A recent study sponsored by the Centers for Disease Control and Prevention examined the effects of internet-distributed HIV self-tests on disease awareness and diagnosis among men who have sex with men (MSM). This group accounts for more than two-thirds of people diagnosed with HIV infections, and approximately 1 in 6 MSM who are infected is unaware of the infection. Self-testing approved by the US Food and Drug Administration has been shown to be feasible and may encourage clinical screening, which could lead to earlier diagnosis and prevention of disease transmission. In results published in JAMA Internal Medicine, researchers hoped to evaluate the effects of self-tests on the frequency of testing and number of new HIV diagnoses.
To recruit men for the study, advertisements were placed online on social network, dating, and other sites frequented by MSM. Participants were screened for eligibility (at least 18 years of age, currently identify as male, reside in the United States, have not been previously diagnosed with HIV, and additional factors). The 2665 participants were randomly assigned to either a control group or a self-testing group. Over 12 months, the self-testing group received 4 HIV self-tests (for themselves and to distribute to their social network members if desired) with options to replenish the tests quarterly, and were given the option of 2 self-tests and 1 dried blood collection kit at the end of the study. Participants were sent quarterly surveys over the 12-month study period to report frequency of testing and number of diagnoses.
Overall, participants in the self-testing group reported greater frequency of testing than the control group, with most testing 3 or more times throughout the 12-month trial. There were 36 newly diagnosed infections reported during the trial, and participants reported that an additional 34 of their social network members tested positive and became aware of their infection. Among self-testing participants, there was a 55.7% increase in annual HIV testing, and 72% of those with newly identified infections reported initiating linkage to care during the trial.
The researchers concluded that distributing the tests to MSM significantly increased testing frequency among self-testing participants and their social networks. Because the study did not require that participants interface with healthcare providers, it may have reduced barriers to testing and care initiation such as time, cost, and stigma. As shown by the initial surveys given to participants, the Centers for Disease Control and Prevention recommendation of yearly screening is not currently being met. Self-testing may be more efficient than standard clinic-based testing, although clinic-based testing has a higher sensitivity and is still of value. The researchers argue that mail-distributed HIV self-tests should be a consideration for HIV prevention programs, as they promote greater testing among high-risk MSM and their social networks.
MacGowan RJ, Chavez PR, Borkowf CB, et al. Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men: a randomized clinical trial [published online November 18, 2019]. JAMA Intern Med. doi10.1001/jamainternmed.2019.5222