HIV Self-tests Promote Screening Among Men at High Risk

Pam Harrison

July 26, 2016

DURBAN, South Africa — When men at high risk for HIV infection are given free kits to test their HIV status at home, the frequency of testing increases, especially among those with a history of infrequent or no previous testing, new research shows.

"In Australia, we have a concentrated epidemic of HIV among gay and bisexual men. About 70% of new HIV diagnoses occur in this population," said Muhammad Jamil, a PhD candidate at the Kirby Institute in Sydney.

"And the prevalence remains high," he told delegates here at the International AIDS Conference 2016.

Jamil and his colleagues targeted HIV-negative gay and bisexual men who had more than five male partners in the previous 3 months or who had engaged in anal intercourse without a condom.

The 180 men randomly assigned to self-testing were given the OraQuick test. Because the specificity of this test is almost 100%, the chances of a false-positive result are very low, Jamil explained.

Current guidelines recommend that high-risk individuals test their HIV status every 3 to 6 months. "We recommended that men self-test every 3 months, so they were given four self-test kits for the 12-month study," he reported.

The 179 men assigned to standard care underwent HIV testing at the usual facilities.

To capture the number of self-tests and the number and location of facility-based tests conducted for HIV and other sexually transmitted infections (STIs), all participants were invited to complete a brief online questionnaire every 3 months.

In addition, the researchers tracked how often men in the self-test group went to a facility to be tested for HIV or other STI.

The intent-to-treat analysis consisted of the 170 men in the self-test group and the 165 men in the standard-care group who completed the 12-month study.

Overall, the mean number of tests conducted was significantly higher in the self-test group than in the standard-care group (4.1 vs 1.9; P < .001).

In the subset of men who had been tested for HIV in the previous 2 years, the mean number of tests conducted was also significantly higher in the self-test group than in the standard-care group (4.2 vs 2.1; P < .001).

And in the subset of men who had not been tested in the previous 2 years, known as infrequent testers, the mean number of tests conducted was significantly higher in the self-test group (2.9 vs 0.7; P < .001).

There was no significant difference between the two groups in the mean number of facility-based HIV or STI tests done during the 12-month study period. This indicates that the men used self-tests as a supplement to their usual testing strategy, rather than replacing it, which is a good outcome, Jamil explained.

 
Self-testing is a very important strategy, and we're going to see it get rolled out in more and more countries.
 

Most men liked the convenience and privacy of having an HIV test they could do at home, but some expressed concern that it was not possible to test for STIs at the same time, he reported. All reported that the test was easy to perform.

"Self-testing among high-risk gay and bisexual men increased HIV testing frequency by more than twofold overall, and by more than fivefold among infrequent testers, without reducing facility-based HIV or STI testing frequency," said Jamil.

"Self-testing should be provided more widely to achieve public health goals of increasing HIV testing frequency," he said.

Participants in the standard-care group are currently being switched to the self-test group; they will be followed for another year.

Self-testing is one of the most important strategies in terms of its potential to help control the epidemic, said session cochair Sheri Lippman, PhD, from the Center for AIDS Prevention Studies at the University of California, San Francisco.

Given the lingering stigma surrounding people with HIV in many countries, "people don't want to be seen in clinics," she told Medscape Medical News.

If a man goes to an HIV clinic in a place like South Africa, "the immediate assumption is that he is HIV-positive," she explained. "We need to give people opportunities to test in places they feel safe."

"Self-testing is a very important strategy, and we're going to see it get rolled out in more and more countries," said Dr Lippman.

"It's a great strategy to let someone know what their HIV status is. Knowing you have HIV is the greatest incentive there is to link to care," she added.

Mr Jamil and Dr Lippman have disclosed no relevant financial relationships.

International AIDS Conference 2016: Abstract FRACO102. Presented July 22, 2016.

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