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Gobin M, Horwood J, Stockwell S, Denford S, Copping J, Lawson L, Hayward S, Harryman L, Kesten JM. Qualitative evaluation of digital vending machines to improve access to STI and HIV testing in South West England: using a Person-Based Approach. BMJ Open 2024; 14:e084786. [PMID: 38862218 PMCID: PMC11168124 DOI: 10.1136/bmjopen-2024-084786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/15/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES To report the development, implementation, acceptability and feasibility of vending machines offering HIV and sexually transmitted infection (STI) testing kits. DESIGN A qualitative study using the Person-Based Approach with patient and public involvement workshops and stakeholder involvement and interviews with machine users, sexual health service (SHS) staff, venue staff and local authority sexual health commissioners. Transcripts were analysed thematically. SETTING Bristol, North Somerset and South Gloucestershire (BNSSG). PARTICIPANTS 15 machine users, 5 SHS staff, 3 venue staff and 3 local authority commissioners. INTERVENTION Four vending machines dispensing free HIV self-testing and STI self-sampling kits in publicly accessible venues across BNSSG were introduced to increase access to testing for groups at higher risk of HIV and STI infection who are less likely to access SHS clinic testing services (young people, people from black communities, and gay, bisexual and other men who have sex with men). RESULTS Machine users reported the service was convenient, easy to use and accessible; however, concerns regarding privacy related to machine placement within the venues and issues of maintenance were raised. Promotional material was inclusive and informative; however, awareness of the service through the promotional campaign was limited. Vending machines were acceptable to venue staff once clear processes for their management were agreed with the SHS. SHS staff identified challenges with the implementation of the service related to the limited involvement of the whole SHS team in the planning and development. CONCLUSIONS The codeveloped vending machine service was acceptable, addressing some barriers to testing. Resources and protected staff time are needed to support greater involvement of the whole SHS team and service providers in venues. Adopting a similarly robust coproduction approach to the implementation of the machines could avoid the challenges reported. The placement of the machines to assure users privacy and repeated, targeted promotion could encourage service use among target groups.
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Affiliation(s)
- Maya Gobin
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Sciences and Evaluation and NIHR Applied Research Collaboration (ARC) West, University of Bristol, Bristol, UK
| | - Sarah Stockwell
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Denford
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Sciences and Evaluation and NIHR Applied Research Collaboration (ARC) West, University of Bristol, Bristol, UK
| | | | - Lottie Lawson
- South Gloucestershire Council, South Gloucestershire, UK
| | | | - Lindsey Harryman
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Joanna M Kesten
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Sciences and Evaluation and NIHR Applied Research Collaboration (ARC) West, University of Bristol, Bristol, UK
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Gobin M, Dhillon S, Kesten JM, Horwood J, Dean GL, Stockwell S, Denford S, Mear J, Cooper R, Copping J, Lawson L, Hayward S, Harryman L, Vera JH. Acceptability of digital vending machines to access STI and HIV tests in two UK cities. Sex Transm Infect 2024; 100:91-97. [PMID: 38302411 DOI: 10.1136/sextrans-2023-055969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/02/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Prompt HIV and STI diagnosis and treatment is a public health priority and relies on accessible testing. Technology-based approaches to distribute test kits have the potential to increase access to testing. We evaluated the acceptability and uptake of vending machines in publicly available settings in Brighton and Hove (BH) and Bristol, North Somerset and South Gloucestershire (BNSSG), to distribute HIV rapid self-test and STI self-sample kits. METHODS Seven machines were installed in BH and four in BNSSG. User characteristics, proportion of kits returned and test results, taken from the machine database and clinic records, combined with online questionnaires completed by self-recruited users and analysed using Stata and SPSS. RESULTS 2536 kits were dispensed over 12 months (April 2022 to March 2023). The STI self-sample kits were most popular (74% of vends). 78% of kits dispensed were among users aged 16-35 years and 56% identified as male. 68% and 59% of users had either not tested in the last 12 months or never tested for HIV and STIs, respectively. 51% of STI kits were returned via post, lower than the local online service (65%). 208 users completed questionnaires. Convenience, desire for instant access and increased confidentiality were the most common reasons for using machines. 92% of respondents thought the machines were user-friendly and 97% would recommend the service. Concerns about safety and privacy while using the machine were reported by 42% and 66% of respondents. CONCLUSIONS This study demonstrates that vending machines are an acceptable and effective means of accessing infrequent or never testers in the general population and can act as a horizontal intervention to tackle HIV and STIs. Research is needed to understand optimal machine locations to assure privacy and safety along with the long-term impact on sexual health services.
