HIV self‐testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales

Abstract

Objectives SELPHI (HIV Self‐Testing Public Health Intervention) is the largest randomized controlled trial (RCT) of HIV self‐testing (HIVST) in a high‐income setting to date, and has recruited 10 000 men who have sex with men (cis‐ and transgender) and transgender women who have sex with men. This qualitative substudy aimed to explore how those utilizing self‐tests experience HIVST and the implications for further intervention development and scale‐up. This is the first qualitative study in Europe investigating experiences of HIVST among intervention users, and the first globally examining the experience of using blood‐based HIVST. Methods Thirty‐seven cisgender MSM SELPHI participants from across England and Wales were purposively recruited to the substudy, in which semi‐structured interviews were used to explore testing history, HIVST experiences and intervention preferences. Interviews were audio‐recorded, transcribed and analysed through a framework analysis. Results Men accessed the intervention because HIVST reduced barriers related to convenience, stigma and privacy concerns. Emotional responses had direct links to acceptability. Supportive intervention components increased engagement with testing and addressed supportive concerns. HIVST facilitated more frequent testing, with the potential to reduce sexually transmitted infection (STI) screening frequency. Substudy participants with an HIV‐positive result (n = 2) linked to care promptly and reported very high acceptability. Minor adverse outcomes (n = 2; relationship discord and fainting) did not reduce acceptability. Ease of use difficulties were with the lancet and the test processing stage. Conclusions Intervention components shaped acceptability, particularly in relation to overcoming a perceived lack of support. The intervention was broadly acceptable and usable; participants expressed an unexpected degree of enthusiasm for HIVST, including those with HIV‐positive results and individuals with minor adverse outcomes.

Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

“…All kits distributed through SELPHI were BioSure™ 2 nd generation blood based HIVSTs. Full descriptions of the interventions and theoretical underpinnings can be found in prior publications [ 19 , 23 , 24 ]. Here we present an abridged version.…”

“…Analysis combined framework and thematic approaches [26,27]. Our framework drew from emerging themes identified during data generation, the wider literature around trans peoples' experiences of HIVST / sexual health services, theorised key components of intervention acceptability from formative and RCT acceptability work and systematic reviews [18,23,[28][29][30]. The analysis framework can be found in additional file 3.…”

Comparing the effects of HIV self-testing to standard HIV testing for key populations: a systematic review and meta-analysis

“…Finally, some outcomes of interest were not recorded in specific population groups. Adverse events were not reported in RCTs recruiting MSM and trans people (although numerous studies have shown that HIVST is highly acceptable for this group [10,11,35,40,[42][43][44][45][46]). Condom use outcomes were collected mainly in RCTs among MSM, with only one RCT reporting on inconsistent condom use for FSW [28].…”

Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales

“…The two-week follow-up was a form of enablement, increasing motivation (reflective & automatic). In the SELPHI pilot, participants reported the test kit was easy to use, that the instructions were simple and the support structures adequate for their needs [14,15], demonstrating that our efforts to ameliorate capability issues through intervention design were successful.…”

“…Participants in SELPHI who receive HIVST kit(s) are provided with a BioSure TM HIVST, which uses a whole blood sample. Intervention acceptability and test kit usability for SELPHI participants has been reported elsewhere [14,15].…”