Abstract
BackgroundWe assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test.MethodsWe conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past.ResultsNearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all.ConclusionHIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result.
Highlights
We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test
Our results suggest that HIV self-testing (HIV-ST) could become the exclusive way of testing for more than a third of an online sample of MSM living in Spain
The use of these online platforms to socialize and meet sexual partners is common among MSM [39, 40], precautions should be made when generalizing our results to other MSM
Summary
We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. Men who have sex with men (MSM) are the most affected group and comprised 56.4% of the total number of new HIV diagnoses reported in Spain during 2018 [1]. Promoting HIV testing and prompt linkage to care allows early treatment initiation and is a key element in the fight against the HIV epidemic. It reduces morbidity and mortality for those diagnosed with HIV [2, 3] and helps to control the epidemic by reducing infectiousness from one person to another [4, 5]. The last testing strategy that has been incorporated into the array of already existing options is HIV self-testing (HIV-ST) which is legally available in the country since 2018 [11]
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