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Affiliation(s)
- Maya Gobin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Syra Dhillon
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Joanna May Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gillian Louise Dean
- HIV and GUM Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Sarah Stockwell
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - John Mear
- HIV and GUM Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- Sexual Health & HIV, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Samuel Hayward
- North Somerset Council, Weston-super-Mare, North Somerset, UK
| | - Lindsey Harryman
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jaime H Vera
- Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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Chen S, Fang Y, Chan PSF, Kawuki J, Mo P, Wang Z. Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e45647. [PMID: 38265866 PMCID: PMC10851126 DOI: 10.2196/45647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. OBJECTIVE This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. METHODS A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. RESULTS A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. CONCLUSIONS Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. TRIAL REGISTRATION PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.
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Affiliation(s)
- Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Paul Shing-Fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Phoenix Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Tieosapjaroen W, Ong JJ, Fairley CK, Saleem K, Phillips TR, Tran J, Bradshaw CS, Chen MY, Chow EPF. Trends and associated factors in HIV testing among heterosexual men and women in Melbourne, Australia, 2011-2020. Sex Health 2023; 20:411-423. [PMID: 37468130 DOI: 10.1071/sh22195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing behaviours. We investigated the trends and factors associated with HIV testing behaviours among heterosexuals. METHODS We analysed the trend and proportion of heterosexuals attending the centre for the first time between 2011 and 2020, who had ever tested and tested for HIV in the past 12months and the median number of months since their last HIV test. We identified factors associated with HIV testing behaviours using univariable and multivariable logistic regressions. RESULTS Of the 78652 heterosexuals included, 53.1% were men and 46.9% were women. Overall, the proportion of heterosexuals who had ever tested for HIV was 40.8%, with a declining testing trend from 40.2% in 2011 to 36.5% in 2020 (P trend <0.001). Overall, the proportion of heterosexuals tested for HIV in the past 12months was 15.7%, with no significant change from 15.3% in 2011 to 14.7% in 2020 (P trend =0.489). The median number of months since the last HIV test decreased from 18.0 (IQR 6.9-37.3) in 2011 to 15.0 (IQR 6.4-32.5) in 2020 (P trend <0.001). Individuals who had condomless sex with casual partners (aOR 0.92, 95% CI 0.88-0.96) and who were diagnosed with a sexually transmitted infection (aOR 0.88, 95% CI 0.84-0.93) were less likely to have ever tested for HIV. CONCLUSIONS HIV testing was low among heterosexuals, and individuals who engaged in condomless sex and had another sexually transmitted infection were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Kanwal Saleem
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
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Rocha GM, Cândido RCF, de Carvalho NP, Carvalho EGA, Costa AAM, Machado IV, da Cruz Pimenta MP, de Paula Júnior JA, Guimarães MDC, de Pádua CAM. Strategies to increase HIV testing among men who have sex with men and transgender women: an integrative review. BMC Infect Dis 2023; 23:240. [PMID: 37072705 PMCID: PMC10111644 DOI: 10.1186/s12879-023-08124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/28/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TGW) are disproportionately affected by HIV, with much higher incidence and prevalence rates than in the general population in different countries. There are several barriers to testing among MSM and TGW, such as low risk perception, anticipation of HIV-related stigma, discrimination of sexual orientation, in addition to difficulties related to care and access to health services. Therefore, analyzing the available evidence of the effectiveness of strategies for scaling up HIV testing among key populations is essential to point out potential knowledge gaps which may need to be addressed and develop public health policies to promote testing and early diagnosis of HIV infection. METHODS An integrative review was carried out to evaluate strategies for scaling up HIV testing in these populations. Search strategy was performed on eight electronic databases, without language restriction. We included clinical trials, quasi-experimental studies, and non-randomized studies. Study selection and data extraction were both performed independently by pairs and disagreements were solved by a third revisor. The screening of the studies was carried out through the selection of titles/abstracts and the reading of the full texts of the pre-selected studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data extraction