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HIV Self-Test Distribution Boosts Testing, Awareness, Study Says

NEW YORK — Distribution of free HIV self-tests via the internet can increase testing for the disease by men who have sex with men (MSM) and boost awareness among members of their social networks, potentially limiting transmission of the disease, according to a new study.

The findings, which appear in this week's JAMA Internal Medicine, suggest that HIV prevention programs should include an HIV self-testing mail distribution program to their portfolios of prevention services for high-risk populations.

In 2015, the Centers for Disease Control and Prevention initiated a longitudinal study — called Evaluation of Rapid HIV Self-testing Among MSM Project, or eSTAMP — to examine the effectiveness of mailing HIV self-tests to MSM in the US, particularly in regards to frequency of testing, diagnoses of HIV infection, sexual risk behaviors, and the use of self-tests by social network members.

A total of 2,665 participants were recruited through advertisements placed on social network, music, and dating websites frequented by MSM. The study was limited to US males at least 18 years of age who reported engaging in anal sex with at least one man in the past 12 months, reported being HIV negative or unaware of HIV status, had never been diagnosed with a bleeding disorder, had never participated in an HIV vaccine trial, and were not taking antiretroviral medications to prevent HIV.

All participants received access to online HIV testing resources and telephone counseling on request, but half were randomly assigned a self-testing arm that were mailed two oral fluid HIV self-tests — OraSure Technologies' OraQuick In-Home HIV test — and two fingerstick whole blood HIV self-tests — Chembio Diagnostics' Sure Check HIV 1/2 assay. Individuals in the self-testing arm could also order additional tests to replace tests that were used or given away.

All study participants were asked to answer surveys every three months in exchange for payment throughout the study's 12-month term, and all received self-tests at the end of the trial.

The eSTAMP researchers found that those who received the self-tests reported testing more frequently than those who did not, with most reporting testing three times or more during the study period. Of the 36 newly identified HIV infections reported by all the trial's participants, 26 were from those who received self-tests. 

Notably, nearly half of the total number of infections reported were among participants who had not been tested in the preceding year, with nine infections diagnosed in individuals who had never been tested before. Additionally, study participants in the self-testing arm reported 34 newly identified HIV infections among members of their social networks with whom they shared the tests.

The investigators also observed a roughly 57 percent overall increase in annual HIV testing among those receiving self-tests. Specifically, 61 percent of trial participants in the self-testing arm received annual testing before enrollment in the study, but that figure climbed to 96 percent at the end of the study. The percentage of control arm participants who tested for HIV annual increased only 5 percent over the course of the study, to 63 percent from 60 percent. Moreover, nearly all of those receiving self-tests reported testing at least once during the study compared with fewer than two-thirds of control arm participants.

Based on these findings, the study's authors wrote, "distribution of HIV self-tests provides a worthwhile mechanism to increase awareness of HIV infection and prevent transmission among MSM," and should be considered for inclusion in prevention programs.

"Additional implementation research on HIV self-testing could provide information about the most cost-effective methods for online recruitment, optimal frequency of self-test provision, linkage of HIV-positive persons to care, and HIV behavioral messaging to improve operational expansion of HIV self-testing," they added.