Regular Testing of HIV and Sexually Transmitted Infections With Self-Collected Samples From Multiple Anatomic Sites to Monitor Sexual Health in Men Who Have Sex With Men: Longitudinal Study

Abstract

Background Regular HIV and sexually transmitted infection (STI) testing for men who have sex with men (MSM) is an important means of infection prevention, the adoption of which remains suboptimal in the community. Objective On the hypothesis that engagement plays an important role in sexual health monitoring, this study aimed to pilot-test internet-based HIV and STI testing with self-sampling to enhance engagement of MSM with regular testing. Methods This 1-year cohort study was conducted on HIV-negative MSM aged 18 years or older. A designated website was set up to enable participants to make appointments for baseline and follow-up visits at 3-monthly intervals. On-site blood sampling was performed for HIV and syphilis tests, along with self-collection of pharyngeal swabs, rectal swabs, and urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Full engagement, as defined by having made at least 3 visits over a 6-12 months’ follow-up period, was compared with partial engagement in the bivariable logistic regression model. Results Between August 2019 and October 2020, 204 MSM were recruited, after the exclusion of 2 baseline HIV-positive MSM. The majority (189/204, 92.7%) were Chinese, the median age was 31 (IQR 26-39) years, and 58.0% (116/200) had experience with pre-exposure prophylaxis (PrEP) at baseline. Full engagement (146/204, 71.6%) was associated with incident STI during the follow-ups (odds ratio [OR] 4.23, 95% CI 1.63-10.94), seeking a medical referral after STI detection (OR 10.25, 95% CI 3.25-29.79), and a synchronized schedule of HIV and STI testing with PrEP visits (OR 51.85, 95% CI 19.30-139.34). No incident HIV was detected in the follow-up period. At baseline, the overall STI (CT, NG, or syphilis) prevalence was 30%, with CT at 18%, NG at 13%, and syphilis at 5%. During follow-up, the incidences were 59.08/100 person-years (py) for any STI, 33.05/100 py for CT, 29.86/100 py for NG, and 10.4/100 py for syphilis. The detection rates of CT and NG in urine samples were lower than with pharyngeal swabs and rectal swabs. The scores for convenience, confidence of correct sampling, and accuracy of self-sampling were high (7 to 8 out of 10). Conclusions Both baseline prevalence and incidence of STI were high among MSM engaged in regular testing. A high degree of engagement in regular STI and HIV testing was positively associated with incident STI, history of health-seeking behaviors, and perceived convenience of self-sampling. Self-sampling could be introduced as a means of enhancing engagement in regular HIV and STI testing.

Self-sampling strategies (with/without digital innovations) in populations at risk ofChlamydia trachomatisandNeisseria gonorrhoeae: a systematic review and meta-analyses

“…Impact of SS with digital innovations was reported in five studies 17 20 21 23 24. SS was successful in detecting 36.8% (14 of 38) and 17.9% (5 of 28) of new infections and detecting 33.1 CT cases per 100 person-years (51/154.29 years) and 29.9 GC cases per 100 person-years (48/160.77 years) 20 21 24. Test uptake was high (85.3%; 110 of 129) in one study offering SS kits via text messaging 21.…”

“…Of all studies, 26.7% (12 of 45) integrated digital innovations (figure 2C). 16–27 These included six with websites to obtain SS kits and/or information on test conduct, combined with notification of results via text (13.3%),17 18 20 24 25 27 five website-based only (11.1%)16 19 22 23 26 and one text-based only (2.2%) strategies 21…”

“…Eighty per cent of studies (36 of 45) detected newly diagnosed positive CT/GC infections and 42.2% of studies (19 of 45) measured test accuracy 16 17 20 22–55. Seventeen studies reported 2×2 table values 22 28 30–33 35 36 38–43 51–53.…”

“…Preference for SS and digital innovation was reported by 54.3% (969 of 1785) of participants who indicated they would still test for CT/GC if at-home SS was not available to them, but would do so less often in one study 19. In two other studies, 51.5% (103 of 200) and 77.0% (307 of 399) of participants preferred this strategy over clinician-based in-hospital testing 16 24…”

“…Of all studies, 26.7% (12 of 45) integrated digital innovations (figure 2C). [16][17][18][19][20][21][22][23][24][25][26][27] These included six with websites to obtain SS kits and/or information on test conduct, combined with notification…”