Introduction The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. Results HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]). Conclusions HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
Introduction: The Philippines, experiencing the fastest rising HIV epidemic globally, has limited options of HIV testing that its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and web-based approaches could synergize efforts to expand its uptake, we aimed to evaluate the outcomes of a community-led web-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. Methods We did a secondary data analysis of routinely collected data in a community-led web-based HIVST demonstration among cis-MSM and TGW in Western Visayas, Philippines. We reviewed data on demographics, sexuality-, and context-related variables and explored associations with opting directly-assisted HIVST (DAH) and willingness to distribute, using multivariable logistic regression. Results HIVST kits were distributed to 706 individuals (648 cis-MSM, 58 TGW), 52.1% were first-time testers, 12.5% opted DAH, and 48.2% were willing to distribute. Reporting rate was high (97.5%) with 8.4% reactivity rate. While linkage to prevention (100%) and care (87.9%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (60.4%) initiation were limited. There were no reports of adverse events. Those who opted for DAH, not willing to distribute, employed, and those who recently had anal intercourse had significantly higher proportions of testing reactive. Those who opted web-based approaches (adjusted odds ratio, aOR=0.28 [confidence interval, CI 0.14-0.57]) were less likely to opt DAH. Those living in urban areas (aOR=1.60 [CI 1.13-2.26]) and with no history of HIV test (aOR=0.45 [CI 0.32-0.61]) were associated with lower likelihood of secondary distribution than their counterparts. Maximal quarantine restrictions were associated with higher likelihood of DAH (aOR = 4.07 [CI 2.42-6.90]) and willingness to distribute (aOR=3.51 [CI 2.45-5.07]) relative to minimal restrictions. Conclusions HIVST could reach those who were never tested for HIV. While there is demand in accessing unassisted and web-based approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
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