- Category: HIV Testing & Diagnosis
- Published on Tuesday, 02 August 2016 00:00
- Written by Roger Pebody
A randomized trial conducted with Australian gay men has shown that easy access to self-testing kits can double the frequency with which men test for HIV, with an even greater increase among men who used to test infrequently, Muhammad Jamil of the Kirby Institute reported at the 21st International AIDS Conference (AIDS 2016) last month in Durban.
Australian guidelines recommend that sexually active gay men should test for HIV at least once a year, and that men at higher risk for HIV should test every 3 to 6 months. However, a third of men at higher risk only test once a year or not at all.
HIV self-tests (devices for home testing) have been approved for sale in the U.S., U.K., France and other countries. Australian policy changed in 2014 to allow manufacturers to submit self-tests for regulatory approval, but none have done so yet.
The Frequency of Oral Rapid Testing at Home (FORTH) study recruited gay and bisexual men who were at higher risk of HIV -- in the previous 3 months they had either had condomless anal intercourse at least once or had had 5 or more sexual partners.
In this randomized study, half the men received 4 self-testing kits (the OraQuick In-Home HIV Test) and could request additional kits if needed. The number of kits provided corresponds to the recommendation that higher risk men test every 3 to 6 months. Men in the control group only had access to HIV testing through the usual services, but would be provided with self-testing kits after a year.
A total of 362 men were recruited through sexual health clinics, AIDS service organizations, and social media in Sydney and Melbourne. Their average age was 35, two-thirds were employed full-time, and a third were university educated. Half had had more than 10 sexual partners in the previous 6 months, and 6 in 10 had had condomless anal sex with a casual partner.
For analysis, men were divided into "recent testers" who had taken an HIV test in the 2 years before the study began and "non-recent testers" who had not. Most men were in the first group.
The primary outcome measured was the average (mean) number of HIV tests per man during the first year of follow-up.
Looking first at recent testers:
- Men in the intervention group took an average of 1.8 tests at health facilities, while men in the control group took 2.1 tests.
- Men in the intervention group also used an average of 2.4 self-tests.
- Men in the intervention group therefore took a total of 4.2 tests during the year, compared with 2.1 tests in the control group --– a doubling of the rate (risk ratio 2.0; p<00.1).
Results were even more impressive among men who had previously tested infrequently:
- Men in the intervention group took an average of 0.8 tests at health facilities, while men in the control group took 0.7 tests.
- Men in the intervention group also used an average of 2.1 self-tests.
- Men in the intervention group therefore took a total of 2.9 tests during the year, compared with 0.7 in the control group -- a 4-fold increase (risk ratio 3.95; p<00.1).
The equal number of tests done at health facilities in the intervention and control arms shows that self-tests supplemented rather than replaced facility-based testing.
The researchers were concerned that the easy access to HIV self-tests could result in fewer men in the intervention group going to a clinic to test for sexually transmitted infections. But there were no differences in the number of sexual health screens done (2 per year among recent testers and 1 per year among non-recent testers).
The researchers asked what men receiving self-tests liked about them. They mentioned being able to test themselves (92% of men), convenience (83%), not needing to go to a doctor or clinic (75%), getting the result within minutes (74%), being able to test when you want (74%), saving time (66%), privacy (62%), not requiring a blood sample (51%), being able to test partners (41%), and being less embarrassing (26%).
The only negative points about HIV self-testing to be agreed on by a comparable number of people were it not being possible to have a full sexual health check (57%) and the results being less accurate (25%).
The findings strengthen the evidence that access to free HIV self-testing increases testing frequency in high-risk gay and bisexual men, concluded Jamil.
In the U.K., a large trial called SELPHI is about to recruit 10,000 men who have sex with men. It aims to assess whether access to self-testing for HIV (offered at no cost via the internet) leads to increased rates of HIV diagnosis and linkage to care.
MS Jamil, G Prestage, CK Fairley, et al. Access to HIV self-testing doubles the frequency of HIV testing among gay and bisexual men at higher risk of infection: a randomised controlled trial. 21st International AIDS Conference. Durban, July 18-22, 2016. Abstract FRAC0102.