Internet-Distributed HIV Self-Tests Can Reduce HIV Transmission Among Gay Men

By Will Boggs MD

November 21, 2019

NEW YORK (Reuters Health) - Internet-distributed HIV self-tests increase testing rates and newly identified infections among men who have sex with men (MSM), according to results from a randomized clinical trial.

"Self-testing is an important option for some people and in some situations - it saves time, offers privacy, and reaches people who may not be able to or willing to access existing testing services," Robin J. MacGowan of the U.S. Centers for Disease Control and Prevention (CDC), in Atlanta, told Reuters Health by email.

MSM account for more than two-thirds of people newly diagnosed with HIV infection, yet one in six MSM is unaware of his infection. Previous studies have shown that providing HIV self-tests directly to participants can increase the uptake or frequency of HIV screening.

MacGowan and colleagues in the eSTAMP study group examined the effect of mailing HIV self-tests to MSM who enrolled in the study via a website on the frequency of testing, diagnoses of HIV infection, sexual risk behaviors and use of the self-test by social-network members.

During the trial, the researchers mailed 8,654 self-tests to participants randomized to the self-test arm of the study. Participants reported using 52.0% of the self-tests and distributing 33.1% of them to their social-network members.

At the 12-month survey, self-test participants reported testing significantly more frequently (mean, 5.3 tests) compared with control participants (mean, 1.5 tests), with 76.6% of self-test participants reporting testing three times or more during the course of the year versus 22% of control participants.

More HIV infections were identified in the self-test arm during the first three months (12/1,325, 0.9%, vs. 2/1,340 controls, 0.1%) as well as the whole 12-month follow-up (1.9% vs. 0.8%), the researchers report in JAMA Internal Medicine, online November 18.

Almost half of these infections (17/36, 47.2%) were among participants who had not been tested in the preceding year (including nine participants who had never been tested before enrollment).

Moreover, 38 self-test participants reported that 52 of their social-network members had obtained a positive result, 29 of whom were unaware of their infection before obtaining a positive self-test result and five of whom had not made the self-test participant aware of their infection prior to the test.

There were no significant differences between participants in the two study arms with respect to most of the secondary sexual-behavior changes.

"CDC recently released specific guidance for HIV screening for gay, bisexual, and other MSM," MacGowan said. "CDC recommends that clinicians screen asymptomatic sexually active MSM at least annually. Furthermore, clinicians should consider the benefits of more frequent screening (e.g., once every 3 or 6 months) for individual MSM at increased risk for HIV infection."

"An HIV test can be a critical gateway to protecting the health of people with HIV and stopping new HIV infections," he said. "A positive HIV test can be a catalyst to linking people with HIV to care and treatment, which can protect their health and is key to preventing transmission of HIV. Even a negative HIV test can create an opportunity for providers to link people to powerful prevention tools like pre-exposure prophylaxis (PrEP)."

Dr. Nitika Pant Pai of McGill University, in Montreal, Canada, who recently surveyed stakeholders regarding their attitudes toward HIV self-testing, told Reuters Health by email, "We have global evidence that provision of HIV self-tests helps improve access (and) uptake, and although we have many different distribution models, the Internet-based distribution model can help increase test frequency and detect infections in friends and family. This finding is relevant to those subpopulations who are in need of a self-testing option."

"HIV self-testing is a success story in Africa and Asia, but the uptake of self-testing in the U.S. has been suboptimal," said Dr. Pai, who was not involved in the new study. "HIV self-testing will be popular in U.S. only if the cost of the kits comes down. We should work to make that happen."

"HIV self-testing is meant to reach everyone," she added. "Affordability of tests will be a key driver of HIV self-testing, and we must ensure that with approval of newer self-tests, manufacturers exercise some kind of corporate social responsibility."


JAMA Intern Med 2019.