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High HIV Positivity Rate When Self-Tests
Distributed by LGBT Health Center Clients
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18th European AIDS Conference, EACS 2021, October 27-30, 2021, London
Mark Mascolini
Over 2% of HIV self-tests passed along by clients of a Paris sexual health clinic for lesbian, gay, bisexual, and trans (LGBT) people yielded positive results, more than 12 times the positivity rate with standard HIV screening in France [1]. Researchers at Pitié-Salpêtrière University Hospital determined that many self-tests ended up in the hands of the target population-at-risk people with undiagnosed HIV.
French HIV experts estimate that 170,000 people in France have HIV infection, including 24,000 (14%) with undiagnosed infection. Men who have sex with men (MSM) account for about one third of those undiagnosed infections. According to one estimate, 3% of sexually active MSM in the Paris area could carry HIV without knowing it. The Pitié-Salpêtrière researchers hypothesized that HIV self-testing could help cut the proportion of undiagnosed HIV infection in certain regions.
Prior research found high acceptability of HIV self-testing in different at-risk populations. Some work also showed that self-testing boosts the overall HIV testing rate, reaching people who have not tested recently or never had an HIV test. Partner testing also has high acceptability in some groups and thus can expand screening in untested individuals.
From July 2018 through August 2020, researchers invited all consecutive patients who sought care at a single sexual health clinic in Paris, regardless of their HIV status. Each person got 3 HIV self-tests (and more, if requested) to distribute in their social or sexual health network. Self-test distributors completed an online questionnaire about their HIV status, sex practices, number of tests distributed, profiles of people who accepted a self-test, and the HIV result if known.
Of the 1062 clinic attendees offered self-tests to distribute, 682 (64%) agreed to do so. And of those 682 people, 284 (42%) answered the online questionnaire. Clinic staff handed out 901 self-tests to distributors, and distributors passed along 455 self-tests (50%) to people they knew. Among all distributors, 31% handed out no self-tests, 15% distributed 1, 27% distributed 2, and 27% distributed 3 or more.
Among 220 self-tests with an available result (48% of 455), 5 (2.3%) yielded an HIV-positive result. That positivity rate far exceeds the 0.19% positive HIV screening rate throughout France and the 0.84% positive rate with HIV screening in community-based organizations. MSM accounted for all 5 positive HIV self-tests; 3 were sex partners of the distributor and 2 were friends. Two of these 5 people with a positive test had never been tested for HIV, 1 had been tested more than 12 months ago, and 1 more than 6 months ago.
A big majority of the 284 self-test distributors who answered the online questionnaire, 91%, were MSM. While 30% of distributors knew they had HIV infection, 42% were using PrEP to prevent HIV. About one quarter had group sex (27%), used drugs during sex (24%), or had used a self-test themselves (24%). Only 25% said they always used a condom with casual partners.
Comparing 196 people who distributed self-tests with 88 people who accepted but did not pass along self-tests, multivariate logistic regression identified only one independent predictor of distributing self-tests: People who had themselves taken an HIV self-test earlier were almost 6-fold more likely to distribute a self-test (adjusted odds ratio [aOR] 5.81, 95% confidence interval [CI] 2.33 to 14.51, P < 0.001). Getting screened for a sexually transmitted infection more than (rather than less than) 3 months ago nearly doubled chances of passing along an HIV self-test, but that association stopped short of statistical significance (aOR 1.87, 95% CI 0.94 to 3.73, P = 0.08). HIV status did not predict self-test distribution, as it has in other studies.
Among the 455 people who received a self-test, 79% were MSM, 61% belonged to the distributor's social network, 35% belonged to the distributor's sexual network, and 42% last had an HIV test more than 12 months ago or never had an HIV test.
The researchers concluded that MSM seeking care in a sexual health clinic could be effective distributors of HIV self-tests, especially if they have self-tested themselves earlier. The Pitié-Salpêtrière team suggested that giving potential self-test distributors more information and short training could improve the two-thirds distribution acceptability rate.
Reference
1. Gosset D, Plathey M, Lert F, et al. Distribution of HIV self-tests by patients attending a French LGBT community sexual health center into their close network: results of the OTO study. 18th European AIDS Conference, EACS 2021, October 27-30, 2021, London. Abstract OS3/4.
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