Individual and network factors associated with HIV self-testing among men who have sex with men in resource-limited settings in China

Abstract

Background HIV self-testing (HIVST) is a potential strategy to overcome challenges of HIV testing among men who have sex with men (MSM). However, for resource-limited settings, technology and diagnostic devices are lagging. Hence, we estimated the status and correlates of HIVST among MSM in resource-limited settings in China to inform the development of HIVST to reach United Nations Programme on HIV and AIDS (UNAIDS) targets to end HIV by 2030. Methods A cross-sectional study was conducted among MSM in Nanning, Guangxi, China, between August 2019 and January 2020. The HIVST status was collected and data on social network features, sociodemographic information, risk behaviours, etc. were compared between prior- and non-HIVST MSM. Logistic regression analyses were conducted to examine the correlates of HIVST. Results The prevalence of HIVST among 446 MSM was 40.4% (95% confidence interval [CI] 35.8–44.9%). The main component of sociocentric network contains more prior-HIVST MSM (38.3%) than non-HIVST MSM (28.6%, P = 0.031). More MSM with individual features such as substance use during anal sex (22.8% vs 15.4%, P = 0.049) and multiple sexual partners (76.1% vs 59.4%, P < 0.001) were detected among prior-HIVST MSM. In multivariable analysis, prior HIVST was associated with the strong strength of ego-alter ties in the egocentric network (adjusted odds ratio [aOR] 1.72; 95% CI 1.09–2.71), HIV-infected partners (aOR, 7.17; 95% CI, 1.40–36.60), and vaginal intercourse (aOR, 0.38; 95% CI, 0.17–0.85). Conclusions HIVST coverage among MSM in resource-limited settings is suboptimal. Integrating social networks into testing services may be viable to promote HIVST in MSM within resource-limited settings.