Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

Abstract

Background: Globally, trans people are disproportionately affected by HIV, but research on strategies to increase testing are limited. SELPHI is a randomised-controlled-trial (RCT) of 10,135 cis men, trans men, and trans women reporting lifetime anal intercourse with male partners (cis or trans), evaluating whether the offer of free HIV self-testing (HIVST) increases diagnosis. This subgroup analysis from the SELPHI RCT aims to describe key HIVST outcomes and HIVST acceptability for trans people. Methods: SELPHI recruited using social networking and trans focused social media. Participants were randomised 60/40 to baseline HIVST (Biosure TM) (BT) vs no baseline HIVST (nBT); and at 3-months (if completed the survey and reported recent CAI) 50/50 to 3-monthly HIVST (RT) vs no repeat HIVST (nRT). Outcomes were self-reported through online surveys. We conducted a qualitative study of semi-structured peer-led participant interviews (n = 20) exploring HIVST motivations and experiences. These were analysed using a framework approach. Findings: SELPHI recruited and randomised 118 trans men and trans women (94 trans men, 24 trans women), of whom 20 (16 trans men, 4 trans women) underwent the second randomisation. Median age at baseline was 29 (IQR: 22, 37), 79% were white, 79% were UK born, 37% had degree level education, and 31% had never tested for HIV. 62% (n = 59) of trans men completed the 3-month survey, but survey completion by trans women in nBT was too low (1/11) for randomised comparison. In trans men HIV testing uptake by 3 months was significantly higher in BT (95% 36/38) vs nBT (29%, 6/21) (RR=3.32 (1.68, 6.55) p<0.001). Trans people randomised to RT reported 3 times higher rate of HIV testing compared to nRT during the two-year followup (IRR 3.66 (1.86, 8.01) p<0.0001). STI testing frequency (mean number of tests during each 13 week period/ 2-year follow-up) was not significantly different across interventions: RT (0.03) and nRT (0.01) (IRR=1.86 95%CI; 0.77, 5.15; p = 0.15). Social harms were rare. Acceptability was very high in BT: 97% (38/39) found instructions easy to understand, 97% (37/38) found the HIVST simple to use and 100% (39/39) reported good overall experience. In interviews, reported HIVST benefits included increased autonomy, privacy, convenience and avoidance of health care providers perceived to be discriminatory and services that increased dysphoria. Minor lancet and test processing issues were reported. Interpretation: HIVST significantly increased testing uptake and frequency in trans men and trans people overall, although recruitment and retention of trans women was low. HIVST acceptability was high and indicates easy access to this novel technology may increase HIV testing access for this key population.

Outcomes of A Community-Led Web-Based HIV Self-Testing Demonstration Among Cisgender Men Who have Sex with Men and Transgender Women in the Philippines During the COVID-19 Pandemic: A Retrospective Cohort Study

“…In this study, we found that web-based HIVST have reached many rst-time testers similar with previous studies among cis-MSM and TGW [25][26][27][28][29]. Reporting and linkage to care and prevention rates were high but ART and PrEP initiation were sub-optimal.…”

“…Despite the inconsistencies, the anxiety regarding linkage to care and the desire for assistance have been reported among cis-MSM and TGW in the country [6], and other KP elsewhere [39]. Additionally, some transgender people have been documented to be needing some form of support during HIVST, mostly from social networks [29]. Secondly, while it may be intuitive that testing for the rst-time is associated with higher odds DAH, similar with previous studies [6, 23,40], it was the opposite in our bivariate model.…”

Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics

“…Most of the included studies had a quantitative descriptive design (n=28) [ 12 , 13 , 15 , 25 - 50 ]. In the remaining studies, a (quantitative) nonrandomized design was reported 6 times [ 32 , 51 - 55 ], a randomized controlled design was reported 5 times [ 56 - 60 ], a mixed methods design was reported 3 times [ 14 , 61 , 62 ], and a qualitative design was reported 3 times [ 63 - 65 ]. In 29 studies, a combination of services was offered; specifically, triage, testing, and a result service in 14 studies [ 13 , 28 , 40 , 42 , 46 , 49 , 51 - 53 , 56 , 57 , 59 , 60 , 63 ], triage and testing in 9 studies [ 26 , 27 , 29 - 33 , 35 , 37 ], and testing and a result service in 6 studies [ 41 , 44 , 45 , 48 , 61 , 64 ].…”

“…In 29 studies, a combination of services was offered; specifically, triage, testing, and a result service in 14 studies [ 13 , 28 , 40 , 42 , 46 , 49 , 51 - 53 , 56 , 57 , 59 , 60 , 63 ], triage and testing in 9 studies [ 26 , 27 , 29 - 33 , 35 , 37 ], and testing and a result service in 6 studies [ 41 , 44 , 45 , 48 , 61 , 64 ]. Furthermore, 8 studies discussed a testing service [ 14 , 25 , 34 , 38 , 43 , 47 , 58 , 62 ], 7 discussed a result service [ 15 , 35 , 39 , 50 , 54 , 55 , 65 ], and 1 discussed a triage service [ 12 ]. In the included studies, the testing service was evaluated most often (ie, 82% of the studies).…”

“…The sample size ranged from 102 to 1736, with a mean of 2205.90 (SD 3514.0) in the quantitative studies. Almost half of the studies included both men and women (n=22) [ 12 , 13 , 25 , 29 , 36 , 38 , 39 , 48 , 50 - 57 , 59 - 62 , 64 , 65 ], 11 studies included MSM [ 27 , 28 , 34 , 35 , 41 - 43 , 45 , 47 , 49 , 63 ], 7 studies included only women [ 30 - 33 , 37 , 44 , 46 ], 2 studies included only men [ 26 , 58 ], 1 study included both MSM and transgender people [ 14 ], 1 study included adults with presumptive tuberculosis [ 15 ], and 1 study included past service users [ 40 ]. The mean percentage of male participants was 62.34% (SD 35.1%), and the mean age was 27.37 years (SD 4.7 years) (the average across the 15 studies that reported a mean) and ranged from 20.70 to 37.90 years.…”