was performed using a structured form. RESULTS Thirty-seven publications referring to 35 studies were included, mostly being carried out in the United States of America and Australia. No studies were found evaluating disaggregated data on TGW. The studies were grouped into four types of intervention strategies: self-test distribution system (n = 10), organization of health services (n = 9), peer education (n = 6), and social marketing campaign (n = 10). Strategies that focused on the first three groups, combined or not, were more effective in increasing HIV testing among MSM. CONCLUSIONS Considering the diversity of interventions and the methodological heterogeneity of the included studies, strategies especially involving self-test distribution systems, associated with new information and communication technologies, should be evaluated in different communities and social contexts. Research evaluating specific studies on TGW population is still needed.
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Kaneko N, Sherriff N, Takaku M, Vera JH, Peralta C, Iwahashi K, Ishida T, Mirandola M. Increasing access to HIV testing for men who have sex with men in Japan using digital vending machine technology. Int J STD AIDS 2022; 33:680-686. [PMID: 35502984 PMCID: PMC9189596 DOI: 10.1177/09564624221094965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In Japan, most new HIV cases are reported amongst men who have sex with men (MSM); thus, there is an urgent need for further widespread testing of MSM. The use of Digital Vending Machines (DVM) in the UK offering HIV test kits targeting MSM show promising results. Digital Vending Machines could be useful to promote and increase the uptake of testing in Japan, although no studies have yet been conducted. We aimed to assess the acceptability and feasibility of distributing HIV test kits using DVMs exploring needs and concerns as well as preferred types of test kits and locations. Methods: Fifty-four individuals participated in workshops and meetings with a further 224 MSM answering a quantitative survey assessing HIV testing and prevention needs. Results: Amongst MSM who had never been tested, 73% showed willingness to purchase tests from DVMs. Responses were broadly positive about DVMs but there were concerns regarding being seen receiving test kits from the machines and linkage to confirmatory testing and appropriate care. Conclusions: Using DVMs to distribute HIV test kits in Japan was found to be both acceptable and feasible and may have the potential to increase access to testing for MSM. Future large-scale evaluation studies are required.
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Affiliation(s)
- Noriyo Kaneko
- Department of Global and Community Health Nursing, School of Nursing, 12963Nagoya City University, Nagoya, Japan
| | - Nigel Sherriff
- School of Sport and Health Sciences, 1947University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, 1947University of Brighton, Brighton, UK
| | - Michiko Takaku
- School of Nursing, 157621Gifu University of Health Sciences, Gifu, Japan
| | - Jaime H Vera
- Centre for Global Health and Infection, 1949Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Carlos Peralta
- Department of Art and Design, 7314Sheffield Hallam University, Sheffield, UK
| | | | | | - Massimo Mirandola
- School of Sport and Health Sciences, 1947University of Brighton, Brighton, UK.,Infectious Diseases Section, Department of Diagnostics and Public Health, 19051University of Verona, Verona, Italy
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Ferguson L, Narasimhan M, Gutierrez J, Jardell W, Gruskin S. Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health. Sex Reprod Health Matters 2022; 29:2105284. [PMID: 35975874 PMCID: PMC9387312 DOI: 10.1080/26410397.2022.2105284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Self-care interventions for health are becoming increasingly available, and among the preferred options, including during the COVID-19 pandemic. This research assessed the extent of attention to laws and policies, human rights and gender in the implementation of self-care interventions for sexual and reproductive health (SRH), to identify where additional efforts to ensure an enabling environment for their use and uptake will be useful. A literature review of relevant studies published between 2010 and 2020 was conducted using PubMed, Scopus and Web of Science. Relevant data were systematically abstracted from 61 articles. In March–April 2021, semi-structured interviews were conducted with 10 key informants, selected for their experience implementing self-care interventions for SRH, and thematically analysed. Laws and policies, rights and gender are not being systematically addressed in the implementation of self-care interventions for SRH. Within countries, there is varied attention to the enabling environment including the acceptability of interventions, privacy, informed consent and gender concerns as they impact both access and use of specific self-care interventions, while other legal considerations appear to have been under-prioritised. Operational guidance is needed to develop and implement supportive laws and policies, as well as to ensure the incorporation of rights and gender concerns in implementing self-care interventions for SRH.
