Implementation of unassisted and community-based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A demonstration study in Metro Manila, Philippines

Abstract

Objective The study aimed to demonstrate the feasibility of an unassisted and community-based HIV self-testing (HIVST) distribution model and to evaluate its acceptability among men-having-sex-with-men (MSM) and transgender women (TGW). Methods Our demonstration study focused on implementing the HIVST distribution model in Metro Manila, Philippines. Convenience sampling was done with the following inclusion criteria: MSM or TGW, at least 18 years old, and had no previous HIV diagnosis. Individuals taking HIV pre-exposure prophylaxis, on antiretroviral therapy, or female sex at birth were excluded. The implementation of the study was done online using a virtual assistant and a delivery system via courier due to COVID-19-related lockdowns. Feasibility was measured by the number of HIVST kits successfully delivered and utilized and the HIV point prevalence. Moreover, acceptability was evaluated by a 10-item system usability scale (SUS). HIV prevalence was estimated with linkage to care prioritized for reactive participants. Results Out of 1,690 kits distributed, only 953 (56.4%) participants reported their results. Overall, HIV point prevalence was 9.8%, with 56 (60.2%) reactive participants linked to further testing. Furthermore, 261 (27.4%) of respondents self-reported, and 35 (13.4%) of the reactive participants were first-time testers. The HIVST service had an overall median and interquartile range (IQR) SUS score of 82.5 (IQR: 75.0, 90.0), rendering the HIVST kits very acceptable. Conclusions Our study suggests the acceptability and feasibility of HIVST among the MSM and TGW in Metro Manila, Philippines, regardless of their age or HIV testing experience. In addition, other platforms of information dissemination and service delivery of HIVST should be explored, including access to online instructional videos and printed materials, which may facilitate easier use and interpretation of results. Furthermore, due to our study’s limited number of TGW respondents, a more targeted implementation strategy to reach the TGW population is warranted to increase their access and uptake of HIVST.

Understanding Reach, Effectiveness, Adoption, Implementation, and Maintenance of home-based comprehensive sexual health care: a Realist Review

“…A recent study among MSM and transgender people found users preferred video instructions when using an HIV self-test. In addition, inaccuracies in the interpretation of HIV testing results were reduced, when using visualized instructions[78]. Moreover, previous studies suggested that if dissemination strategies are tailored, home-based CSH will be more accessible to key populations [39].…”

Community-led digital health and HIV in the Philippines

“…4 Implementing digital health interventions (DHI) during the COVID-19 pandemic occurred rather smoothly in HIV-specific services in community-based organizations (CBOs). The ease may be attributed to the years of experience of CBOs implementing promising DHI, including online-based demand generation programmes which increased engagement of cis-MSM and TGW communities in HIV services, 5 mobile-based technology which improved adherence to anti-retroviral therapy and clinic attendance, 6 and an online-based HIV self-testing platform which expanded access to HIV testing, 7,8 especially among first-time testers in rural areas. 8 While the passage of the Philippine telehealth law is still on the process, the recently revised national HIV testing contained specific provisions on DHI.…”

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

“…CBOs were at the forefront of research, advocacy, and policy work that expanded HIV testing from the traditional facility-based screening to now include community-based screening and HIV self-testing [ 55 , 56 ]. Monumental to the introduction of HIV self-testing in the country were HIV self-testing demonstration projects held in the Western Visayas region and in Metro Manila [ 57 , 58 ]. In the former, multiple CBO project sites reached many first-time testers among MSM and trans women [ 57 ].…”

“…In the former, multiple CBO project sites reached many first-time testers among MSM and trans women [ 57 ]. In the latter, participants reported high acceptability for HIV self-testing [ 58 ]. In both projects, about 8–9% tested positive for HIV antibody, and more than half were linked to further testing and treatment [ 57 , 58 ].…”

“…In the latter, participants reported high acceptability for HIV self-testing [ 58 ]. In both projects, about 8–9% tested positive for HIV antibody, and more than half were linked to further testing and treatment [ 57 , 58 ]. These projects were conducted successfully despite the stringent quarantine protocols during the COVID-19 pandemic.…”