Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States

Abstract

Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one’s HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.

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

“…Several interventions did not specify the form in which instructions were provided. Clear instructions were reported to increase the usability of self-(sampling) testing [26, 34, 36, 37]. Complementary (photo or animated) images of the puncture site could support correct performance [24].…”

“…Overall, though HIV positivity rate varied between different contexts and populations, from 0.2% in a British study to 14.3% in a Chinese study among MSM [32, 60]. A substantial number of studies did not identify any new positive HIV results [20, 26, 30, 31, 33, 34, 40, 53, 61, 62]. Those studies were mainly based in Western continents (Europe, North America) and are focused on MSM.…”

“…Several interventions did not specify the form in which instructions were provided. Clear instructions were reported to increase the usability of self-(sampling) testing [26,34,36,37].…”

“…It was feasible and could be done successfully [24,25]. Reported challenges were mainly a result of insufficient knowledge of correct performance [26][27][28]. Blood collection with a vacuum system was highly acceptable and feasible for sampling among PrEP-using MSM.…”