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Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| | - Jose Gutierrez
- Student, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- Project Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Professor of Population and Public Health Sciences and Law, Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Muwanguzi PA, Nasuuna EM, Namimbi F, Osingada CP, Ngabirano TD. Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study. BMC Health Serv Res 2021; 21:1217. [PMID: 34753460 PMCID: PMC8577403 DOI: 10.1186/s12913-021-07259-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men’s preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. Methods This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. Results Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. Conclusion We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men’s leisure and recreation ‘hot spots’, Additionally, female partners, peers and established men’s group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.
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Affiliation(s)
- Patience A Muwanguzi
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Esther M Nasuuna
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Florence Namimbi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Peter Osingada
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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McGuire M, de Waal A, Karellis A, Janssen R, Engel N, Sampath R, Carmona S, Zwerling AA, Suarez MF, Pai NP. HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010-2021). EClinicalMedicine 2021; 39:101059. [PMID: 34430835 PMCID: PMC8367787 DOI: 10.1016/j.eclinm.2021.101059] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. METHODS We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. FINDINGS 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77-97%), preferred over in-person and hybrid options by more first-time testers (47-48%), highly feasible (93-95%), and were overall effective in supporting linkage to care (53-100%). Social media and app-based innovations also had high acceptability (87-95%) and linkage to care proportions (80-100%). SMS innovations increased kit return rates (54-94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54-93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. INTERPRETATION HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally.
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Affiliation(s)
- Madison McGuire
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Anna de Waal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Angela Karellis
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
| | - Ricky Janssen
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Nora Engel
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Rangarajan Sampath
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z, Canada
| | | | - Nitika Pant Pai
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
- Corresponding author at: The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada.
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10
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Romero RA, Klausner JD, Marsch LA, Young SD. Technology-Delivered Intervention Strategies to Bolster HIV Testing. Curr HIV/AIDS Rep 2021; 18:391-405. [PMID: 34109549 PMCID: PMC8188945 DOI: 10.1007/s11904-021-00565-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. PURPOSE OF REVIEW: This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. RECENT FINDINGS: A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors' experiences using a number of these technologies in our research.
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Affiliation(s)
- Romina A Romero
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
| | - Jeffrey D Klausner
- Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA.
- Department of Informatics, University of California, Irvine, 6091 Bren Hall, Irvine, CA, 92617, USA.
