Home Self-testing Research Articles

SynNotch-Programmed Macrophages for Cancerous Cell Detection and Sensing.

Synthetic Notch (synNotch) receptors have enabled mammalian cells to sense extracellular ligands and respond by activating user-prescribed transcriptional programs. Based on the synNotch system, we describe a cell-based in vivo sensor for cancerous cell detection. We attempted to engineer synNotch-programmed macrophages to sense cancer cells via urinary analysis of human chorionic gonadotropin (HCGB5). Principally, when the synNotch receptors of macrophages bind to the ligands of cancer cells, Notch is activated and undergoes intramembrane proteolysis to release the transcriptional activator into the nucleus. The transcriptional activator targets and activates downstream gene expression, such as human chorionic gonadotropin (HCGB5) in macrophages. When HCGB5 is secreted extracellularly into urine, it can be detected with commercial HCGB5 colloidal gold test strips. As a proof of principle, we demonstrated the feasibility of synNotch-programmed macrophages in detecting breast cancer cells engineered with artificial EGFP ligands. We demonstrated that HCGB5 expression was only induced when the cancer cell expressing EGFP ligands is present; thereby, extracellular HCGB5 expression is directly proportional to the number of cancer cells. Further optimizations of the synNotch system can realize the ultimate goal of establishing cell-based in vivo sensors as the paragon of cancer diagnostics for point-of-care testing and home self-test.

Home self-testing of complete blood counts in patients with breast cancer during chemotherapy: A proof-of-concept cohort study in e-oncology.

Before administration of myelosuppressive chemotherapy, complete blood counts (CBC) collected at the hospital/nursing stations are evaluated to avoid severe bone marrow suppression. This maintains disease fixation which often reduces their quality of life. This mixed-method study examined at home self-testing of CBC, the test quality, and the effects on patients' mental well-being. Patients with breast cancer receiving chemotherapy were recruited and trained to perform capillary finger prick CBC testing at home using the HemoScreen Point-of-Care instrument and to upload the test results to the hospital's IT system subsequently. A venous reference CBC sample was taken and tested at the hospital on the day of self-testing. Semi-structured interviews with open-ended components were performed to investigate the user experience and the impact of self-testing on the patients' everyday lives. Thirty-nine patients completed the self-testing education using the HemoScreen instrument. Eight patients withdrew, while the remaining 31 patients performed 161 home tests (2-11 tests per patient) over a 4-month period. The test results compared well with the venous reference CBCs except for platelet counts (correlation coefficient 0.26). Qualitative interviews with nine of the 31 patients emphasized that the patients were comfortable using the self-testing instrument and becoming an active partner in their own treatment. CBC self-testing at home produced clinically valid hemoglobin and white blood cell counts with the added benefit that the patients became active partners in their own treatment course, which was of great importance for the patients and increased their wellbeing.

Direct-to-consumer testing as consumer initiated testing: compromises to the testing process and opportunities for quality improvement.

Direct-to-consumer testing (DTCT) refers to commercial laboratory tests initiated by laypersons without the involvement of healthcare professionals. As this market grows in size and variety of products, a clear definition of DTCT to ground the conceptualization of their harms and benefits is needed. We describe how three different modalities of DTCT (home self-testing, self-sampled tests, and direct access tests) present caveats to the traditional testing process ('brain-to-brain loop'), and how this might differ between medical vs. non-medical laboratories. We make recommendations for ways to improve quality and reduce errors with respect to DTCT. The potential benefits and harms of DTCT will invariably depend on the context and situation of individual consumers and the types of tests involved. Importantly, implications for both consumers and the healthcare system should be considered, such as the effects on improving health outcomes and reducing unnecessary testing and use of clinical resources. 'Consumer initiation' must be a central defining characteristic of DTCT, to clearly demarcate the key drawbacks as well as opportunities of this type of testing from a laboratory specialists' perspective. The concept of 'consumer initiated testing' should also help define DTCT regulation, and provide a locus of efforts to support consumers as the main decision-makers in the purchasing and conducting of these tests in the absence of clinician gatekeeping.

