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BackgroundMen who have sex with men (MSM) continue to be disproportionately impacted by the Human Immunodeficiency Virus (HIV) epidemic in the United States (US). Testing for HIV is the cornerstone of comprehensive prevention efforts and the gateway to early engagement of infected individuals in medical care. We sought to determine attitudes towards six different HIV testing modalities presented collectively to internet-using MSM and identify which options rank higher than others in terms of intended usage preference.MethodsBetween October and November 2012, we surveyed 973 HIV-negative or -unknown status MSM and assessed their acceptability of each of the following services hypothetically offered free of charge: Testing at a physician’s office; Individual voluntary counseling and testing (VCT); Couples’ HIV counseling and testing (CHCT); Expedited/express testing; Rapid home self-testing using an oral fluid test; Home dried blood spot (DBS) specimen self-collection for laboratory testing. Kruskal-Wallis tests were used to determine whether the stated likelihood of using each of these modalities differed by selected respondent characteristics. Men were also asked to rank these options in order of intended usage preference, and consensual rankings were determined using the modified Borda count (MBC) method.ResultsMost participants reported being extremely likely or somewhat likely to use all HIV testing modalities except DBS self-collection for laboratory testing. Younger MSM indicated greater acceptability for expedited/express testing (P < 0.001), and MSM with lower educational levels reported being more likely to use CHCT (P < 0.001). Non-Hispanic black MSM indicated lower acceptability for VCT (P < 0.001). Rapid home self-testing using an oral fluid test and testing at a physician’s office were the two most preferred options across all demographic and behavioral strata.ConclusionsNovel approaches to increase the frequency of HIV testing among US MSM are urgently needed. Combination testing packages could enable high risk MSM in putting together annual testing strategies personalized to their circumstances, and warrant due consideration as an element of combination HIV prevention packages.

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Objectives Online HIV prevention studies have been limited in their ability to obtain biological specimens to measure study outcomes. We describe the factors associated with willingness of MSM to take a free anonymous home HIV test, and the self-identified barriers to home testing as part of an online prevention study. Methods Between March-April 2009 we recruited 6163 internet-using self-reported HIV negative MSM, who indicated their willingness to test for HIV infection using a commercially available home collection kit when offered hypothetically no incentive, $10, $25 or $50. Results 3833 (62%) men reported being very likely and 1236 (20%) men reported being somewhat likely to take a home HIV test offered as part of an online HIV prevention study. When compared to men who were not offered any hypothetical incentive, the odds of being willing to test at home were approximately twice as great for men offered hypothetically $10 (odds ratio (OR), 1.8; 95% confidence interval (CI), 1.5–2.2), $25 (OR, 1.8; CI, 1.5–2.2) or $50 (OR, 2.1; CI, 1.8–2.6). Black MSM (OR, 1.3; CI, 1.1–1.7), men who had unprotected anal intercourse in the past 12 months (OR, 1.3; CI, 1.1–1.5), and men who were unaware of their HIV status (OR, 1.2; CI, 1.0–1.4) had increased odds of being willing to test at home. Conclusions Home testing offered as part of online HIV prevention research is acceptable, and future research and interventions should focus on addressing self-identified barriers faced by MSM to testing using home collection kits.

Peer-driven HIV prevention strategies can be effective in identifying high-risk persons with undiagnosed infections. Besides individual self-testing, other potential uses of rapid home HIV test kits include distributing them, and testing with others within one's social or sexual networks. We sought to identify factors associated with the willingness to engage in these alternative activities among men who have sex with men (MSM) in the United States. From May to October 2014, we surveyed 828 HIV-negative or unknown status MSM about multiple aspects of rapid home HIV testing. A greater proportion indicated being likely to distribute free oral fluid (OF) tests compared to free finger-stick blood (FSB) tests (91% versus 79%), and almost three-fourths (72%) reported being likely to test with their friends or sex partners in the future. MSM not identifying as homosexual/gay were less willing to distribute OF tests, and those with lower educational attainment were more willing to distribute FSB tests. MSM unaware of their HIV status were less likely to report potentially testing with others using free rapid home HIV tests compared to those who were HIV-negative. Finally, MSM willing to self-test were more likely to report future test kit distribution, and those willing to distribute kits were more likely to report potentially testing with others. Engaging individuals with positive attitudes towards these strategies in prevention efforts could help increase HIV testing levels among MSM. A greater understanding of the potential public health impact of rapid home HIV test kits is necessary.

HIV testing is the gateway into both prevention and treatment services. It is important to understand how men who have sex with men (MSM) perceive HIV self-tests. We conducted focus groups and individual interviews to collect feedback on two HIV self-tests, and on a dried blood spot (DBS) specimen collection kit. Perceptions and attitudes around HIV self-testing (HIVST), and willingness to distribute HIV self-tests to others were assessed. MSM reported HIVST to be complementary to facility-based testing, and liked this approach because it offers privacy and convenience, does not require counseling, and could lead to linkage to care. However, they also had concerns around the accuracy of HIV self-tests, their cost, and receiving a positive test result without immediate access to follow-up services. Despite these issues, they perceived HIVST as a positive addition to their HIV prevention toolbox.

Structured Summary Background The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators for improving the HIV care continuum, but the economic and epidemiological impact of achieving those indicators remains unclear. Methods We constructed a dynamic transmission model of HIV progression and care engagement to project HIV incidence, prevalence, mortality, and costs among adults in the United States over ten years. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within one month), and indicator 5 (90% of diagnosed individuals in care). Finding At current rates of engagement in the HIV care continuum, we project 524,000 (95% Uncertainty Range 442,000 – 712,000) new HIV infections and 375,000 deaths (364,000 – 578,000) between 2016 and 2025. Achieving NHAS progress indicators 1 and 4 has modest epidemiologic impact (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (indicator 5) averts 52% (47-56%) of new infections. Achieving all NHAS targets resulted in a 58% reduction (52%-61%) in new infections and 128,000 lives saved (106,000-223,000) at an incremental health system cost of $105 billion dollars. Interpretation Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the United States.

Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast.