Rationale and design of FORTH: a randomised controlled trial assessing the effectiveness of HIV self-testing in increasing HIV testing frequency among gay and bisexual men

Abstract

BackgroundGay and bisexual men (GBM) are a major risk group for HIV acquisition, yet the majority of higher-risk GBM test for HIV less often than recommended (3–6 monthly). HIV self-testing has the potential to increase testing frequency and improve awareness of personal HIV status. HIV self-tests have been approved in some countries, however there are concerns whether self-testing would increase HIV testing frequency enough to compensate for the reduced sensitivity of self-tests in early infection. We describe here a randomised controlled trial to assess the effectiveness of self-testing in increasing HIV testing frequency among higher-risk GBM, and its acceptability.Methods/designParticipants are higher-risk HIV negative GBM (>5 partners or condomless anal intercourse in previous 3 months; n = 350), including 50 GBM who tested for HIV over two years ago or never tested before (‘infrequent-testers’). Participants are recruited from sexual health clinics and community-based organisations, and randomised 1:1 to either self-testing or standard-care (routine clinic-based testing) arms. The trial employs a wait-list control design: participants in the standard-care arm switch to self-testing arm in the second year, and gain access to self-test kits. Participants in the self-testing arm receive four oral-fluid self-test kits at enrolment, with additional kits provided on request. Demographics, sexual behaviour and HIV testing preferences are collected at baseline, and the frequency and pattern of HIV and sexually transmissible infection (STI) testing is collected via online 3-monthly questionnaires. The acceptability of self-testing is assessed at 12 months via an online questionnaire and in-depth interviews. A 24-h telephone support is provided, with expedited follow-up of those with reactive self-test results. The primary outcome is HIV testing frequency (mean number of HIV tests per person) over 12 months, and the secondary outcomes are: mean number of STI tests (chlamydia, gonorrhoea, syphilis) per person; reasons for HIV testing; and acceptability of HIV self-testing.DiscussionThis is the first trial to evaluate the use of self-testing among GBM in Australia, and the first internationally among infrequent testers. The study will provide evidence on whether self-testing increases HIV testing frequency, and its acceptability among GBM. The findings will improve our understanding of self-testing patterns, and whether GBM supplement or replace their existing testing routine.Trial registrationAustralian and New Zealand Clinical Trial Registration number: ACTRN12613001236785, registered on November 12, 2013.

New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self‐testing among men who have sex with men and transgender women in Yangon, Myanmar

“…In Myanmar, this requires the availability of well-written Myanmar language instructions that are easy for participants to understand and interpret. Both directly assisted and unassisted methods, however, can incorporate the use of additional methods for counselling and linkage to services, including availability of telephone hotlines, text messages, videos, social media, and other online applications, which have been used for key populations [ 17 , 33 , 34 ]. Both assisted and unassisted methods are considered screening methods for HIV infection and require confirmatory HIV testing [ 32 ]; in Myanmar, HIVST could include direct linkage to NGOs and other MSM and TW friendly HIV services for confirmatory testing and subsequent care.…”

Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men

“…Successful experiences have demonstrated the benefits of self-testing, such as time/location convenience, protection against privacy disclosure, and increased HIV testing frequency. 28,29,56,57 Innovative testing provisions, such as the community-initiated home-based counseling and self-testing, should be expanded to see whether they can succeed in involving more Chinese MSM to periodically test for HIV.…”

HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design

“…Additionally, HIVST may enhance health system efficiency as a screening tool by directing human resources toward people with a positive self-test result who are in need of further testing, support and referral, thereby directing services more appropriately [8]. Furthermore, HIVST may be more convenient for users as it displays the potential to reduce the number of facility visits for frequent testers and eliminate the need for individuals to travel long distances or wait in long lines to access HIV testing [9].…”