At-Home STI/HIV Testing Could Increase Screening Rates

Rapid self-testing for sexually transmitted infections (STIs) and HIV could help improve rates of screening, which currently fall below recommendations in the US Centers for Disease Control and Prevention guidelines, according to a recent study.

The study, published in Open Forum Infectious Diseases, included 109 participants, made up of men who have sex with men (MSM) recruited at an HIV/STI testing and treatment program in 2014, who took part in an online questionnaire. The investigation was completed with assistance from the University of California San Diego Antiviral Research Center and funded by the National Institutes of Health.

It found that 78.5% of participants preferred accessing HIV testing at home, with a rapid oral test being preferred by 71.1%. Although participants indicated a preference for the convenience of home testing, educational outreach and provider support remain important. The study found increased high-risk behavior after negative HIV test results. Most participants (70%) preferred direct provider notification of HIV-positive results, while 76.4% wanted to hear about HIV-negative results electronically.

"Although additional research is needed to identify the optimal utilization of multiple aspects of a large-scale HIV and STI self-testing program, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV and STI testing, particularly by reducing inconvenience in the testing process," the study said. "However, efforts to improve convenience in testing programs should be carefully balanced with the need for continued educational outreach efforts."

The study allowed participants to rank a variety of testing methods, such as community outreach events, mobile testing, and kiosks in public spaces against home testing. Respondents under age 45 were slightly less likely to prefer home specimen collection for STI testing, which may have been related to issues with transporting the specimen to the lab.

The risk of HIV transmission is increased among patients diagnosed with an STI such as syphilis, Neisseria gonorrhea and Chlamydia trachomatis. Nearly 70% of respondents reported taking part in risky behavior. The CDC recommends MSM testing at least annually for STIs and HIV and more frequently for those who engage in risky behavior. The most common reason cited for not getting tested was a lack of known prior exposure, and more than half cited lack of symptoms, indicating a need for more educational outreach. Inconvenience was cited as another barrier to testing, particularly among younger respondents.

"The prioritized integration of home rapid HIV and STI testing options into large-scale testing programs has the potential to address this barrier, particularly among young MSM who are at the greatest risk for acquiring HIV and STIs," the study said.

Some limitations of the study included that it was a small sample size with only 109 respondents and reached a relatively homogenous group.

A recent study found that using a smartphone app could link people with positive at-home rapid HIV test results with access to care. The HIVSmart! app provides crucial support to patients from testing to interpreting results to accessing counseling or health care.

Improvements in testing have decreased the percentage of people in the United States who are infected with HIV without being aware of it. In the United States, about 12% to 15% of people infected with HIV are unaware of their infection, compared with about 30% in 2005, according to a recent Contagion^® Peer Exchange program titled “HIV Screening, Prevention, and Treatment Advances.”