Social Media–Based Secondary Distribution of Human Immunodeficiency Virus/Syphilis Self-testing Among Chinese Men Who Have Sex with Men

Wu, Dan; Zhou, Yi; Yang, Nancy; Huang, Shanzi; He, Xi; Tucker, Joseph D.; Li, Xiaofeng; Smith, M. Kumi; Ritchwood, Tiarney D.; Jiang, Xiaohui; Li, Xuan; Wang, Yehua; Huang, Wenting; Ong, Jason J.; Fu, Hongyun; Bao, Huanyu; Pan, Stephen W.; Dai, Weiyu; Tang, Weiming

doi:10.1093/cid/ciaa825

Cited by 50 publications

(75 citation statements)

References 23 publications

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“…Strategies to promote HIVST including but not limited to improving access and expanding coverage, should be tailored to meet the testing needs of MSM. Third, although HIVST filled the HIV testing gap during the pandemic, linkage to care remained a challenge for self-testers [22]. Targeted measures should be implemented to strengthen the linkage between HIVST and antiretroviral treatment initiation facilities, when the situation could be worse during the pandemic [4].…”

Section: Resultsmentioning

confidence: 99%

HIV self‐testing partially filled the HIV testing gap among men who have sex with men in China during the COVID‐19 pandemic: results from an online survey

et al. 2021

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Introduction: HIV self-testing (HIVST) is a useful strategy to promote HIV testing among key populations. This study aimed to understand HIV testing behaviours among men who have sex with men (MSM) and specifically how HIVST was used during the coronavirus disease 2019 (COVID-19) measures in China when access to facility-based testing was limited. Methods: An online cross-sectional study was conducted to recruit men who have sex with men (MSM) in China from May to June of 2020, a period when COVID-19 measures were easing. Data on socio-demographic characteristics, sexual behaviours and HIV testing in the three months before and during COVID-19 measures (23 January 2020) were collected. Chi-square test and logistic regression were used for analyses. Results: Overall, 685 MSM were recruited from 135 cities in 30 provinces of China, whose mean age was 28.8 (SD: 6.9) years old. The majority of participants self-identified as gay (81.9%) and had disclosed their sexual orientation (66.7%). In the last three months, 69.6% ever had sex with men, nearly half of whom had multiple sexual partners (47.2%). Although the overall HIV testing rates before and during COVID-19 measures were comparable, more MSM self-tested for HIV during COVID-19 measures (52.1%) compared to before COVID-19 measures (41.6%, p = 0.038). Fewer MSM used facility-based HIV testing during COVID-19 measures (42.9%) compared to before COVID-19 measures (54.1%, p = 0.038). Among 138 facility-based testers before COVID-19 measures, 59.4% stopped facility-based testing during COVID-19 measures. Among 136 self-testers during COVID-19 measures, 58.1% had no HIV self-testing before COVID-19 measures. Multivariable logistic regression showed that having sex with other men in the last three months (adjusted odds ratio, aOR = 2.04, 95% CI: 1.38 to 3.03), self-identifying as gay (aOR = 2.03, 95% CI: 1.31 to 3.13), ever disclosing their sexual orientation (aOR = 1.72, 95% CI: 1.19 to 2.50) and tested for HIV in three months before COVID-19 measures (aOR = 4.74, 95% CI: 3.35 to 6.70) were associated with HIV testing during COVID-19 measures. Conclusions: Facility-based HIV testing decreased and HIVST increased among MSM during COVID-19 measures in China. MSM successfully accessed HIVST as substitute for facility-based testing, with no overall decrease in HIV testing rates.

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Section: Resultsmentioning

confidence: 99%

HIV self‐testing partially filled the HIV testing gap among men who have sex with men in China during the COVID‐19 pandemic: results from an online survey

et al. 2021

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“…Our previous implementation program used a secondary distribution strategy to promote HIV/syphilis self-testing among Chinese MSM [ 20 ]. Secondary distribution is a social network–based strategy that involves giving one individual (index) multiple self-testing kits for distribution to their social contacts (alters) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Secondary distribution is a social network–based strategy that involves giving one individual (index) multiple self-testing kits for distribution to their social contacts (alters) [ 12 ]. Evaluation of this implementation program demonstrated that secondary distribution can expand HIV/syphilis self-testing among MSM in a middle-income country [ 20 ]. Nonetheless, it remains unexplored whether sexual health influencer status is associated with greater promotion of HIV/STI self-testing among peers, especially peers who have less access to testing.…”

