Abstract
IntroductionThe Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes.MethodsWe did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits.ResultsHIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]).ConclusionsHIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
Highlights
The Philippines, which has the fastest rising Human immunodeficiency virus (HIV) epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men and transgender women (TGW), especially amid the COVID-19 pandemic
Estimated national prevalence is at 0.2%, the epidemic is concentrated among key populations (KP) with prevalence disproportionately higher among people who inject drugs (PWID) (29.0%), cisgender men who have sex with men (5.0%), transgender women (TGW) (4.9%), and female sex workers (0.6%) [2]
Improvements in the first 95% of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95-95 targets were noted in the recent years until the COVID-19 pandemic has decreased HIV tests done by 61% in 2020, leading to 68% of estimated people living with HIV (PLHIV) knowing their status in 2021 [a], similar to the proportion estimated 5 years ago [2]
Summary
The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. The low uptake of HIV testing among cisMSM and TGW has been attributed to meager options for testing in the Philippines [4, 5], limited currently to facility-based and community-based testing The former is the more prevalent model [6] and involves using rapid diagnostic test (RDT) kits, available only in Department of Health (DOH)-accredited stand-alone laboratories, hospitals, and clinics, and is only facilitated by medical technologists trained for HIV [7]. In the Philippines, limited evidence shows acceptability and preference of bloodbased over fluid-based tests among cis-MSM and TGW [14, 15]
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