HIV Self-Testing Increases HIV Testing Frequency in High-Risk Men Who Have Sex With Men: A Randomized Controlled Trial

Katz, David A.; Golden, Matthew R.; Hughes, James P.; Farquhar, Carey; Stekler, Joanne D.

doi:10.1097/qai.0000000000001709

Cited by 141 publications

(180 citation statements)

References 48 publications

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“…This qualitative study demonstrates the potential for HIVST to increase testing frequency for frequent and infrequent testers, in line with existing RCT evidence [26,27]. Infrequent testers may access sexual health clinics less often, however, potentially reducing STI testing in this group, also consistent with existing evidence from the USA but contradicting an Australian study [26,27].…”

Section: Discussionsupporting

confidence: 80%

HIV self‐testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales

et al. 2019

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Objectives SELPHI (HIV Self‐Testing Public Health Intervention) is the largest randomized controlled trial (RCT) of HIV self‐testing (HIVST) in a high‐income setting to date, and has recruited 10 000 men who have sex with men (cis‐ and transgender) and transgender women who have sex with men. This qualitative substudy aimed to explore how those utilizing self‐tests experience HIVST and the implications for further intervention development and scale‐up. This is the first qualitative study in Europe investigating experiences of HIVST among intervention users, and the first globally examining the experience of using blood‐based HIVST. Methods Thirty‐seven cisgender MSM SELPHI participants from across England and Wales were purposively recruited to the substudy, in which semi‐structured interviews were used to explore testing history, HIVST experiences and intervention preferences. Interviews were audio‐recorded, transcribed and analysed through a framework analysis. Results Men accessed the intervention because HIVST reduced barriers related to convenience, stigma and privacy concerns. Emotional responses had direct links to acceptability. Supportive intervention components increased engagement with testing and addressed supportive concerns. HIVST facilitated more frequent testing, with the potential to reduce sexually transmitted infection (STI) screening frequency. Substudy participants with an HIV‐positive result (n = 2) linked to care promptly and reported very high acceptability. Minor adverse outcomes (n = 2; relationship discord and fainting) did not reduce acceptability. Ease of use difficulties were with the lancet and the test processing stage. Conclusions Intervention components shaped acceptability, particularly in relation to overcoming a perceived lack of support. The intervention was broadly acceptable and usable; participants expressed an unexpected degree of enthusiasm for HIVST, including those with HIV‐positive results and individuals with minor adverse outcomes.

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Section: Discussionsupporting

confidence: 80%

HIV self‐testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales

et al. 2019

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“…Study was completed at 12 months.OraQuickUnassisted: Provided HIVST kit with manufacturer instructions, as well as a video link and 24 hr hotline. HIVST kits were also labelled with stickers with local information and resources to access support and for emergenciesKatz et al, 2015 [34] USAHigh-risk MSM (n = 230)HIV-negative men >18 years of age who could speak English and had a stable home or mailing address reporting >1 event of CAI with partners of discordant or unknown HIV status, a STI, methamphetamine/popper use, or ≥10 male oral or anal sex partners in the past yearRCT: Men were randomized (1:1) to free HIVST or to standard facility-based testing. All participants were told quarterly HIV testing is recommended, informed about acute HIV infection, given a calendar marked with test dates and were offered reminders to test.…”

Section: Resultsmentioning

confidence: 99%

Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis

Johnson

Kennedy

Fonner

et al. 2017

Journal of the International AIDS Society

326

319

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Introduction: HIV self-testing (HIVST) is a discreet and convenient way to reach people with HIV who do not know their status, including many who may not otherwise test. To inform World Health Organization (WHO) guidance, we assessed the effect of HIVST on uptake and frequency of testing, as well as identification of HIV-positive persons, linkage to care, social harm, and risk behaviour.Methods: We systematically searched for studies comparing HIVST to standard HIV testing until 1 June 2016. Meta-analyses of studies reporting comparable outcomes were conducted using a random-effects model for relative risks (RR) and 95% confidence intervals. The quality of evidence was evaluated using GRADE.Results: After screening 638 citations, we identified five randomized controlled trials (RCTs) comparing HIVST to standard HIV testing services among 4,145 total participants from four countries. All offered free oral-fluid rapid tests for HIVST and were among men. Meta-analysis of three RCTs showed HIVST doubled uptake of testing among men (RR = 2.12; 95% CI: 1.51, 2.98). Meta-analysis of two RCTs among men who have sex with men showed frequency of testing nearly doubled (Rate ratio = 1.88; 95% CI: 1.17; 3.01), resulting in two more tests in a 12–15-month period (Mean difference = 2.13; 95% CI: 1.59, 2.66). Meta-analysis of two RCTs showed HIVST also doubled the likelihood of an HIV-positive diagnosis (RR = 2.02; 95% CI: 0.37, 10.76, 5.32). Across all RCTs, there was no indication of harm attributable to HIVST and potential increases in risk-taking behaviour appeared to be minimal.Conclusions: HIVST is associated with increased uptake and frequency of testing in RCTs. Such increases, particularly among those at risk who may not otherwise test, will likely identify more HIV-positive individuals as compared to standard testing services alone. However, further research on how to support linkage to confirmatory testing, prevention, treatment and care services is needed. WHO now recommends HIVST as an additional HIV testing approach.

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“…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%

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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HIV Self-Testing Increases HIV Testing Frequency in High-Risk Men Who Have Sex With Men: A Randomized Controlled Trial

Abstract: Access to free HIV self-testing increased testing frequency among high-risk men who have sex with men and did not impact sexual behavior or STI acquisition.

Cited by 141 publications

References 48 publications

HIV self‐testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales

HIV self‐testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales

Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis

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

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