Fast, portable and sensitive detection of group B streptococcus DNA using one-pot MIRA-CRISPR system with suboptimal PAM

The group B Streptococcus (GBS) can generate vertical transmission to infants during delivery, has been seriously threatening the health of infants. Rapid and accurate prenatal GBS diagnosis for pregnant women is a deterministic blueprint to avoid infant viruses. Here, we developed an extraction-free nucleic acid isothermal amplification/CRISPR-Cas12a cutting one-pot system for GBS diagnostic assay by using suboptimal protospacer adjacent motifs, effectively avoiding multiple handling steps and uncapping contamination. The GBS diagnosis assay based on a one-pot system was validated by using fluorescent technique and lateral flow assay strips, exhibited fantastic specificity, accuracy and sensitivity with a limit of detection of 32 copies per reaction (0.64 copies/μL). Moreover, a portable device was constructed and integrated with the one-pot system to realize the GBS detection without professional and scene restrictions, it showed excellent performance in clinical sample detection, which achieved optical and portable GBS detection for point-of-care testing or home-self testing.

Willingness to be contacted via the patient portal for health screening, research recruitment, and at home self-test kits for health monitoring: A Pilot Quantitative Survey (Preprint)

Willingness to be contacted via the patient portal for health screening, research recruitment, and at home self-test kits for health monitoring: A Pilot Quantitative Survey (Preprint)

Perceived barriers to self-collected HPV testing for cervical cancer screening, and knowledge of HPV: a survey of primary healthcare smear-takers across Aotearoa New Zealand.

Cervical cancer remains a burden within Aotearoa New Zealand, with 2022 screening rates sitting 12.7% below target. The National Cervical Screening Programme has changed to primary human papillomavirus (HPV) testing for all screen-eligible people, with the aim for home self-testing. Little is known about the readiness of primary care for the change to self-testing and its associated challenges. A pilot HPV cervical cancer screening programme is being conducted in 17 practice centres. The aim of this study is to explore smear-taker knowledge at these centres about the use of primary HPV testing for cervical cancer screening. This is an ethically approved questionnaire study, with data from a structured web-based questionnaire sent to all smear-takers at the pilot centres. We achieved a total completion rate of 57.8%. The average score for "Knowledge of HPV" was 56.5% (range=20-100%). The challenges to patient home HPV self-testing were felt to be overall "not at all" to "mildly challenging". Up to 73.3% of participants identified ongoing needs for further education. The findings indicate knowledge deficits regarding HPV testing for cervical cancer screening and a desire for the provision of further education. Overall, respondents felt that no major barriers to implementing HPV self-testing would occur.

Home Haemoglobin Monitoring for the Titration of Erythropoietin-Stimulating Agents in Chronic Kidney Disease: A Pragmatic Pilot Trial.

No trials of POCT device pathways have been published in the field of anaemia of CKD. We describe the results of a year of use of a novel POCT device with its associated eHealth pathway in the home monitoring of ESA therapy, with the aim of evaluating device performance and pathway feasibility. We used a POCT device designed for home self-testing, able to measure Hb from a drop of capillary blood (Luma, Entia, UK). Results were shared with HCPs via an associated mobile application. The pilot ran from August 2020 to March 2022 in a single UK renal centre. All adult non-dialysis-dependent-CKD patients on ESAs were eligible for inclusion. Participants were mailed the device and trained remotely. Participants were encouraged to self-test twice weekly for up to 1 year, with data collected on a pragmatic basis. Lab and Luma's results were compared. Seventeen participants returned comparable datasets (underwent ≥ 4 lab Hb measurements and self-tested for >5 months) with a mean testing frequency of 1.6 tests/wk. 1062 Luma and 113 lab Hb results were analysed. The coefficient of variation (CV) for raw results was 8.3% with a bias of -2.0% and SD 8.5. The percentage of Luma results differing by >10% lab results was 30.9%, dropping to 17.7% using an 8-point-moving-average. Participants stated they preferred Luma to traditional ESA monitoring and recommended the pathway to others. One year of home self-testing with Luma yielded comparable device utility to other POCT haematology analysers derived via HCP testing. Innovative pilot trials such as this form the basis for new empowering and home-based models of care required and desired by patients and HCPs.

