An Unsupervised Smart App–Optimized HIV Self-Testing Program in Montreal, Canada: Cross-Sectional Study (Preprint)

BACKGROUND Although HIV self-testing strategies have been recommended by the World Health Organization, HIV self-tests are not yet approved in Canada. Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing. We developed an innovative, multilingual software app called HIVSmart! to plug these gaps. OBJECTIVE This study aimed to test our app-optimized oral HIV self-testing strategy for feasibility in men who have sex with men (MSM) who presented to test at a large sexual health clinic (Clinique Médicale L’Actuel) in Montreal. METHODS Between July 2016 and February 2017, we offered a strategy consisting of the OraQuick In-Home HIV Test (an investigational device) and a tablet installed with the HIVSmart! app to study participants, who presented at a private office in the clinic, mimicking an unsupervised home environment. We evaluated the strategy for its feasibility, acceptability, and preference. Using the HIVSmart! app, participants were guided through the self-testing process. We determined feasibility with a metric defined as the completion rate, which consisted of the following 3 steps: (1) self-test conduct; (2) self-test interpretation; and (3) linkages to care. Participants independently performed, interpreted, recorded their self-test and result, engaged in pre- and posttest counseling, and sought linkages to care. Laboratory tests (p24, Western Blot, and RNA), as per country algorithms, were expedited, and linkages based on the rapid test status were arranged. RESULTS Mean age of the 451 participants enrolled was 34 (range, 18-73) years. Of all participants, 97.1% (438/451) completed and submitted the survey through the HIVSmart! app. In total, 84.7% (371/438) of the participants were well educated (beyond high school) and 52.5% (230/438) had been tested within the past 6 months. Of the 451, 11.5% (52/451) were on pre-exposure prophylaxis. Feasibility (completion rate), an average proportion of the 3 steps, was computed to be 96.6% (419/451). The acceptability of the strategy was high at 98.5% (451/458). A majority of the participants (448/451, 99.3%) were found to be self-tested and lab-confirmed negative and were counseled after self- and rapid tests. In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. Furthermore, 98.8% (417/422) of the participants found the app to be useful and 94.0% (424/451) were willing to recommend it to a friend or partner. CONCLUSIONS The HIVSmart! app-optimized strategy was feasible, accepted, and preferred by an educated, urban MSM population of Montreal. With the app, participants were able to perform, interpret, store results, and get rapidly linked to care. The HIVSmart!-optimized, self-testing strategy could be adapted and contextualized to many at-risk populations within Canada and worldwide, thereby maximizing its public health impact.

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Can an HIVSmart! App-optimized Self-Testing Strategy be Operationalized in Canada?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1075 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S426-S426

Author(s):

Nitika Pant Pai ◽

Megan Smallwood ◽

Laurence Desjardins ◽

Alexandre Goyette ◽

Anne-Fanny Vassal ◽

...

Keyword(s):

Testing Procedure ◽

The Self ◽

Health Clinic ◽

Test Results ◽

Testing Strategy ◽

Self Testing ◽

Hiv Test ◽

Post Test ◽

Self Test ◽

Sex With Men

Abstract Background Although HIV self-tests are recommended by the WHO, they are not yet approved in Canada. Service delivery gaps such as linkages to counseling and care remain unachieved by offering self-tests without adequate support. In this first Canadian study, we evaluated the feasibility of operationalizing an innovative HIVSmart! app-optimized oral HIV self-testing strategy in men who have sex with men (MSM), presenting at a large sexual health clinic in Montreal. Methods Between July 2016 to February 2017, participants were offered the OraQuick In-Home HIV Test, and a tablet installed with the HIVSmart! app, at a private office in the clinic to simulate an unsupervised home environment. With the HIVSmart! app, participants independently performed and interpreted self-tests, and were linked to in-person post-test counseling and care. Self-test results were confirmed by laboratory tests (p24, Western Blot, RNA as needed). Results The mean age of the 451 participants was 34 years (18–73); 85% were well educated (beyond high school, n = 371/438); 53% (230/438) were frequent testers (past 6 months), and 13% were on PrEP (52/451). 99% (417/422) of participants found the HIVSmart! app helpful in guiding them through the self-testing procedure; 93% (418/451) of participants interpreted their tests accurately; and 94% (395/419) stated they would recommend the app-optimized self-testing strategy to their partners. Feasibility (completion rate of self-testing) was 93% (419/451), and acceptability of the strategy was high at 99% (451/458). All HIV self-test negative participants (448/451, 100%) were counseled following the self-test. Three participants self-tested positive, were confirmed HIV positive (0.7% prevalence), and were rapidly linked to care with a physician. Conclusion The HIVSmart! app-optimized strategy was feasible, and highly accepted by an educated, frequently testing, urban MSM population of Montréal. With the app, participants were able to interpret their test results accurately and were rapidly linked to care. Innovations like HIVSmart! which engage, aid, and facilitate linkages to care, can be adapted to suit the needs of many populations in Canada and internationally, maximizing global impact through reverse innovation. Disclosures All authors: No reported disclosures.

