Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Abstract

Background Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing. Methods A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing. Results Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32–2.73), reporting 2–5 male sexual partners (aOR, 1.81; 95% CI, 1.04–3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00–93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86–4.72). Self-reported harms associated with syphilis self-testing were minimal. Conclusions Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services.

Promoting routine syphilis screening among men who have sex with men in China: study protocol for a randomised controlled trial of syphilis self-testing and lottery incentive

“…The major challenge of this study is to retrieve validated testing proof to verify self-testing results. Our previous study reported that 47% of men submitted proof of syphilis self-testing with 20 RMB (about 3 US dollar) cash incentive [17]. This was a cross sectional survey, and people are not always able to find the required proof, especially for those who tested a long time ago.…”

“…Another potential limitation of this study is the possibility of contamination between arms. We cannot prevent participants from the control arm to purchase syphilis self-testing kits for use through online e-market which we have been previously found in some MSM in China [17]. To mitigate this, we will record the participants' testing method in each group and if necessary adjust for this in the data analysis.…”

“…Results showed that half of MSM who ever tested for syphilis had ever used a selftest. Self-testing potentially reached MSM who would not otherwise have attended health facilities for testing [17]. Several studies in literature have explored the use of syphilis self-testing among MSM [12,[18][19][20], few studies have examined the effectiveness of intervention strategies which found that Internet-based strategy, such as using Facebook or smartphone applications, could be an effective way to promote syphilis self-testing uptake.…”

Risk attitudes, risky sexual behaviours and willingness to test negative for syphilis using lottery-based financial incentives among Chinese men who have sex with men

“…We distributed links to potential participants through local health departments and gay-friendly community-based organisations using Weibo (a microblogging platform) and WeChat (a messaging app). Further details of recruitment are reported in our previous research 5. Men were eligible to participate if they were aged over 16 years, born biologically male and reported ever having sex with another man.…”

HIV and other STIs self-testing to reduce risk compensation among men who have sex with men who use oral pre-exposure prophylaxis in China: protocol for a randomised waitlist-controlled trial

“…Recent studies found that STIs self-testing may be an efficient way to identify STIs, 27 may increase the rate of first-time STI testing, and could be integrated into HIVST services. 28 However, the study of self-testing combined with HIV and other STIs is lacking. The effects of STI self-testing on STI treatment initiation and adherence after a positive STI self-test result has not been explored among PrEP users.…”