Advances in HIV self-testing: Systematic review of current developments and the road ahead in high-burden countries of Africa.

Although HIV self-testing technologies have created new opportunities for achieving national and global HIV testing goals, current developments have not been compiled to inform policy and practice, especially in high HIV burden countries of Africa. We aimed to compile and synthesize the evidence about HIV self-testing technologies, strategies, and uptake in the top-10 high HIV burden countries of Africa. We searched CINAHL, PubMed, Web of Science, PsycINFO, Social Science Citation Index, and EMBASE to include eligible articles published in English between January 2012 and November 2022. In total, 865 articles were retrieved and only 16 studies conducted in five African countries were eligible and included in this review. The two types of HIV self-testing modalities presently being used in Africa are: The first is Home Self-Test which is done entirely at home or in another private location by using oral fluid or blood specimen. The second modality is Mail-In Self-Test (self-sampling), where the user collects their own sample and sends this to a laboratory for testing. Perceived opportunities for the uptake of HIV self-testing were autonomy and self-empowerment, privacy, suitability, creating a chance to test, and simplicity of use. The potential barriers to HIV self-testing included fear and worry of a positive test result, concern of the test results is not reliable, low literacy, and potential psychological and social harms. The oral-fluid self-testing is preferred by most users because it is easy to use, less invasive, and painless. The difficulty of instructions on how to use self-test kits, and the presence of different products of HIV self-testing kits, increase rates of user errors. Adopting HIV self-testing by overcoming the challenging potential barriers could enable early detection, care, treatment, and prevention of the disease to achieve the 95-95-95 goal by 2030. Further study is necessary to explore the actual practices related to HIV self-testing among different populations in Africa.

SERS/photothermal-based dual-modal lateral flow immunoassays for sensitive and simultaneous antigen detection of respiratory viral infections

Lateral flow immunoassay (LFIA) is one of the most common analytical platforms for point-of-care testing (POCT), which is capable of large-scale primary screening and home self-testing of infectious diseases. However, the sensitivity of conventional AuNPs-based LFIA is relatively low and more prone to false negatives. Herein, we report a novel LFIA based on gold-core-silver-shell bimetallic nanoparticles (Au4-ATP@Ag NPs) emitting Surface-enhanced Raman scatting (SERS) and Photothermal (PT) effect, named SERS/PT-based dual-modal LFIA (SERS/PT-dmLFIA), for the antigen detection of infectious diseases pathogens, which displayed an excellent performance. For influenza A virus (IAV), influenza B virus (IBV), and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) N protein detection, the limit of detections (LoD) with Raman as signal were 31.25, 93.75, and 31.25 pg mL-1 respectively, and the LoDs with temperature difference (∆T) as signal were as low as 15.63, 187.5, and 15.63 pg mL-1 respectively, which were over 4-fold more sensitive than visual-based LFIA. The proposed SERS/PT-dmLFIA was used for detecting virus antigen in pharyngeal swabs and showed ideal coincidence rate of over 95% compared to the commercialized assays. In addition, we explored the development of multiplex SERS/PT-dmLFIA that can detect IAV, IBV, and SARS-CoV-2 antigens simultaneously without cross reactivity. Overall, the SERS/PT-dmLFIA for antigen detection not only exhibits high sensitivity, accuracy and specificity, but also have characteristics of rapidity and simplicity, which holds high potential for rapid diagnosis of infectious diseases in laboratory testing, mass screening, and home self-testing.