Section: Introductionmentioning

confidence: 99%

Sexual Health Influencer Distribution of HIV/Syphilis Self-Tests Among Men Who Have Sex With Men in China: Secondary Analysis to Inform Community-Based Interventions

Yang¹,

Wu²,

Zhou³

et al. 2021

J Med Internet Res

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Background Social network–based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. Objective The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. Methods In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, P<.001) than noninfluencers. More alters of sexual health influencers came from a rural area (45.5% vs 23.8%, P<.001), had below-college education (57.7% vs 37.1%, P<.001), and had multiple casual male sexual partners in the past 6 months (25.2% vs 11.9%, P<.001). Conclusions Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage.

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“…Secondary distribution is one of the novel ways to increase the use of HIVST (8). In this service delivery model, individuals (defined as indexes) apply for multiple HIVST kits and then distribute these HIVST kits to people in their social network, such as sexual partners and gay friends (defined as alters) (9,10). Such a strategy could significantly improve HIV testing coverage by reaching people who have limited access to HIV testing and potentially detect more people with undiagnosed HIV (10).…”

Section: Introductionmentioning

confidence: 99%

“…In this service delivery model, individuals (defined as indexes) apply for multiple HIVST kits and then distribute these HIVST kits to people in their social network, such as sexual partners and gay friends (defined as alters) (9,10). Such a strategy could significantly improve HIV testing coverage by reaching people who have limited access to HIV testing and potentially detect more people with undiagnosed HIV (10). To further expand the use of this strategy and enhance the efficiency of distribution, it could be useful to identify influential indexes who are more likely to distribute kits to more alters (e.g., ≥2 alters), or to people living with HIV (PLWH) who are undiagnosed, or to first-time testers.…”

Section: Introductionmentioning

confidence: 99%

Identification of Key Influencers for Secondary Distribution of HIV Self-Testing among Chinese MSM: A Machine Learning Approach

Jing

Yang

Zhou

et al. 2021

Preprint

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Background. HIV self-testing (HIVST) has been rapidly scaled up and additional strategies further expand testing uptake. Secondary distribution has people (indexes) apply for multiple kits and pass these kits to people (alters) in their social networks. However, identifying key influencers is difficult. This study aimed to develop an innovative ensemble machine learning approach to identify key influencers among Chinese men who have sex with men (MSM) for HIVST secondary distribution. Method. We defined three types of key influencers: 1) key distributors who can distribute more kits; 2) key promoters who can contribute to finding first-time testing alters; 3) key detectors who can help to find positive alters. Four machine learning models (logistic regression, support vector machine, decision tree, random forest) were trained to identify key influencers. An ensemble learning algorithm was adopted to combine these four models. Simulation experiments were run to validate our approach. Results. 309 indexes distributed kits to 269 alters. Our approach outperformed human identification (self-reported scales cut-off), exceeding by an average accuracy of 11.0%, could distribute 18.2% (95%CI: 9.9%-26.5%) more kits, find 13.6% (95%CI: 1.9%-25.3%) more first-time testing alters and 12.0% (95%CI: -14.7%-38.7%) more positive-testing alters. Our approach could also increase simulated intervention efficiency by 17.7% (95%CI: -3.5%-38.8%) than human identification. Conclusion. We built machine learning models to identify key influencers among Chinese MSM who were more likely to engage in HIVST secondary distribution.

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Social Media–Based Secondary Distribution of Human Immunodeficiency Virus/Syphilis Self-testing Among Chinese Men Who Have Sex with Men

Cited by 50 publications

References 23 publications

HIV self‐testing partially filled the HIV testing gap among men who have sex with men in China during the COVID‐19 pandemic: results from an online survey

HIV self‐testing partially filled the HIV testing gap among men who have sex with men in China during the COVID‐19 pandemic: results from an online survey

Sexual Health Influencer Distribution of HIV/Syphilis Self-Tests Among Men Who Have Sex With Men in China: Secondary Analysis to Inform Community-Based Interventions

Identification of Key Influencers for Secondary Distribution of HIV Self-Testing among Chinese MSM: A Machine Learning Approach

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