Abstract
This study tested a mobile health (mHealth) intervention program entitled WeTest, delivered via the WeChat mobile app, to promote oral HIV self-testing (HIVST) among MSM in Hefei, China. A total of 100 MSM participants enrolled, completed baseline assessment, were randomly assigned to intervention or control, and completed 6-month follow-up surveys. Intervention participants (n = 50) received two oral HIVST kits and access to WeTest, a private WeChat group which provided app-based messages and referrals to health services related to HIV. Control participants (n = 50) received two oral HIVST kits only. All participants received instructions to upload photographic results of their oral HIVST, which were sent to the project counselor via a secure WeChat online portal; immediate contact and referrals were made to any participants who tested HIV-positive. In GEE analyses adjusting for time effects and baseline confounders, intervention participants had significantly higher rates of HIV testing (adjusted rate ratio RR = 1.99, 95% confidence interval (CI) 1.07–3.84) and, in particular, higher rates of testing via oral HIVST (adjusted RR = 2.17, 95% CI 1.08–4.37) compared with the control group. Significant time effects were also found such that all participants, regardless of group allocation, had significantly higher rates of reporting consistent condom use with main partners (adjusted RR = 18.13, 95% CI 5.19–63.31) and with non-main partners (adjusted RR = 5.33, 95% CI 2.35–12.08). Findings from this study provide evidence for the feasibility, acceptability and preliminary effects of this mHealth approach to promoting oral HIVST among MSM in China.
Highlights
The WHO recommends that all sexually active men who have sex with men (MSM) should take an HIV test every 6–12 months [1]
Based on analysis of qualitative data, an interdisciplinary research team worked in collaboration with staff from a community-based, MSMfocused, HIV prevention organization in Hefei to create a library of messages to provide information, motivation, and behavioral recommendations regarding the need for regular HIV testing and condom use among MSM
Results showed that the intervention increased HIV testing behavior, self-administration of HIV self-testing (HIVST), and trust in results of HIVST results over 6 months of follow-up compared to the control group, but had limited effects on increasing consistent condom use in the intervention group compared to the control group
Summary
The WHO recommends that all sexually active men who have sex with men (MSM) should take an HIV test every 6–12 months [1]. Low rates of testing and undiagnosed HIV infection pose substantial risks for furthering the growth of the HIV epidemic [4, 5]. In many parts of the world, suboptimal rates of HIV testing among MSM is a key barrier to this target. MSM are among the key populations at highest risk for HIV infection in China. MSM in China accounted for 25.5% of the country’s newly identified HIV cases and AIDS patients in 2017 [7], and MSM infection rates in China are expected to continue to rise in the absence of effective population-specific prevention programs [8]. Despite a national HIV prevention plan that prioritizes targeted HIV testing services for MSM, HIV testing rates among MSM in China remain low. A systematic review showed that 62% of Chinese MSM had not been tested in the past 12 months and about half of them had never been tested for HIV in their lifetime [9]
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