Patient Self-Testing of Kidney Function at Home, a Prospective Clinical Feasibility Study in Kidney Transplant Recipients

People with long-term health conditions often attend clinics for kidney function tests. The Self-Testing Own Kidneys (STOK) study assessed feasibility of kidney transplant recipients using hand-held devices to self-test kidney function at home and investigated agreement between home self-test and standard clinic test results. A prospective, observational, single-center, clinical feasibility study (TRN: ISRCTN68116915), with N= 15 stable kidney transplant recipients, investigated blood potassium and creatinine results agreement between index self-tests at home (patient self-testing of capillary blood, using Abbott i-STAT Alinity analyzers [i-STAT]) and reference tests in clinic (staff sampled venous blood, analyzed with laboratory Siemens Advia Chemistry XPT analyzer) using Bland-Altman and error grid analysis. The mean within-patient difference between index and reference test in creatinine was 2.25 μmol/l (95% confidence interval [CI]:-12.13, 16.81 μmol/l) and in potassium was 0.66 mmol/l (95% CI:-1.47, 2.79 mmol/l). All creatinine pairs and 27 of 40 (67.5%) potassium pairs were judged clinically equivalent. Planned follow-up analysis suggests that biochemical variables associated with potassium measurement in capillary blood were predominant sources of paired test result differences. Paired patient and nurse i-STAT capillary blood test potassium results were not statistically significantly different. This small feasibility study observed that training selected patients to competently use hand-held devices to self-test kidney function at home is possible. Self-test creatinine results showed good analytical and clinical agreement with standard clinic test results. Self-test potassium results showed poorer agreement with standard clinic test results; however, patient self-use of i-STATs at home was not a statistically significant source of difference between paired potassium test results.

Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City: 2020-2021.

African American and Hispanic populations have been affected disproportionately by COVID-19. Reasons are multifactorial and include social and structural determinants of health. During the onset and height of the pandemic, evidence suggested decreased access to SARS CoV-2 testing. In 2020, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx)- Underserved Populations initiative to improve SARS CoV-2 testing in underserved communities. In this study, we explored attitudes, experiences, and barriers to SARS CoV-2 testing and vaccination among New York City public housing residents. Between December 2020 and March 2021, we conducted 9 virtual focus groups among 36 low-income minority residents living in New York City public housing. Among residents reporting a prior SARS CoV-2 test, main reasons for testing were to prepare for a medical procedure or because of a high-risk exposure. Barriers to testing included fear of discomfort from the nasal swab, fear of exposure to COVID-19 while traveling to get tested, concerns about the consequences of testing positive and the belief that testing was not necessary. Residents reported a mistrust of information sources and the health care system in general; they depended more on "word of mouth" for information. The major barrier to vaccination was lack of trust in vaccine safety. Residents endorsed more convenient testing, onsite testing at residential buildings, and home self-test kits. Residents also emphasized the need for language-concordant information sharing and for information to come from "people who look like [them] and come from the same background as [them]". Barriers to SARS CoV-2 testing and vaccination centered on themes of a lack of accurate information, fear, mistrust, safety, and convenience. Resident-endorsed strategies to increase testing include making testing easier to access either through home or onsite testing locations. Education and information sharing by trusted members of the community are important tools to combat misinformation and build trust.

Sensitive and Quantitative Point-of-Care HIV Viral Load Quantification from Blood Using a Power-Free Plasma Separation and Portable Magnetofluidic Polymerase Chain Reaction Instrument.

Point-of-care (POC) HIV viral load (VL) tests are needed to enhance access to HIV VL testing in low- and middle-income countries (LMICs) and to enable HIV VL self-testing at home, which in turn have the potential to enhance the global management of the disease. While methods based on real-time reverse transcription-polymerase chain reaction (RT-PCR) are highly sensitive and quantitatively accurate, they often require bulky and expensive instruments, making applications at the POC challenging. On the other hand, although methods based on isothermal amplification techniques could be performed using low-cost instruments, they have shown limited quantitative accuracies, i.e., being only semiquantitative. Herein, we present a sensitive and quantitative POC HIV VL quantification method from blood that can be performed using a small power-free three-dimensional-printed plasma separation device and a portable, low-cost magnetofluidic real-time RT-PCR instrument. The plasma separation device, which is composed of a plasma separation membrane and an absorbent material, demonstrated 96% plasma separation efficiency per 100 μL of whole blood. The plasma solution was then processed in a magnetofluidic cartridge for automated HIV RNA extraction and quantification using the portable instrument, which completed 50 cycles of PCR in 15 min. Using the method, we achieved a limit of detection of 500 HIV RNA copies/mL, which is below the World Health Organization's virological failure threshold, and a good quantitative accuracy. The method has the potential for sensitive and quantitative HIV VL testing at the POC and at home self-testing.

