The Lancet Regional Health. Western Pacific (Sep 2021)

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

  • Ye Zhang, Mph,
  • Muhammad S Jamil, PhD,
  • Kirsty S Smith, PhD,
  • Tanya L Applegate, PhD,
  • Garrett Prestage, PhD.,
  • Martin Holt, PhD,
  • Phillip Keen, BA,
  • Benjamin R Bavinton, PhD,
  • Marcus Chen, PhD,
  • Damian P Conway, PhD,
  • Handan Wand, PhD,
  • Anna M McNulty, MMed,
  • Darren Russell, PhD,
  • Matthew Vaughan, MS,
  • Colin Batrouney, BA,
  • Virginia Wiseman, PhD,
  • Christopher K Fairley, PhD,
  • Andrew E Grulich, PhD,
  • Matthew Law, PhD,
  • John M Kaldor, PhD,
  • Rebecca J Guy, PhD

Journal volume & issue
Vol. 14
p. 100214

Abstract

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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: : 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: : 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: : 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: : This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.

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