Bringing HIV Self-Testing to Scale in the United States: a Review of Challenges, Potential Solutions, and Future Opportunities

Steehler, Kevin; Siegler, Aaron J

doi:10.1128/jcm.00257-19

Cited by 50 publications

(42 citation statements)

References 50 publications

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“…The authors also noted that more over-the-counter options for HIV self-testing would enhance competitive pricing and make HIVST more affordable, a barrier that was reported in many of the studies included in our review. 73 Other HIVST innovative delivery models have been presented in conference abstracts, although not all have appeared in peer-reviewed literature. The presence of these abstracts is encouraging because it suggests that findings from these studies will be available for researchers and providers to build on, expanding the reach and availability of HIVST services and research.…”

Section: Discussionmentioning

confidence: 99%

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

Hawk¹,

Chung²,

Creasy³

et al. 2020

PPA

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Purpose: Despite marked progress in the ability to test for, treat, and prevent HIV, the epidemic remains a significant public health concern, especially among key populations including prisoners; sex workers; transgender individuals; gay, bisexual, and other men who have sex with men (MSM); and Black and Latinx MSM. This scoping review was conducted to provide an overview of the current research describing patient preferences for HIVST in the United States to understand what key populations value about HIVST and why they are willing to use it. A targeted search for published literature on patient preferences for HIVST was conducted using Ovid Medline, PsychINFO, and an HIVST research database. Results: We reviewed 700 abstracts and 139 full texts. We found 19 articles published between January 2014 and April 2020 that included findings related to HIVST preferences. Overall, HIVST was preferred to more traditional testing. Six primary factors emerged as important HIVST values including: 1) convenience, 2) type of test; 3) cost, 4) stigma reduction, 5) risk reduction, and 6) self-control. Linkage to care was also identified as a key factor when considering HIVST as an option. Much of what makes HIVST attractive to individuals is their ability to self-determine how HIVST can be best integrated into their lives as a harm reduction tool for stigma and sexual risk mitigation. Conclusion: While there is substantial evidence suggesting HIVST is feasible for use and there are aspects of HIVST that are beneficial and preferred over traditional testing approaches, there is a lack of rigorous implementation studies exploring how best to scale up HIVST in community settings. HIVST has the potential to be a powerful biobehavioral HIV prevention and harm reduction tool to empower individuals to engage with testing on their own terms while providing pathways to prevention and care support.

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Section: Discussionmentioning

confidence: 99%

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

Hawk¹,

Chung²,

Creasy³

et al. 2020

PPA

View full text Add to dashboard Cite

show abstract

“…In this study, most participants in the UH arm who tested HIV seropositive were linked to care without a difference between the UH and DAH arms, thereby indicating the potential value of UH as a way to test and treat individuals living with HIV. Nevertheless, the monitoring and evaluation of UH present a real challenge in the DRC, where the health system remains very poor [27].…”

Section: Discussionmentioning

confidence: 99%

Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: a randomized feasibility trial

et al. 2020

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Background HIV self-testing (HIVST) can be performed using directly assisted and unassisted approaches in facilities or communities to reach different populations. The aim of this study was to compare the practicability and effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) and directly assisted HIVST (DAH), in the field setting of Kisangani, the Democratic Republic of the Congo (DRC). Methods A randomized (1:1), non-blinded, non-inferiority trial using a blood-based and facility-based HIVST method was carried out in four facilities in Kisangani, the DRC, targeting populations at high risk for HIV infection. The primary outcome was the difference in the practicability of the HIV self-test between the two arms. Practicability was defined as successfully performing the test and correctly interpreting the result. Requests for assistance, positivity rate, linkage to care, and willingness to buy an HIV self-test kit constituted the secondary outcomes for HIVST effectiveness. The adjusted risk ratios (aRRs) were calculated using Poisson regression. Results The rate of successfully performing the test was same (93.2%) in the UH and DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of − 6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). Although the positivity rate was 3.4% among the participants in the DAH arm and 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, and linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001). Conclusion The results of this study indicate that UH is as practicable and effective as DAH among individuals at high risk for HIV infection in Kisangani, the DRC. However, additional support tools need to be assessed to improve the interpretation of the self-test results when using the UH approach. Trial registration PACTR201904546865585. Registered 03 April 2019 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=6032

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“…Acceptability and willingness to consent to take at-home HIV testing may have been higher with OraQuick’s oral fluid HIV test given that it provides results in just 20 min and is less invasive [ 40 , 43 ]. However, while oral swab rapid self-testing kits are suitable for some populations and settings as they do not require samples to be sent to a laboratory for analysis [ 23 , 44 ], lower sensitivity in comparison to blood specimen and lack of counseling and supervision may lead to false reassurance and the possibility of risk compensation [ 23 , 45 ].…”

Section: Limitationsmentioning

confidence: 99%

“…Given limited HIV prevention and testing infrastructure [17,18] and the roles that stigma, lack of confidentiality, and barriers to transportation play in suboptimal uptake of HIV testing and prevention services in rural communities [20], at-home HIV testing may present an innovative opportunity to increase access to and frequency of HIV testing among PWID [21][22][23]. Studies have explored acceptability and uptake of at-home HIV testing involving dried blood spots, but these have primarily been conducted among men who have sex with men (MSM) [21,[24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Willingness to Participate in At-Home HIV Testing Among Young Adults Who Use Opioids in Rural Appalachia

et al. 2020

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New HIV infections associated with injection drug use are of major concern in rural US communities. This study explores acceptability of, consent for, and uptake of free at-home HIV testing among people who use drugs (PWUD) in one of the nation's epicenters for drug-related harms and HIV vulnerability: Rural Central Appalachia. Eligible participants were 18-35 years old, lived in Appalachian Kentucky, and reported using opioids to get high in the previous 30 days. A majority reported being likely (63.6%, 96/151) to take a free at-home HIV tests and 66.9% (101/151) consented to receive one. Among those who were randomly selected to receive a Home Access HIV-1 test kit (n = 37), 37.8% mailed in blood spots and 21.6% called to receive results. This study provides evidence that PWUD may be willing to take an at-home test, but other barriers may inhibit actual completion.

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Bringing HIV Self-Testing to Scale in the United States: a Review of Challenges, Potential Solutions, and Future Opportunities

Cited by 50 publications

References 50 publications

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

<p>A Scoping Review of Patient Preferences for HIV Self-Testing Services in the United States: Implications for Harm Reduction</p>

Comparison of practicability and effectiveness between unassisted HIV self-testing and directly assisted HIV self-testing in the Democratic Republic of the Congo: a randomized feasibility trial

Willingness to Participate in At-Home HIV Testing Among Young Adults Who Use Opioids in Rural Appalachia

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