Misdiagnosis of COVID-19 infection before molecular confirmation in Sulaimaniyah City, Iraq

BackgroundDuring the last 2 years, in the Kurdistan Region, Northern Iraq, there were thousands of COVID-19 cases that have not been reported officially, but diagnosed and confirmed by private laboratories and private hospitals, or clinicians based on typical clinical signs, as well as few people using home self-test after appearing of some flu-like clinical symptoms. Thus, this study aims to assess the misdiagnosis and mismanagement of cases before COVID-19 confirmation.MethodsThis study enrolled 100 consecutive patients who visited an outpatient clinic of Shar Hospital that had symptoms highly suspicious of COVID-19 infection while misdiagnosed previously to have other types of disease. Detailed questionnaires were filled for all studied patients, including age, gender, main presenting symptoms, and duration of these symptoms with the following questions: who made the false diagnosis, depending on which diagnostic test the false diagnosis was made, which medication was used for the false diagnosis, who prescribed those medications, and how long those medications were used. They were investigated by RT-PCR on their nasopharyngeal swab for confirmation.ResultsMost of the false diagnoses were typhoid (63%), influenza (14%), pneumonia (9%), gastroenteritis (5%), common cold (4%), brucellosis (4%), and meningitis (1%). Regarding the false diagnosis of cases, 92% were made by non-physician healthcare workers, and only 8% were made by physicians. All false diagnoses with typhoid, gastroenteritis, and common cold were made by non-physician healthcare workers, together with about half of the diagnosis of pneumonia and brucellosis, with statistically significant results (P < 0.001).ConclusionsWe realized that some patients had been misdiagnosed before the COVID-19 infection confirmation. Their health conditions improved drastically after correct diagnosis and treatment, and this research is considered the first research to be conducted in Iraq in this regard.

Do young black men who have sex with men in the deep south prefer traditional over alternative STI testing?

BackgroundHigh sexually transmitted infection (STI) rates in the South, especially among young black men who have sex with men (YB MSM), make STI testing imperative for public health.PurposeTo identify STI testing preferences in this population to improve testing delivery and utilization.MethodsYB MSM ages 16–35 in Birmingham, Alabama participated in focus groups (FG). A trained qualitative researcher coded transcripts after each FG and added questions to explore emerging themes.ResultsBetween September 2017 and January 2018, 36 YB MSM participated in 5 focus groups. Median age was 25.5 (Interquartile range 22–30). Participants preferred STI testing at doctors’ offices conducted by physicians but they also preferred having options related to testing locations, frequency, and timing to address diverse needs. Participants did not prefer testing by non-physician staff or home self-testing.ConclusionA variety of options, including varied locations, personnel, and methods (self-collected and provider collected) are needed to make patient-preferred STI testing a reality among YB MSM in the Deep South. Further, the desire to be tested by a trusted physician highlights the need for access to primary care providers. Results suggest that newer home-based tests and self-collected tests are less preferable to YB MSM in the South, which deserves further study as these tests are rapidly integrated into clinical care.

Nationwide study of factors associated with public's willingness to use home self-test kit for dengue fever in Malaysia.

