Study Evaluating Self-Collected Specimen Return for HIV, Bacterial STI, and Potential Pre-Exposure Prophylaxis Adherence Testing Among Sexual Minority Men in the United States

Abstract

Web-based HIV and sexually transmitted infection (STI) prevention studies are increasingly requesting gay, bisexual, and other men who have sex with men (GBMSM) to return self-collected specimens for laboratory processing. Some studies have solicited self-collected extragenital swabs for gonorrhea and chlamydia testing, but to date, none have solicited self-collected hair samples for pre-exposure prophylaxis (PrEP) adherence testing. Project Caboodle! offered 100 racially/ethnically diverse GBMSM aged 18 to 34 years residing across the United States a choice to self-collect at home and return by mail any of the following: a finger-stick blood sample (for HIV testing), a pharyngeal swab, a rectal swab and a urine specimen (for gonorrhea and chlamydia testing), and a hair sample (to visually assess its adequacy for PrEP drug level testing). Despite not incentivizing specimen return, 51% mailed back at least one type of specimen within 6 weeks (1% returned three specimens, 11% returned four specimens and 39% returned all five specimens). The majority of returned specimens were adequate for laboratory processing. Significantly more participants without a college education ( p = .0003) and those who were working full-time or part-time ( p = .0070) did not return any specimens. In addition, lower levels of HIV-related knowledge ( p = .0390), STI-related knowledge ( p = .0162), concern about contracting HIV ( p = .0484), and concern about contracting STIs ( p = .0108) were observed among participants who did not return any specimens. Self-collection of specimens holds promise as a remote monitoring strategy that could supplement testing in clinical settings, but a better understanding of why some GBMSM may choose to fully, partially, or not engage in this approach is warranted.

Understanding Reach, Effectiveness, Adoption, Implementation, and Maintenance of home-based comprehensive sexual health care: a Realist Review

“…They were confident of performing this without supervision at home [29]. Saliva-based sampling was also experienced as acceptable and mostly easy to perform [27, 30–34]. In addition, saliva-based samples had a higher return rate than blood samples [23].…”

“…Overall, though HIV positivity rate varied between different contexts and populations, from 0.2% in a British study to 14.3% in a Chinese study among MSM [32, 60]. A substantial number of studies did not identify any new positive HIV results [20, 26, 30, 31, 33, 34, 40, 53, 61, 62]. Those studies were mainly based in Western continents (Europe, North America) and are focused on MSM.…”

I Can’t Afford it Right Now, So it Doesn’t Matter” Structural Drivers of Viral Suppression Among Men Who Have Sex With Men: A Longitudinal Qualitative Approach

“…Offering home based HIV care is another strategy that has the potential to HIV care inequities experienced among BSMM (37). For those study participants who struggled with either transportation or time barriers to physically getting clinics, home-based care is one way to increase access.…”

HIV and STI Testing Among South Asian Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

“…Patterns of HIV and STI testing were assessed using a series of questions analogous to previous research conducted with GBMSM (Rendina et al, 2014;Sharma et al, 2022;Vincent et al, 2017). Participants were asked to indicate whether they had ever been tested, separately for HIV and STIs (response options: ''Yes'' or ''No''), and if so, when they took their most recent tests (response options: ''In the past 3 months,'' ''3 to 6 months ago,'' ''6 months to 1 year ago,'' ''1 to 2 years ago,'' ''More than 2 years ago''), where they took their most recent tests (response options: ''Private doctor's office,'' ''Community health center,'' ''Urgent care center or walk-in clinic,'' ''Hospital emergency room,'' ''School or college clinic,'' ''HIV or STI testing center,'' ''Mobile testing unit,'' ''Home or other private location''), and how often they got tested (response options: ''Every 3 months,'' ''Every 6 months,'' ''Every year,'' ''Every time I think I might have been exposed,'' ''I do not test regularly'').…”