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One Quarter Ordering Free HIV Self-Tests in US Never Tested Before
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2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
One quarter of 57,000 US residents receiving a free HIV self-test via a CDC program never had a prior HIV test, and one third had not been tested in the past year [1]. Black cis-gender women accounted for 11% of self-test orders and transgender women for 1.6% in this direct-to-consumer program.
HIV self-testing could contribute to ending the HIV epidemic in the United States, CDC researchers proposed. Their Evaluation of HIV Self-Testing Among MSM Project (eSTAMP) boosted self-testing and HIV diagnoses in men who have sex with men (MSM) participating in the program compared with control MSM [2].
The CDC’s direct-to-consumer free HIV self-test distribution aimed to send the OraQuick In-Home HIV Self-Test to people who could order tests via https://together.takemehome.org/. Priority self-test target groups were black and Latino gay men, transgender women of all races and ethnicities, and black women. The CDC stirred awareness of the program via google search, popular social media sites, MSM dating sites, digital and terrestrial radio, and “paid influencers.” To order a self-test online, people had to be at least 17 years old and living in the United States (including Puerto Rico). They were encouraged to take a short survey and could reorder in 90 days.
The program generated 57,277 orders between February 4 and October 11, 2021 and delivered 100,000 HIV self-tests in that time. Three quarters of people placing orders asked for 2 tests, while the rest requested 1. Researchers determined that 55% of orders came from Ending the HIV Epidemic in the US (EHE) priority locations. Most states east of the Mississippi had high order volumes, as did Texas and California. Three quarters of respondents completed the survey and another 16% partially completed the survey.
While 41% of participants got tested for HIV in the past 12 months, 33% got tested but not in the past 12 months, and 26% never had an HIV test. Only 1.6% said they ever had a positive HIV test, and only 5% currently took PrEP.
People 18 to 44 years old made up 84.4% of respondents (overall median age 30). Age groups with the highest proportions who never had an HIV test were age 17 (80.5%) and age 18 to 24 (45.6%). More than 68% of every age group reported having 2 or more sex partners, including 77.1% of 18- to 24-year-olds and 68.8% of those 65 or older. On average, 73.7% of respondents had 2 or more sex partners.
Among people placing self-test orders, 36.5% were non-Hispanic white, 24.8% non-Hispanic black, and 26.8% Hispanic. All told, 63.3% were nonwhite. Majorities of most gender identities had anal sex with a man in the past 12 months: 69.0% for men, 71.7% for genderqueer, 78.7% for transgender women, and 65.5% for other gender identities. Fewer than half of only two gender groups had anal sex with a man in the past 12 months: 26.1% for women and 39.8% for transgender men.
Among 13,747 cis-gender women (26% of all orders), non-Hispanic Asian women had the highest proportion who never had a previous HIV test (52.8%), followed by non-Hispanic whites (40.6%), Hispanics (39.5%), non-Hispanic American Indian/Alaska Natives (28.6%), and other non-Hispanic women (26.4%). Among cis-gender men who had anal sex with men in the past 12 months (47% of all orders), proportions of never-testers by race/ethnicity were highest for non-Hispanic American Indian/Alaska Natives (21.4%), followed by non-Hispanic blacks (19.6%), Hispanics (18.8%), non-Hispanic whites (18.0%), non-Hispanic other races/ethnicities (17.9%), and non-Hispanic Asians (15.4%).
CDC investigators underlined these key findings: The program delivered 100,000 free HIV self-tests in about 8 months to all 50 states, Washington, DC, and Puerto Rico. One third of test orderers had not been tested in the past 12 months, and one quarter had never been tested. Cis-gender MSM placed almost half of all orders (47%), and 18.4% never had a previous HIV test. Cis-gender black women accounted for 11% of all orders, and 22% never had an earlier test.
The CDC team believes these results underscore the demand for HIV self-tests, even in people never previously tested for HIV.
References
1. Chavez PR, Emerson B, Lilo E, et al. CDC’s direct-to-consumer distribution of 100,000 HIV self-tests. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 143.
2. MacGowan RJ, Chavez PR, Borkowf CB, et al. Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men: a randomized clinical trial. JAMA Intern Med. 2020;180:117-125. doi:10.1001/jamainternmed.2019.5222.
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