BackgroundAs there is no specific treatment for dengue, early detection and access to proper treatment may lower dengue fatality. Therefore, having new techniques for the early detection of dengue fever, such as the use of dengue test kit, is vitally important. The aims of the study were: 1) identify factors associated with acceptance of a home self-test kit for dengue fever if the dengue test is available to the public and 2) find out the characteristics of the test kits that influence the use of the dengue test kit.MethodsA national telephone survey was carried out with 2,512 individuals of the Malaysian public aged 18–60 years old. Individuals were contacted by random digit dialling covering the whole of Malaysia from February 2012 to June 2013.ResultsFrom 2,512 participants, 6.1 % reported to have heard of the availability of the dengue home test kit and of these, 44.8 % expressed their intention to use the test kit if it was available. Multivariate logistic regressions indicated that participants with primary (OR: 0.65; 95 % CI: 0.43–0.89; p = 0.02, vs. tertiary educational level) and secondary educational levels (OR: 0.73; 95 % CI: 0.57–0.90; p = 0.01, vs. tertiary educational level) were less likely than participants with a tertiary educational level to use a home self-testing dengue kit for dengue if the kit was available. Participants with lower perceived barriers to dengue prevention (level of barriers 0–5) were less likely (OR: 0.67, 95 % CI: 0.53–0.85, p < 0.001, vs. higher perceived barriers) to use a home self-testing dengue kit for dengue if the kit was available compared to those with higher perceived barriers to dengue prevention (level of barriers 6-10). Participants with a lower total dengue fever knowledge score (range 0–22) were also less likely to use a home self-testing dengue kit for dengue if the kit was available (OR: 0.75; 95 % CI: 0.61–0.91, p = 0.001, vs. higher total dengue fever knowledge score) compared to those with a higher total dengue fever knowledge score (range 23–44). With response to characteristics of the test kit, participants indicated that ease of usability and easy to understand instructions were the most important factors influencing the decision to use the dengue home test kit; this was followed by the price of the test kit.ConclusionsThe study highlights the need for provision of information to increase knowledge about the home self-testing dengue kit. Educational interventions should target people with low educational levels, those with lower dengue fever knowledge and those with lower perceived barriers to dengue prevention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3409-y) contains supplementary material, which is available to authorized users.

HIV testing practices and the potential role of HIV self-testing among men who have sex with men in Mexico.

The objective of this study was to characterize HIV testing practices among men who have sex with men in Mexico and intention to use HIV self-testing. In 2012, members of one of the largest social/sexual networking websites for men who have sex with men in Latin America completed an anonymous online survey. This analysis was restricted to HIV-uninfected men who have sex with men residing in Mexico. Multivariable logistic regression models were fit to assess factors associated with HIV testing and intention to use a HIV self-test. Of 4537 respondents, 70.9% reported ever having a HIV test, of whom 75.5% reported testing at least yearly. The majority (94.3%) indicated that they would use a HIV home self-test if it were available. Participants identifying as bisexual less often reported ever HIV testing compared to those identifying as gay/homosexual (adjusted odds ratio = 0.52, 95% confidence interval: 0.44-0.62). Having a physical exam in the past year was associated with increased ever HIV testing (adjusted odds ratio = 4.35, 95% confidence interval: 3.73-5.07), but associated with decreased interest in HIV self-testing (adjusted odds ratio = 0.66, 95% confidence interval: 0.48-0.89). The high intention to use HIV home self-testing supports the use of this method as an acceptable alternative to clinic- or hospital-based HIV testing.

Promoting HIV testing with home self-test kit among men who have sex with men in China: a feasibility study

