Abstract
BackgroundRoutine HIV testing accompanied with pre-exposure prophylaxis (PrEP) requires innovative support in a real-world setting.ObjectiveThis study aimed to determine the usage of HIV self-testing (HIVST) kits and their secondary distribution to partners among men who have sex with men (MSM) in China, who use PrEP, in an observational study between 2018 and 2019.MethodsIn 4 major cities in China, we prospectively followed-up MSM from the China Real-world oral PrEP demonstration study, which provides daily or on-demand PrEP for 12 months, to assess the usage and secondary distribution of HIVST on quarterly follow-ups. Half of the PrEP users were randomized to receive 2 HIVSTs per month in addition to quarterly facility-based HIV testing. We evaluated the feasibility of providing HIVST to PrEP users.ResultsWe recruited 939 MSM and randomized 471 to receive HIVST, among whom 235 (49.9%) were daily and 236 (50.1%) were on-demand PrEP users. At baseline, the median age was 29 years, 390 (82.0%) men had at least college-level education, and 119 (25.3%) had never undergone facility-based HIV testing before. Three months after PrEP initiation, 341 (74.5%) men had used the HIVST provided to them and found it very easy to use. Among them, 180 of 341 (52.8%) men had distributed the HIVST kits it to other MSM, and 132 (51.6%) among the 256 men who returned HIVST results reported that used it with their sexual partners at the onset of intercourse. Participants on daily PrEP were more likely to use HIVST (adjusted hazard ratio=1.3, 95% CI 1.0-1.6) and distribute HIVST kits (adjusted hazard ratio=1.3, 95% CI 1.1-1.7) than those using on-demand PrEP.ConclusionsMSM who used PrEP had a high rate of usage and secondary distribution of HIVST kits, especially among those on daily PrEP, which suggested high feasibility and necessity for HIVST after PrEP initiation. Assuming that fourth-generation HIVST kits are available, HIVST may be able to replace facility-based HIV testing to a certain extent.Trial RegistrationChinese Clinical Trial Registry ChiCTR1800020374; https://www.chictr.org.cn/showprojen.aspx?proj=32481International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-036231
Highlights
Oral pre-exposure prophylaxis (PrEP) can reduce HIV infections among adherent men who have sex with men (MSM) [1,2,3]
Participants on daily PrEP were more likely to use HIV self-testing (HIVST) and distribute HIVST kits than those using on-demand PrEP
MSM who used PrEP had a high rate of usage and secondary distribution of HIVST kits, especially among those on daily PrEP, which suggested high feasibility and necessity for HIVST after PrEP initiation
Summary
Oral pre-exposure prophylaxis (PrEP) can reduce HIV infections among adherent men who have sex with men (MSM) [1,2,3]. While the adherence to PrEP is only approximately 60% in the real-world setting [4], it is crucial for all PrEP users to undergo quarterly HIV testing to avoid a breakthrough infection and acquiring resistance to antiretroviral therapy [5]. Difficulty attending clinical visits and missing laboratory testing has become one of the main reasons for the interruption [8] and discontinuation [9] in PrEP use in clinical settings. Since the outbreak of COVID-19, attendance at facility-based HIV testing became more difficult because of clinic closure, challenges with social distancing, and related difficulties [10]. Routine HIV testing accompanied with pre-exposure prophylaxis (PrEP) requires innovative support in a real-world setting
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