The effects of regular home delivery of HIV self‐testing and follow‐up counselling on HIV testing and prevention outcomes in men who have sex with men who test infrequently in the United States: a pragmatic, virtual randomized controlled trial

Author:

Wray Tyler B.1ORCID,Chan Philip A.2ORCID,Klausner Jeffrey D.3,Ward Lori M.4,Ocean Erik M. S.1,Carr Daniel J.5,Guigayoma John P.1,Nadkarni Siddhi6

Affiliation:

1. Department of Behavioral and Social Sciences Brown University School of Public Health Providence Rhode Island USA

2. Department of Medicine Warren Alpert Medical School of Brown University Providence Rhode Island USA

3. Department of Population and Public Health Sciences Keck School of Medicine University of Southern California Los Angeles California USA

4. Department of Population Health Science John D. Bower School of Population Health University of Mississippi Medical Center Jackson Mississippi USA

5. School of Psychology Cardiff University Cardiff UK

6. Yale School of Medicine New Haven Connecticut USA

Abstract

AbstractIntroductionPast research shows that HIV self‐testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care.MethodsFrom January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow‐up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre‐exposure prophylaxis (PrEP) use and sexual risk behaviour.FindingsEight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (OR = 7.9, 95% CI = 4.9−12.9 and OR = 6.6, 95% CI = 4.2−10.5) and repeat testing (>1 test; OR = 8.5, 95% CI = 5.7−12.6; OR = 8.9, 95% CI = 6.1−13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups.ConclusionsHIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow‐up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.

Funder

National Institute of Mental Health

Publisher

Wiley

Reference21 articles.

1. Ending the HIV pandemic: preparing for the future

2. Centers for Disease Control and Prevention.The state of the epidemic in the United States.NCHHSTP Newsroom;2020. Available from:https://www.cdc.gov/nchhstp/newsroom/fact‐sheets/hiv/state‐of‐the‐hiv‐epidemic‐factsheet.html#ending‐hiv‐epidemic. Accessed 1 Oct 2023.

3. Centers for Disease Control and Prevention.HIV declines among young people and drives overall decrease in new HIV infections.NCHHSTP Newsroom;2023. Available from:https://www.cdc.gov/nchhstp/newsroom/2023/2021‐hiv‐incidence.html. Accessed 1 Oct 2023.

4. HIV testing: the cornerstone of HIV prevention efforts in the USA

5. Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men — United States, 2017

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