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11
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#Testathome: Implementing 2 Phases of a HIV Self-Testing Program Through Community-Based Organization Partnerships in New York City. Sex Transm Dis 2021; 47:S48-S52. [PMID: 32149962 DOI: 10.1097/olq.0000000000001151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Access to human immnodeficiency virus (HIV) testing in New York City (NYC) has increased, but disparities in testing rates still exist among most communities impacted by HIV. HIV self-tests (HIVSTs) present an opportunity to address testing barriers, but HIV-affected communities experience difficulties accessing HIVSTs, including lack of awareness and cost. To support increased access to HIVSTs, the NYC Health Department launched a partnership with select organizations to pilot distribution of free HIVSTs in 2 phases among priority populations across NYC. METHODS Organizations that were diverse in their missions, experiences, capacities and populations served were recruited through a formal application process. The program initially launched with 10 organization partners (phase 1); as the pilot continued, partners identified necessary revisions to the program and launched a second phase in year 2. Both phases included outreach to NYC priority populations, HIVST distribution/redemption, and a follow-up survey. RESULTS From March 2017 to August 2019, organizations distributed 75 HIVSTs during phase 1 and 252 during phase 2. All intended priority populations were reached, notably, those who had never tested before: 35% in phase 1 and 12% in phase 2. Over half of the follow-up survey respondents reported testing sooner. Respondents reported liking the HIVST because it did not require a visit to a clinic (84%) and preferred an HIVST to testing in a clinic (92%). CONCLUSIONS Through 2 phases of implementation, this innovative partnership was able to reach and offer HIVSTs to priority populations across NYC. This program supports the feasibility of distributing HIVSTs through close partnerships with diverse organizations.
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12
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Magno L, Leal AF, Knauth D, Dourado I, Guimarães MDC, Santana EP, Jordão T, Rocha GM, Veras MA, Kendall C, Pontes AK, de Brito AM, Kerr L. Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil. BMC Infect Dis 2020; 20:865. [PMID: 33213389 PMCID: PMC7678175 DOI: 10.1186/s12879-020-05589-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. METHODS Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile's estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). RESULTS For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. CONCLUSIONS The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.
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Affiliation(s)
- Laio Magno
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil.
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil.
| | - Andrea Fachel Leal
- Sociology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Universidade Federal do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | | | - Elis Passos Santana
- Institute of Collective Health, Federal University of Bahia, R. Basílio da Gama, s/n - Canela, Salvador, 45760-030, Bahia, Brazil
| | - Tiago Jordão
- Department of Life Sciences, Bahia State University, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Bahia, Brazil
| | | | | | - Carl Kendall
- Tulane School of Public Health and Tropical Medicine, New Orleans, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Ligia Kerr
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
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13
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Ong JJ, De Abreu Lourenco R, Street D, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton B, Grulich A, Stoove M, Holt M, Kaldor J, Guy R. The Preferred Qualities of Human Immunodeficiency Virus Testing and Self-Testing Among Men Who Have Sex With Men: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:870-879. [PMID: 32762988 DOI: 10.1016/j.jval.2020.04.1826] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/27/2020] [Accepted: 04/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Human immunodeficiency virus self-testing (HIVST) is a promising approach to improve HIV testing coverage. We aimed to understand HIV testing preferences of men who have sex with men (MSM) to optimize HIVST implementation. METHODS Discrete choice experiments (DCEs) were conducted among HIV-negative MSM living in Australia and aged ≥18 years. Men completed 1 of 2 DCEs: DCETest for preferred qualities of HIV testing (price, speed, window period, test type, and collector of specimen) and DCEKits for preferred qualities of HIVST kits (price, location of access, packaging, and usage instructions). Latent class conditional logit regression was used to explore similarities (or "classes") in preference behavior. RESULTS Overall, the study recruited 1606 men: 62% born in Australia, who had an average age of 36.0 years (SD 11.7), and a self-reported median of 4 (interquartile range 2-8) sexual partners in the last 6 months. The respondents to DCETest was described by 4 classes: "prefer shorter window period" (36%), "prefer self-testing" (27%), "prefer highly accurate tests" (22%), and "prefer low prices" (15%). Respondents to DCEKits were described by 4 classes: "prefer low prices" (48%), "prefer retail access (from pharmacy or online stores)" (29%), "prefer access at sex venues" (15%), and "prefer to buy from healthcare staff" (12%). Preferences varied by when someone migrated to Australia, age, frequency of testing, and number of sexual partners. CONCLUSION A subset of MSM, particularly infrequent testers, value access to HIVST. Expanding access to HIVST kits through online portals and pharmacies and at sex venues should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Adam Hynes
