Online HIV self-testing may be a treatment gateway for MSM, TGW
Online HIV self-testing may provide a channel for men who have sex with men (MSM) and transgender women (TGW) to access treatment, according to a Thai study presented at AIDS 2018.
Of the 571 MSM and TGW enrolled (n=472 and 99, respectively, mean age 27.9 years), 202, 158, and 211 chose the offline (conventional clinic-based HIV testing and counseling), mixed (online pretest counseling and offline HIV testing), and online methods (online pretest counseling and supervised HIV self-testing), respectively. [AIDS 2018, abstract WEPDC0107]
Compared with the mixed group, the online and offline groups had higher HIV prevalence (15.9 percent and 13.0 percent vs 3.4 percent; p=0.001) and more first-time testers (47.3 percent and 42.4 percent vs 18.1 percent; p<0.001).
However, the online group was the least receptive to antiretroviral treatment (ART) compared with the offline and mixed groups (52.8 percent vs 83.9 percent and 75.0 percent; p=0.02).
Unsuccessful linkage to ART was highly influenced by being in the online group (adjusted odds ratio [adjOR], 8.54, 95 percent confidence interval [CI], 1.08–67.59; p=0.04), and was high among those who were <17 years at sexual debut (adjOR, 13.16, 95 percent CI, 1.62–107.08; p=0.02) and those who had single partners (adjOR, 12.61, 95 percent CI, 1.52–104.9; p=0.02).
Persuading participants found to be HIV-reactive online to come out for offline HIV confirmation and ART initiation proved to be a challenge, noted the researchers, hence the need for innovative methods to support their transition from online to offline services.
Given the high prevalence of HIV cases in Thailand involving MSM and TGW, effective strategies to improve the Recruit-Test-Treat-Prevent-Retain cascade for HIV prevention and care are imperative, said the researchers. “Integrating various levels of online HIV services has high potential to engage specific sections of MSM and TGW populations in HIV services.”
A separate Chinese study evaluated Easy Test, an online self-testing model developed by the AIDS Healthcare Foundation, in 879 MSM (median age 28 years) who were reluctant to undergo testing at conventional facilities. [AIDS 2018, abstract WEPDC0105]
Of the 78 percent who provided feedback, 14.3 percent were found to be HIV positive, 72.4 percent of whom enrolled for treatment, suggesting that patients were more receptive to treatment as opposed to the Thai study.
Apart from the usual factors affecting HIV infection in the internet-based MSM community (eg, those with multiple sexual partners who have receptive/insertive anal sexual roles or both, low and inconsistent condom use, and lack of knowledge of HIV status of sexual partners/spouses), social media heightened the platform for online activity in China (>80 percent reported using social networks or apps), consequently increasing the chances to socialize and search for casual sexual partners. [BMC Infect Dis 2014;14:696; Clin Infect Dis 2013;57:298-309] However, less than 30 percent had HIV testing in the last year. [Chin J AIDS STD 2016;22:441-443]
Innovative and convenient HIV testing models such as Easy Test would be an effective strategy to reach out to the MSM community who have limited access to, or are reluctant to undergo, testing in conventional offline testing facilities, said the researchers. In line with this, optimizing the testing process (ie, faster test turnaround to establish HIV diagnosis, online access to more testing and services) and expanding the Easy Test model throughout China is being planned. This could subsequently help in bridging the gap between HIV-reactive/positive patients and HIV treatment, they said.