Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study

Abstract

Background HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206

Social network strategies to distribute HIV self‐testing kits: a global systematic review and network meta‐analysis

“…Six studies were from high‐income countries, 24 in middle‐income countries and nine in low‐income countries. The included studies were conducted in eight countries from 2010 to 2021, seven in China [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ], six in South Africa [ 32 , 33 , 34 , 35 , 36 , 37 ], six in the United States [ 38 , 39 , 40 , 41 , 42 , 43 ], six in Uganda [ 44 , 45 , 46 , 47 , 48 , 49 ], eight in Kenya [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ], three in Malawi [ 58 , 59 , 60 ], two in Vietnam [ 61 , 62 ] and one in Zambia [ 63 ].…”

“…Overall, 16 studies distributed HIVST kits directly from participants to their sexual partners [ 28 , 31 , 34 , 37 , 45 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. As for social network strategies, 15 studies recruited index participants and encouraged participants to distribute HIVST kits to people in their social networks (alters) [ 25 , 26 , 27 , 29 , 30 , 33 , 35 , 36 , 38 , 42 , 43 , 46 , 47 , 48 , 52 ]. Most studies had multiple HIVST kits provided directly to index participants by HCWs for distribution to alters.…”

“…In most studies, HIVST kits were distributed person‐to‐person, with participants applying for HIVST kits and then distributing them face‐to‐face in their social networks [ 25 , 28 , 33 – 37 , 45 , 50 , 51 , 53 , 58 – 60 ]. In contrast, a subset of studies were based on social media, an HIVST application link on a phone app [ 26 , 27 , 29 ] or a web‐based platform [ 30 , 38 , 43 ] that provides HIVST kits in the form of online ordering and mailing.…”

A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study

“…One promising model is the social network–based SD-HIVST. As an innovative social network method, SD-HIVST is promising to help reach naïve testers and increase HIVST uptake among men who have never tested before [ 15 - 17 ]. The strategy of SD-HIVST involves individuals (defined as “index”) obtaining multiple HIVST kits and distributing them face-to-face or through peer referral (PR) links on the web to members within their social networks (defined as “alters”) [ 15 , 16 ].…”