Outcomes of a community-led online-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

Abstract

Introduction The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. Results HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]). Conclusions HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.

Self-Testing as a Hope to Reduce HIV in Transgender Women—Literature Review

“…HIVST has been shown to be safe and effective in increasing HIV testing rates without affecting condom use, social protection, or treatment inclusion [ 65 , 66 ]. Home testing provides easy access for high-risk individuals who rarely get tested [ 13 ].…”

Telehealth Interventions for HIV in Low- and Middle-Income Countries

“…Laboratory services pose another important challenge to telemedicine in LMICs. Small-scale HIV self-testing interventions increased linkage to HIV care in the Philippines [ 72 ], Thailand [ 73 ], and Vietnam [ 74 ]. However, few programs had the capacity to also prescribe treatment, resulting in low rates of PrEP and ART initiation.…”

“…However, few programs had the capacity to also prescribe treatment, resulting in low rates of PrEP and ART initiation. Community-led programs with integrated testing and treatment services, such as that in Vietnam and in one Philippines-based health center, saw higher ART initiation rates [ 72 , 74 ]. Creating a fully virtual telemedicine experience requires the integration of all required laboratory testing, including screening for sexually transmitted infections, into the virtual care model.…”

The Use of ICT in Providing HIV Services during the COVID-19 Pandemic: A Qualitative Study among Filipino HIV Volunteers

“…However, there is limited evidence in the Philippines and ASEAN that investigates the actual experiences of the actors involved in these modifications and innovative strategies. On this topic, only one study in the Philippines has been published, demonstrating the effectiveness of an online-based HIV selftesting program among priority populations (Eustaquio et al, 2022).…”

“…The experience of CBO HIV volunteers, some of whom are nurses, can help further contextualize this field of nursing in the country and examine how frugal and advanced ICT innovations can address service disruptions during crises. There is limited research on COVID-focused, ICT-mediated HIV services in the Philippines (i.e., Eustaquio et al, 2022), which only focused on clients rather than the experiences of CBO-based volunteers. We argue that the volunteers' perspectives can provide insights into the availability, design, and implementation of these ICT strategies for HIV care and inform technology-based practices and systems during the pandemic and beyond.…”