The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial.
Gay and bisexual men
HIV
HIV self-testing
Randomised controlled trial
Journal
The Lancet regional health. Western Pacific
ISSN: 2666-6065
Titre abrégé: Lancet Reg Health West Pac
Pays: England
ID NLM: 101774968
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
18
03
2021
revised:
31
05
2021
accepted:
29
06
2021
entrez:
21
10
2021
pubmed:
22
10
2021
medline:
22
10
2021
Statut:
epublish
Résumé
A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months. Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test). Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history. In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies. This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.
Sections du résumé
BACKGROUND
BACKGROUND
A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months.
METHODS
METHODS
Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test).
FINDINGS
RESULTS
Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history.
INTERPRETATION
CONCLUSIONS
In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies.
FUNDING
BACKGROUND
This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.
Identifiants
pubmed: 34671752
doi: 10.1016/j.lanwpc.2021.100214
pii: S2666-6065(21)00123-1
pmc: PMC8484892
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100214Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Informations de copyright
© 2021 Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
BRB and RJG received a grant from Gilead Sciences outside the submitted work. ML reports grant from Gilead Sciences, Janssen-Cilag and ViiV Healthcare outside the submitted work. DPC reports personal fees from Atomo Diagnostics. All other authors declare there are no conflicts of interest.
Références
AIDS. 2018 Jan 28;32(3):371-381
pubmed: 29194120
Stat Med. 1999 Jul 15;18(13):1707-32
pubmed: 10407239
AIDS Behav. 2018 Jan;22(1):190-201
pubmed: 28831616
BMC Public Health. 2018 Feb 2;18(1):210
pubmed: 29394918
PLoS Med. 2020 Oct 9;17(10):e1003365
pubmed: 33035206
BMJ. 2013 Jan 21;346:e8668
pubmed: 23338004
BMC Health Serv Res. 2013 May 28;13:198
pubmed: 23714167
AIDS Behav. 2015 Nov;19(11):1949-65
pubmed: 26054390
PLoS One. 2016 Nov 9;11(11):e0166129
pubmed: 27829064
Value Health. 2020 Jul;23(7):870-879
pubmed: 32762988
BMC Med Res Methodol. 2018 May 29;18(1):48
pubmed: 29843614
Int J Environ Res Public Health. 2019 Mar 21;16(6):
pubmed: 30901957
BMC Infect Dis. 2015 Dec 10;15:561
pubmed: 26653203
AIDS Care. 2020 Jan;32(1):50-56
pubmed: 31416354
PLoS Med. 2020 Mar 10;17(3):e1003044
pubmed: 32155145
Health Psychol Rev. 2016 Sep;10(3):277-96
pubmed: 26854092
Sex Health. 2016 Feb;13(1):55-62
pubmed: 26502289
PLoS Med. 2013;10(4):e1001414
pubmed: 23565066
AIDS Behav. 2014 Jul;18 Suppl 4:S450-8
pubmed: 24957978
Med J Aust. 2015 Jun 1;202(10):529-31
pubmed: 26021364
Lancet HIV. 2017 Jun;4(6):e241-e250
pubmed: 28219619
J Acquir Immune Defic Syndr. 2018 Aug 15;78(5):505-512
pubmed: 29697595
PLoS One. 2016 Sep 09;11(9):e0162713
pubmed: 27611777
J Int AIDS Soc. 2017 May 15;20(1):21594
pubmed: 28530049
Sex Transm Dis. 2014 Jan;41(1):2-9
pubmed: 24335742
JAMA. 2019 Apr 9;321(14):1380-1390
pubmed: 30964528
J Int AIDS Soc. 2019 Mar;22 Suppl 1:e25249
pubmed: 30907517