BackgroundIn China, the prevalence of HIV infection is high among men who have sex with men (MSM), but the HIV testing rate is rather low. HIV and sexuality stigma are the main barriers faced by Chinese MSM to testing for HIV with available testing services. The aim of this study was to assess the accuracy and acceptability of oral-based home self-testing, which might address the issue. MethodThis two-stage interventional study of HIV testing at baseline and at follow-up took place in two big cities and involved 3 clinics in Beijing and Nanning. The study population is MSM in the previous year, 18 years or older, currently living in Beijing or Nanning. The two main recruitment methods were peer-referral and disseminating testing and survey information through internet. We collected data by asking participants to fill out a questionnaire, which covers demographic characteristics, behaviour characteristics, HIV testing history, willingness to use the oral fluid rapid HIV test, and test preference. The questionnaire was pretested among five MSM and modified according to the MSM's suggestion. We also sampled blood for HIV tests and monitored oral fluid rapid self-testing. Follow-up was in the 3–12 months range after baseline study. The diagnostic accuracy of oral fluid rapid test kit for HIV infection were measured with sensitivity, specificity, and conformity by comparing oral test results with blood tests for ELISA/Western blot. The blood tests was done after the oral fluid self testing at baseline. HIV-negative MSM at the baseline were recommended to use oral testing kits as HIV home test kits to repeatedly test for HIV between baseline and follow-up. Sample size was estimated with the formula of screening. All participants provided written informed consent for voluntary rapid oral fluid testing and/or blood testing, and participation in questionnaire interview. The study protocol and informed consent form was approved by the institutional review board of Guangxi Provincial Center for Disease Control and Prevention. FindingsBetween April, 2013, and April, 2014, we enrolled 510 MSM for baseline analysis, 279 of whom were available for follow-up. The sensitivity of oral fluid HIV self-testing at baseline was 86% (95% CI 81·09–95·62); and the specificity was 98·2% (97·88–98·52). 401 (79%) MSM at baseline were willing to test for HIV with oral fluid testing kits. The associated factors were no passive unprotected anal intercourse (UAI) with male partners in the past 6 months, active UAI with regular male partners in the past 6 months, and the first choice of being tested for HIV being an oral test. 176 (35%) MSM at baseline and 125 (40%) MSM at follow-up preferred oral HIV testing. The associated factors at baseline were to grow up in urban areas and willingness to self-test for HIV using oral test kit in future. 102 (25%) MSM were willing to purchase oral fluid test kit in the following 6 months. The associated factors were 25 years of age or younger, college-level or higher education, known HIV serostatus of non-regular male sex partners through testing, and the oral test being the first choice of test. InterpretationHome HIV self-testing using oral fluid rapid testing kit of high accuracy is promising to facilitate HIV testing among MSM in China. Self-testing with oral fluid self testing kits in our study was mainly in a supervised context and the researcher could provide on-site post counseling and refer to care immediately, hence lacking data on linkage into care following a positive HIV test. FundingGuangxi Provincial Center for Disease Prevention and Control.

Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Which Gay Men Would Increase Their Frequency of HIV Testing with Home Self-testing?

Many Australian gay men do not get tested for HIV at the recommended frequency. Barriers to HIV testing may be reduced by the availability of home HIV self-testing (HHST). An online cross-sectional questionnaire was conducted with 2,306 Australian gay men during 2009. Multivariate logistic regression identified factors associated with being likely to increase testing frequency if HHST was available, among previously-tested and never-tested men. Among 2,018 non-HIV-positive men, 83.9% had been tested. Two-thirds indicated they would test more often if HHST was available irrespective of previous testing history. In multivariate analysis, independent predictors of increased testing frequency with HHST included preferences for more convenient testing, not having to see a doctor when testing and wanting immediate results among all men, as well as not being from an Anglo-Australian background and recent unprotected anal sex with casual partners among previously-tested men only. The majority of gay men report that being able to test themselves at home would increase their frequency of HIV testing.

Patients Can Accurately Perform Their Own Rapid HIV Point-of-Care Test in the Emergency Department

The objective of this study was to evaluate the feasibility, acceptability, and accuracy of having emergency department (ED) patients perform a rapid, point-of-care (POC) self-test for HIV before routine HIV testing. Patients aged 18 to 65 years were recruited to perform a rapid POC HIV oral fluid at The Johns Hopkins ED in conjunction with the standard-of-care HIV POC test. Acceptability and ease of use were assessed by a questionnaire. A total of 259 patients were approached for testing, and 249 (96.1%) consented to perform a self POC HIV test. Of patients performing a self-test, 100% had concordant results with those obtained by the health care worker. Four females (1.6%) were newly identified as HIV positive. Median participant age was 41 years, and 58% of patients were female; 83% were African American, and 16% were white. Overall, greater than 90% of patients reported trust of the test results, ease of testing, and willingness to test again. Approximately 35% of patients indicated they would pay up to a maximum price of $30 for testing. Overall, 46.9% of patients preferred self-testing, and 39.5% preferred health care professional testing. Regarding preferred location for testing, 51.0% preferred home self-testing, 39.5% preferred clinic/ED self-testing (P > 0.05), and 9.5% had no preference. A significant proportion of patients offered POC testing in the ED agreed to perform a self-HIV test. Patients' results were concordant with those obtained by the health care worker; 1.6% were HIV positive. The majority of participants believed the veracity of their results. A greater number of patients preferred self-testing.