Self-administration Can Help to Alleviate HIV-Related Testing Hurdles

According to the CDC’s most recent Morbidity and Mortality Weekly Report, publicly funded HIV self-test kits distributed directly to potential consumers may help to overcome testing-related hurdles and facilitate access to HIV-related care services.

The report out this week highlights how as recently as 2019, a disproportionate 80% of HIV transmission was the result of persons not knowing their serostatus or individuals falling out of regular care, despite the CDC’s 2006 recommendation of yearly testing among at-risk populations—one of which is men who have sex with men (MSM).

A potential solution is self-testing, and coinciding with the start of the COVID-19 pandemic, the TakeMeHome partnership aimed to reach those seeking home-care options for reasons that included lack of access to clinic testing and stay-at-home orders that restricted traditional testing services.

“The COVID-19 pandemic disrupted HIV testing services, persons reported not being able to access HIV testing services, and hundreds of thousands of HIV screening tests were either delayed or skipped,” the report notes.

For the March 31, 2020, through March 31, 2021, period, 17 state and local health departments participated by first reaching out to gay, bisexual, and other MSM through gay dating apps and offering no-cost rapid HIV self-tests and following up with a survey 10 days after the self-test kits were mailed. Thirty-six percent of participants noted they had never tested for HIV and 56% said their most recent test was more than a year prior.

A total of 5325 kits were mailed to 4904 persons—67% self-identified as cisgender men and 6%, transgender, nonbinary, or genderqueer—in this first year of TakeMeHome, and 17% responded to the follow-up survey. Most were aged 25 to 34 years (39%) or 18 to 24 years (30%), were of White (38%) or Hispanic/Latino (26%) ethnicity, and had 1 (34%) or at least 3 (26%) sexual partners in the past year.

Analysis of the follow-up survey data also revealed the following:

• 86% reported a recent HIV risk
• 73% reported male-to-male sexual contact
• 71% heard about TakeMeHome through a gay-dating app
• 34% said they used TakeMeHome because of less HIV testing due to the pandemic
• 10% accessed testing for other sexually transmitted infections (STIs)
• 8% accessed pre-exposure prophylaxis (PrEP)
• 90% would recommend TakeMeHome to a friend
• 63% liked the program’s convenience
• 46% liked the privacy the program allowed

Results were also positive for those reporting they had never gotten tested for HIV: 8% accessed testing for other STIs and 6% accessed PrEP.

TakeMeHome has since expanded nationwide and to Puerto Rico, with more than 43,000 orders encompassing over 76,000 HIV self-test kits from February through July 2021 alone.

“HIV self-testing is a proven intervention that represents a paradigm shift in testing practices and is a key strategy to support the goals of the Ending the HIV Epidemic in the United States initiative,” the report concludes. “HIV self-test distribution addresses many privacy concerns, and this program demonstrated, among the subset who provided follow-up data, that self-testing served as a bridge to additional HIV and STI prevention services for persons who needed them.”

To continue making progress in this space, the authors wrote, future marketing needs to target minority groups disproportionately affected by HIV and increase engagement with health departments in areas with greater numbers of disproportionately affected populations.

Reference

Hecht J, Sanchez T, Sullivan PS, DiNenno EA, Cramer N, Delaney KP. Increasing access to HIV testing through direct-to-consumer HIV self-test distribution—United States, March 31, 2020–March 30, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(38):1322-1325. doi:10.15585/mmwr.mm7038a2