Abstract
BackgroundHIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. In the absence of HIVST in Malaysia, there is no guidance to inform HIVST delivery. This study investigated the acceptability of HIVST and preferences about the HIVST service delivery approaches using a standardized stated preference method.MethodsA cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs.ResultsOverall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99–100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08).ConclusionsAcceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
Highlights
HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like men who have sex with men (MSM) who experience multiple barriers accessing clinic-based HIV testing
Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs
To better understand preferences about HIVST in MSM, we examined the acceptability of HIVST and relative preferences about the elements of HIVST delivery, using a standardized stated preference method to assess how Malaysian MSM value various attributes of hypothetical HIVST service delivery models
Summary
HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. For key population groups like men who have sex with men (MSM), HIV testing uptake is often low due to multilevel factors like fear, stigma and discrimination, criminalization, and disclosure of sexual/gender identity, lack of anonymity, and concerns about confidentiality [3,4,5,6,7,8]. MSM in Malaysia inadequately test, which has thwarted scale-up of effective HIV testing, prevention, and treatment programs for the lesbian, gay, bisexual, and transgender (LGBT) community. HIV prevention and treatment programs are inadequately designed for MSM, who account for most new HIV infections in Malaysia [9]. HIVST increases convenience, privacy, and confidentiality, but its uptake may be limited by cost for some MSM, in Malaysia, concerned with legal constraints and face high rates of stigma and discrimination
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