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  IAS 2015: 8th IAS Conference on
HIV Pathogenesis Treatment and Prevention
Vancouver, Canada
18-22 July 2015
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HIV Self-Testing Raises Testing Rate in Randomized Trial of Seattle MSM
  IAS 2015, July 19-22, 2015, Vancouver
Mark Mascolini
Men randomized to HIV self-testing reported significantly more HIV tests through 15 months than men randomized to standard testing in a trial enrolling Seattle men who have sex with men (MSM). Self-testers also acquired fewer sexually transmitted infections (STIs) during this 230-man study.
University of Washington researchers who conducted the trial noted that self-testing may boost testing rates and cut the time people remain unaware of HIV infection, and that could lead to lower HIV transmission and improved individual care. But concerns about the safety and accuracy of HIV self-testing persist. They planned this trial in 230 HIV-negative MSM at high risk of infection to compare testing frequency between self-testers and standard testers and to determine whether self-testing is noninferior to standard testing in HIV acquisition risk.
The investigators randomized men to use the OraQuick Advance Rapid HIV-1/2 Antibody Test on oral fluids or to seek testing as usual for 15 months. Participants had to be 18 or older and report high HIV risk factors such as condomless anal intercourse, methamphetamine or popper use, a bacterial STI diagnosis, or 10 or more male anal sex partners during the past year.
Self-testers got the OraQuick kit at baseline and could get up to one kit per month afterwards at no cost. Researchers advised all men to test quarterly, all men received testing reminders, and participants could test through any HIV testing source. Among 116 men randomized to self-testing, 81 (70%) completed a 9-month survey and 98 (84%) completed 15 months of follow-up. Among 114 men assigned to standard testing, 81 (71%) completed a 9-month survey and 99 (87%) completed 15 months of follow-up.
Age averaged 35.5 years in self-testers, compared with 37.5 in the standard-test group. Racial/ethnic proportions were 78% white, 18% Hispanic, 10% black, and 4% Asian among self-testers and 73% white, 12% Hispanic, 9% black, and 6% Asian among standard testers. Fifty-seven self-testers (50%) and 65 standard-testers (59%) graduated from college. Median number of oral or anal sex partners in the last 3 months stood at 5 in the self-testing group and 5.5 in the standard-testing group.
Self-testers reported an average of 5.3 tests during follow-up, compared with 3.6 in the control arm (P < 0. 0001). Proportions who got tested 4 times or more (as recommended) were 76% among self-testers and 54% among standard testers (P = 0.001). In the self-testing group, an average of 3.9 HIV tests were self-tests. Four self-testers and 2 standard-testers had a positive test.
Rates of condomless anal intercourse with a nonconcordant partner did not differ much between self-testers and standard-testers at 9 months (21% versus 22%) or 15 months (29% versus 24%).
At the final study visit 5.4% of self-testers versus 12.2% of standard-testers had a bacterial STI, for a risk difference of -6.8% (95% confidence interval [CI] -16% to 1.6%). Self-testing also proved noninferior to standard testing on two other measures of HIV risk, number of nonconcordant condomless anal intercourse acts in the last 3 months (odds ratio 1.08, 95% CI 0.61 to 1.90) and number of male condomless anal intercourse partners during the last 3 months (incidence rate ratio 0.92, 95% CI 0.64 to 1.33).
The University of Washington team cautioned that the MSM in this study may be more interested in self-testing than the general population and that their findings may not apply to other high-risk populations. They also noted that testing and sexual behavior outcomes relied on self-report. With those limitations in mind, they concluded that "access to HIV self-testing at no cost increased testing frequency among high-risk MSM and did not impact sexual risk behavior or STI acquisition." If the findings do apply to other high-risk populations, they suggested that "self-testing programs may increase earlier HIV diagnosis."
1. Katz D, Golden M, Hughes J, Farquhar C, Stekler J. HIV self-testing increases HIV testing frequency among high-risk men who have sex with men: a randomized controlled trial. IAS 2015. 8th Conference on HIV Pathogenesis, Treatment and Prevention. July 19-22, 2015. Vancouver. Abstract MOPDC0103.