A Pilot, Randomized Controlled Trial of HIV Self-Testing and Real-Time Post-Test Counseling/Referral on Screening and Preventative Care Among Men Who Have Sex with Men

Abstract

HIV self-testing (HST) could be an effective strategy for helping those at high risk test more regularly. However, concerns about HST's lack of follow-up care and referral have so far limited its use. In a pilot, randomized controlled trial, high-risk HIV-negative, or status unknown men who have sex with men (MSM; N = 65) were recruited from January 2016 to February 2017 and received (1) HST kits by mail, equipped with devices that detected when kits were opened and prompted a follow-up call from a counselor (eTEST); (2) standard HST kits with no follow-up (standard); or (3) informational letters about HIV testing locations (control) at baseline, 3 months, and 6 months. Monthly surveys over 7 months assessed HIV testing, sexually transmitted infection (STI) testing, access to prevention services, and behavioral risk reduction. All participants (100%) in the eTEST and standard HST groups reported HIV testing at least once during the 7-month period compared with 72% of controls. Repeat testing was higher among those in the HST groups versus controls (79% vs. 41%). Participants in the eTEST group were significantly more likely to receive risk reduction counseling, prevention supplies (e.g., condoms and lube), and PrEP referrals during the study period compared with standard HST and controls. No effects on STI testing or PrEP initiation emerged. Delivering HST kits to high-risk MSM at regular intervals could increase HIV testing rates and encourage more regular testing. Providing active post-test referrals alongside HST might also connect high-risk men with some other important services that encourage prevention behaviors.

Promoting routine syphilis screening among men who have sex with men in China: study protocol for a randomised controlled trial of syphilis self-testing and lottery incentive

“…Several implementation challenges that have emerged from HIV self-testing practice have limited its public health impact. Many are concerned that self-testing does not sufficiently connect users with critical post-testing services, such as confirmatory testing and management of those who test positive and that these limitations may result in delayed linkage to care [11,25,27,28]. For syphilis self-testing, this problem could be more salient.…”

Uptake and acceptability of assisted and unassisted HIV self-testing among men who purchase sex in brothels in Indonesia: a pilot intervention study

“…Despite the call to introduce HIV self-tests to improve HIV testing coverage in key populations [25,26], there have been no demonstration projects among MWPS particularly when HIV self-testing is offered by lay health providers at brothels. There have been numerous studies of HIV self-testing conducted among other risk and marginalised populations such as FSWs [49][50][51] and men who have sex with men [52,53], but findings from these key populations cannot be applied to MWPS. Further, only a few studies have compared unassisted with assisted or supervised HIV self-testing [54][55][56][57][58] to allow for the identification of strategy which is preferable.…”

eTest: a limited-interaction, longitudinal randomized controlled trial of a mobile health platform that enables real-time phone counseling after HIV self-testing among high-risk men who have sex with men

“…We used past studies [50,51] and GLIMMPSE software [52] to determine the sample sizes necessary to detect significant effects using each of the proposed analysis models in section 20a. In our pilot data [47], differences in most outcomes (both any and regular HIV testing, STI testing, and PrEP uptake) across the HST and control conditions were very large, while differences across standard HST and eTest conditions were small (OR = 1.5). Given our interest in whether eTest improves outcomes relative to standard HST, we therefore estimated the sample size necessary to detect small effects across all models.…”

“…Once a beacon-equipped HST kit is opened, the eTest system notifies researchers that a user may have initiated HST, prompting counselors to call these users to provide post-test counseling and referrals. In a smaller 7-month pilot study (N = 65) [47], all participants (100%) in the eTest and standard HST groups reported HIV testing at least once, compared with 72% of controls. More of those in the HST groups also tested two or more times during this 7-month period, aligning with recommendations from the Centers for Disease Control, than those in the control group (79% vs. 41%).…”