A Pilot, Randomized Controlled Trial of HIV Self-Testing and Real-Time Post-Test Counseling/Referral on Screening and Preventative Care Among Men Who Have Sex with Men

Abstract

HIV self-testing (HST) could be an effective strategy for helping those at high risk test more regularly. However, concerns about HST's lack of follow-up care and referral have so far limited its use. In a pilot, randomized controlled trial, high-risk HIV-negative, or status unknown men who have sex with men (MSM; N = 65) were recruited from January 2016 to February 2017 and received (1) HST kits by mail, equipped with devices that detected when kits were opened and prompted a follow-up call from a counselor (eTEST); (2) standard HST kits with no follow-up (standard); or (3) informational letters about HIV testing locations (control) at baseline, 3 months, and 6 months. Monthly surveys over 7 months assessed HIV testing, sexually transmitted infection (STI) testing, access to prevention services, and behavioral risk reduction. All participants (100%) in the eTEST and standard HST groups reported HIV testing at least once during the 7-month period compared with 72% of controls. Repeat testing was higher among those in the HST groups versus controls (79% vs. 41%). Participants in the eTEST group were significantly more likely to receive risk reduction counseling, prevention supplies (e.g., condoms and lube), and PrEP referrals during the study period compared with standard HST and controls. No effects on STI testing or PrEP initiation emerged. Delivering HST kits to high-risk MSM at regular intervals could increase HIV testing rates and encourage more regular testing. Providing active post-test referrals alongside HST might also connect high-risk men with some other important services that encourage prevention behaviors.