An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China

Abstract

Background With China’s explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. Objective This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. Methods A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. Results A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ 2 3 =55.0; P <.001). Conclusions The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self...

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing&nbsp;Program Among Men Who Have Sex With Men in China

“…[30] Similar studies con rm that HIVST is acceptable. [4,31,32] We strengthen the growing literature of the acceptability of HIVST among MSM, by also con rming the costeffectiveness of HIVST, compared to facility-based testing. We found that the cost per person tested using HIVST was $14.57, which is comparable to a systematic review of HIVST in sub-Saharan Africa that reported an average of $12.39 per person tested (Nurilign Ahmed, London School of Hygiene and Tropical Medicine, personal communication), and cheaper than the estimate from the US: $61 per person tested.…”

“…[1][2][3] In 2017, MSM accounted for 26% of all newly reported HIV cases in China, compared with 15% in 2011. [4] The global strategy to control the HIV epidemic hinges on early diagnosis and treatment of HIV. [5] A low HIV testing rate is one of the important reasons for the ongoing spread of HIV among MSM in China.…”

Social Media–Based Secondary Distribution of Human Immunodeficiency Virus/Syphilis Self-testing Among Chinese Men Who Have Sex with Men

“…[15]In China, the demand for and acceptability of HIVST among MSM has been high, and many Chinese local community-based-organizations (CBOs) are working with health bureaus in piloting HIVST among MSM. [16,17] No policies or guidelines are in place to improve integrative syphilis testing for MSM in China; only one cross-sectional survey study with Chinese MSMfound that 92.5% of syphilis self-testers did HIVST at the same time,demonstrating the feasibility of integrating syphilis self-testing into HIV self-testing services. [18]Nevertheless, this study did not explore strategies for further expanding testing uptake.…”

HIV and other STIs self-testing to reduce risk compensation among men who have sex with men who use oral pre-exposure prophylaxis in China: protocol for a randomised waitlist-controlled trial

“…We have successfully conducted a large study of MSM who were using HIVST for the first time, which demonstrated widespread acceptance. 33 …”

“…We have successfully conducted a large study of MSM who were using HIVST for the first time, which demonstrated widespread acceptance. 33 After randomisation, doctors will provide the participants in the intervention group face-to-face and paper-based HIVST instructions. All information and demonstration videos will be available on study sites' WeChat and Tencent QQ account.…”