HIV Self-Tests Boost Testing Among MSM

Providing HIV self-tests directly to populations at high risk for HIV infection could help increase access to testing and additional prevention services, according to a recent Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention.

The report analyzed the TakeMeHome program, a public-private partnership to distribute HIV self-test home kits to at-risk populations, between March 31, 2020, to March 30, 2021. The program targeted gay, bisexual and other men who have sex with men (MSM) through online dating apps like Grindr along with public health campaigns.

“Our goal here was to reach individuals who weren’t accessing traditional testing services and we found that we were able to do that demonstrated by 36% of the program participants reporting that they’d never had an HIV test before,” Jen Hecht, MPH, co-founder of Building Healthy Online Communities (BHOC) and leader of the TakeMeHome program, told Contagion. “We did this by developing relationships with nontraditional partners and removing as many barriers to testing as possible.”

BHOC developed the program in partnership with Emory University and the National Alliance of State & Territorial AIDS Directors (NASTAD), offering OraQuick In-Home HIV Tests paid for by state and local health departments or other partners. The CDC provided technical assistance.

“We know the barriers to testing can include time or transportation, stigma and sometimes not even knowing where to go,” Hecht said. “What we heard from our users was that they wanted tests that were convenient, free and discrete and we worked to make the experience as seamless as possible and to normalize the process as much as possible. We think ordering an HIV test should be as easy as ordering a pizza.”

During the first year of the program, 17 state and local health departments supported mailing 5325 self-test home kits to 4904 people, including 36% who reported never having been tested for HIV before and 56% who reported that it had been more than a year since their last HIV test.

The CDC recommends MSM and other at-risk groups get tested for HIV at least once a year.

Participants were offered a follow-up survey 10 days after test kits were mailed, yielding responses from 855 participants (17%). A majority (71%) said they heard of the program through messaging on gay dating apps and even more (90%) said they would recommend the program to a friend. Many listed convenience (63%) and privacy (46%) as strengths of the program.

The follow-up survey also found that 10% of respondents accessed additional STI testing, and 8% accessed PrEP.

“I think that Jen’s ability to follow up with the people who participated in the program and document that they are having good and appropriate follow-up and outcomes adds peace of mind to the health departments that are looking to partner with her and continue to make this program grow,” corresponding author Kevin P. Delaney, PhD, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, told Contagion.

The TakeMeHome program was developed before the COVID-19 pandemic. In-person health care visits dropped in the early days of the pandemic as public health measures encouraged people to stay home. A study by Monogram Biosciences/Labcorp in San Francisco found a 17.5% decrease in HIV diagnostic test volume in the United States from March to October 2020, versus the same time period in 2019. This opened an opportunity for at-home self-testing.

“It was complete chance that it launched right as COVID was beginning to impact the US,” Hecht said. “I feel like the silver lining for some of this was that we were able to step in when health departments had to deploy staff to support COVID work. So, this was an opportunity that really gained momentum as a result of what was happening with the COVID pandemic.”

A demonstration project expanding marketing of HIV self-testing has shown increased uptake among other groups, including high-risk heterosexual individuals, minority women and others, corresponding author Kevin P. Delaney, PhD, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, told Contagion.

“Even before the pandemic, HIV self-testing was going to be a key component of CDC’s efforts to end the HIV epidemic in the US and so I think continuing to expand access to self-testing as an option to complement the other places that people can get a test is going to be one of our key strategies going forward,” Delaney said.

Another recent study that examined HIV self-testing among people who use drugs in Louisville, Kentucky, showed that 97% said the self-test kits were easy to use, and 77% said the kits made them feel more confident in tracking their HIV status than traditional testing methods. Most (87.8%) took the self-tests at the health department with the help of staff, but 72% planned to take the test kit at home next time.

Home-based HIV self-tests also were well-received among older adults in South Africa, increasing uptake and knowledge of HIV status, according to a recent study.