136, 90.6%) of participants felt that self-testing was easy to perform independently, and 143 (95%) reported that they would recommend HIVST to their peers. Conclusion HIVST is acceptable among TGs and identified by first-time testers as undiagnosed infections. Peer-led distribution appears to be a feasible approach for implementation in this setting. HIVST should be considered for routine implementation and scale up to reduce testing gaps among Pakistan’s key population, particularly TGs.

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Section: Plos Onementioning

confidence: 99%

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project

Altaf

Pasha

Majeed³

et al. 2022

PLoS ONE

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“…Of the eight studies, seven were conducted in high-income countries (HICs): four in the USA [13][14][15][16], two in Australia [17,18], and one in Hong Kong [19]. One was conducted in a low-middle-income country (LMIC) in Myanmar [20]. The characteristics of the included RCTs are shown in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…All studies compared HIVST with standard HTS. The HIVST kits were either distributed at the study site (n = 4) [13,17,18,20] or mailed (n = 3) [14,16,19] to the participants. In one study, the participants were provided with a weblink to purchase the kits online [15].…”

Section: Resultsmentioning

confidence: 99%

“…All the five RCTs showed an increase in the uptake of HIV testing, which was statistically significant (p-value = 0.0005) (Figure 3). Wirtz et al [20] reported a 76% increase in testing rates across both arms, relative to baseline lifetime HIV testing history. In the study by Wang et al [19], high uptake of any type of HIV testing was reported in the HIVST group at month 6 (89.8% versus 50.7%; RR = 1.77; 95% CI = 1.54, 2.03; NNT = 2.56; 95% CI = 2.13, 3.20; p = 0.001).…”

Section: Uptake Of Hiv Testingmentioning

confidence: 98%

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Comparing the Effects of Oral HIV Self-Testing With Those of Standard HIV Testing for Men Who Have Sex With Men (MSM): A Systematic Review and Meta-Analysis

Vashisht¹,

Jha²,

Thakur³

et al. 2022

Cureus

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The WHO recommends HIV self-testing (HIVST) as an innovative strategy and an additional testing approach to attain UNAIDS targets to end HIV by 2030. HIVST is a process whereby a person collects his or her own specimen (either oral fluid or blood), performs an HIV test, and interprets the result. It has been described as a discreet and convenient way to reach the hidden, unreached key populations (KPs) who do not know their HIV status or do not get tested. Among the KPs, men who have sex with men (MSM) is one such group that by far remains hidden due to feared stigma and discrimination associated both with their sexuality and HIV. Fear of pain and blood while HIV testing also deters MSM from getting tested. In this review, we assessed the effect of oral HIVST on the uptake and frequency of testing and risk behavior as compared to standard HIV testing.For this review, we systematically searched various electronic databases for clinical trials comparing HIVST to standard HIV testing from January 1, 2011, to December 31, 2021. A meta-analysis of studies was conducted using a random-effects model for relative risks (RRs) and 95% confidence intervals (CIs). The protocol was registered with PROSPERO, and PRISMA guidelines for systematic reviews and meta-analyses were followed. The quality of the clinical trials was assessed using Cochrane's risk of bias tool version 2.0 (RoB 2.0).We identified eight studies comparing HIVST to standard HIV testing services (HTSs). The eight randomized controlled trials (RCTs) enrolled 5,297 participants, of which 5,212 were MSM and 85 were transgender (TG) women. Seven RCTs were conducted in high-income countries (HICs): four in the USA, two in Australia, and one in Hong Kong. One was conducted in a low-middle-income country (LMIC) in Myanmar. In all the studies, HIVST intervention was provided with oral HIVST kits, except for one study in which both bloodbased and oral HIVST kits were used. Meta-analysis (five RCTs) showed that HIVST increased the uptake of HIV testing by 1.43 times compared to standard of care (SoC) (RR = 1.43; 95% CI = 1.25, 1.64). Meta-analysis (four RCTs) found that HIVST increased the mean number of HIV tests by 2.34 during follow-up (mean difference = 2.34; 95% CI = 1.66, 3.02). Meta-analysis (four RCTs) showed that HIVST doubled the detection of new HIV infections among those tested (RR = 2.10; 95% CI = 1.35, 3.28) and reported higher repeat testing as compared to the control arm (RR = 2.04; 95% CI = 1.22, 3.42). A meta-analysis of three trials found no significant difference in risk behavior in respect of condomless anal intercourse (CAI) (odds ratio (OR) = 0.90; 95% CI = 0.67, 1.22) and multiple male partnership (RR = 0.89; 95% CI = 0.83, 0.94).Oral HIVST could increase the HIV testing and detection of new HIV infections among MSM who may not otherwise test, as compared to standard testing services alone. However, further research from low-middleincome countries is required for generalizability.

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“…HIV self-testing (HIVST) has emerged as a promising strategy to reduce the gap between HIV acquisition and diagnosis, particularly in vulnerable and hard-to-reach populations, by overcoming structural and individual barriers such as stigma and discrimination. 4–7 Between 2015 and 2021, a study in Yangon among TGW and men who have sex with men (MSM) 8 found that HIVST was highly acceptable due to its practicality, privacy and convenience, while similar findings were found among the same populations in the United States, Puerto Rico, 9 and Cambodia. 10 According to a recent meta-analysis, HIVST increased the mean number of HIV tests by 2.56 over follow-up among female sex workers, MSM and a small number of TGW.…”

Section: Introductionmentioning

confidence: 98%

“If I’m at home, I do it at home”: Qualitative study on HIV self-testing among transgender women in Argentina

et al. 2022

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Background Evidence among key populations supports acceptability of HIV self-testing (HIVST) due to its privacy and convenience. However, insufficient research has been done among transgender women (TGW), especially in Latin America. Consequently, the aim of this study was to explore the acceptability, perceptions and recommendations for HIVST implementation among TGW in Buenos Aires. Methods A focus group was conducted in July 2019. Particpants were invited to touch and learn about a displayed HIVST kit. The following main topics were explored: acceptability, reasons for seeking self-testing, preferences for training, distribution, periodicity and recommendations for HIVST implementation. Results The sample consisted of 12 TGWs; mean age of 26 years (IQR = 22–28); 66% had history of sex-work. The main motivations for seeking HIVST were convenience, privacy, and usage to reduce stigma and discrimination by health-care providers. Recommendations for HIVST were: distribution from primary health centers and trans-sensitive centers; affordable price; assistance by peer health promoters; and the provision of clear written and video instructions. Conclusions Tailored implementation of HIVST can increase HIV testing rates, early detection, and linkage to HIV-care in this high-prevalence group. This study provided community-driven suggestions to inform and adapt an HIVST feasibility pilot study and future implementation in Argentina.

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High acceptability of HIV self-testing in a randomized trial among transgender women and men who have sex with men, Myanmar

Cited by 9 publications

References 22 publications

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project

Comparing the Effects of Oral HIV Self-Testing With Those of Standard HIV Testing for Men Who Have Sex With Men (MSM): A Systematic Review and Meta-Analysis

“If I’m at home, I do it at home”: Qualitative study on HIV self-testing among transgender women in Argentina

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