- Thorne Harbour Health, Melbourne, Australia
| | | | | | | | | | | | - Martin Holt
- University of New South Wales, Sydney, Australia
| | - John Kaldor
- University of New South Wales, Sydney, Australia
| | - Rebecca Guy
- University of New South Wales, Sydney, Australia
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14
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Witzel TC, Weatherburn P, Bourne A, Rodger AJ, Bonell C, Gafos M, Trevelion R, Speakman A, Lampe F, Ward D, Dunn DT, Gabriel MM, McCabe L, Harbottle J, Collaco Moraes Y, Michie S, Phillips AN, McCormack S, Burns FM. Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020466. [PMID: 31936798 PMCID: PMC7014239 DOI: 10.3390/ijerph17020466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/02/2022]
Abstract
SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
- Correspondence:
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne 3086, Australia;
| | - Alison J. Rodger
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1h 9SH, UK;
| | | | - Andrew Speakman
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Fiona Lampe
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - David T. Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Michelle M. Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | | | - Yolanda Collaco Moraes
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Susan Michie
- Centre for Behaviour Change, University College London, London WC1N 3AZ, UK;
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Fiona M. Burns
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
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15
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Witzel TC, Bourne A, Burns FM, Rodger AJ, McCabe L, Gabriel MM, Gafos M, Ward D, Collaco-Moraes Y, Dunn DT, Speakman A, Bonell C, Pebody R, Lampe FC, Harbottle J, Phillips AN, McCormack S, Weatherburn P. HIV self-testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self-Testing Public Health Intervention) randomized controlled trial in England and Wales. HIV Med 2019; 21:189-197. [PMID: 31821698 PMCID: PMC7065141 DOI: 10.1111/hiv.12818] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/21/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
Objectives SELPHI (HIV Self‐Testing Public Health Intervention) is the largest randomized controlled trial (RCT) of HIV self‐testing (HIVST) in a high‐income setting to date, and has recruited 10 000 men who have sex with men (cis‐ and transgender) and transgender women who have sex with men. This qualitative substudy aimed to explore how those utilizing self‐tests experience HIVST and the implications for further intervention development and scale‐up. This is the first qualitative study in Europe investigating experiences of HIVST among intervention users, and the first globally examining the experience of using blood‐based HIVST. Methods Thirty‐seven cisgender MSM SELPHI participants from across England and Wales were purposively recruited to the substudy, in which semi‐structured interviews were used to explore testing history, HIVST experiences and intervention preferences. Interviews were audio‐recorded, transcribed and analysed through a framework analysis. Results Men accessed the intervention because HIVST reduced barriers related to convenience, stigma and privacy concerns. Emotional responses had direct links to acceptability. Supportive intervention components increased engagement with testing and addressed supportive concerns. HIVST facilitated more frequent testing, with the potential to reduce sexually transmitted infection (STI) screening frequency. Substudy participants with an HIV‐positive result (n = 2) linked to care promptly and reported very high acceptability. Minor adverse outcomes (n = 2; relationship discord and fainting) did not reduce acceptability. Ease of use difficulties were with the lancet and the test processing stage. Conclusions Intervention components shaped acceptability, particularly in relation to overcoming a perceived lack of support. The intervention was broadly acceptable and usable; participants expressed an unexpected degree of enthusiasm for HIVST, including those with HIV‐positive results and individuals with minor adverse outcomes.
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Affiliation(s)
- T C Witzel
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - F M Burns
- Institute for Global Health, University College London, London, UK
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - L McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - M M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - M Gafos
- Medical Research Council Clinical Trials Unit, University College London, London, UK.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Y Collaco-Moraes
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - D T Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - C Bonell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - F C Lampe
- Institute for Global Health, University College London, London, UK
| | | | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - S McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - P Weatherburn
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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