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Feasibility of Indirect Secondary Distribution of HIV Self-Test Kits via WeChat Among Men Who Have Sex with Men: A National Cross-Sectional Study in China (Preprint)

10.2196/preprints.28508 ◽

2021 ◽

Author(s):

Li Shangcao ◽

Jing Zhang ◽

Xiang Mao ◽

Tianyi Lu ◽

Yangyang Gao ◽

...

Keyword(s):

Social Media ◽

Online Survey ◽

Sexual Partners ◽

Cross Sectional ◽

Self Testing ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Secondary Distribution ◽

Self Test ◽

Sex With Men

BACKGROUND The use of HIV self-test (HST) kits is commonplace in key sexually active populations. The direct secondary distribution of HST kits (DSDHK) is effective in improving the uptake of HIV self-testing. However, there are concerns about various limitations of DSDHK, including limited geographic location, payment problems, and face-to-face interaction. OBJECTIVE We evaluated the feasibility and characteristics of the indirect secondary distribution of HST kits (ISDHK) via WeChat (distributing HST application links and follow-up HST kits to partners) among men who have sex with men (MSM). METHODS From October 2017 to September 2019, an HIV self-testing (HIVST) recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for HST kits (referred to as “index participants” [Ips]). All of the MSM participants were encouraged to distribute the HST application link to their friends and sexual partners (referred to as “Alters”) through their social networks. All Alters were further encouraged to continue to distribute the HST application link. All participants paid a deposit (USD 7), refundable upon completion of the questionnaire and uploading of the test result via an online survey system. RESULTS 2,263 MSM met the criteria and successfully applied for HST. Of these, 1,816 participants returned their HST test results, including 1,422 (88.3%) IPs and 394 (21.7%) Alters. Compared with the IPs, the Alters practiced more condomless anal intercourse (CAI), a higher proportion of them never previously had an HIV test, and they had a greater willingness to distribute HST kits to sexual partners (all p < 0.05). After controlling for age, education, and income, the Alters had a greater proportion of MSM who had never tested for HIV before (aOR = 1.29, 95% CI 1.00–1.68), were more willing to distribute the HST application link (aOR = 1.71, 95% CI 1.21–2.40), had a lower number of sexual partners (aOR = 0.71, 95% CI 0.57–0.90), and were less likely to search for sexual partners via online means (aOR = 0.78, 95% CI 0.60–1.02). In comparison, the rates of reactive HST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy (ART) were similar for IPs and Alters. CONCLUSIONS The ISDHK mode of distributing HST application links via social media is feasible among the MSM population. The ISDHK mode should be used to supplement the DSDHK mode in order to enable a greater proportion of the MSM population to know their HIV infection status.

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Feasibility of large-scale population testing for SARS-CoV-2 detection by self-testing at home

Scientific Reports ◽

10.1038/s41598-021-89236-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paula Iruzubieta ◽

Tatiana Fernández-Lanas ◽

Laura Rasines ◽

Lorena Cayon ◽

Ana Álvarez-Cancelo ◽

...

Keyword(s):

Large Scale ◽

Rapid Test ◽

The Self ◽

Healthcare Personnel ◽

Testing Strategy ◽

Self Testing ◽

Scale Population ◽

Self Test ◽

Test Result ◽

At Home

AbstractThe simplicity and low cost of rapid point-of-care tests greatly facilitate large-scale population testing, which can contribute to controlling the spread of the COVID-19 virus. We evaluated the applicability of a self-testing strategy for SARS-CoV2 in a population-based, cross-sectional study in Cantabria, Spain, between April and May 2020. For the self-testing strategy, participants received the necessary material for the self-collection of blood and performance of a rapid antibody test using lateral flow immunoassay at home without the supervision of healthcare personnel. A total of 1,022 participants were enrolled. Most participants correctly performed the COVID-19 self-test the first time (91.3% [95% CI 89.4–92.9]). Only a minority of the participants (0.7%) needed the help of healthcare personnel, while 6.9% required a second kit delivery, for a total valid test result in 96.9% of the participants. Incorrect use of the self-test was not associated with the educational level, age over 65, or housing area. Prevalence of IgG antibodies against SARS-CoV2 for subjects with a valid rapid test result was 3.1% (95% CI 2.2–4.4), similar to the seroprevalence result obtained using a conventional approach carried out by healthcare professionals. In conclusion, COVID-19 self-testing should be considered as a screening tool.

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Will an Unsupervised Self-Testing Strategy Be Feasible to Operationalize in Canada? Results from a Pilot Study in Students of a Large Canadian University

AIDS Research and Treatment ◽

10.1155/2014/747619 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Nitika Pant Pai ◽

Madhavi Bhargava ◽

Lawrence Joseph ◽

Jigyasa Sharma ◽

Sabrina Pillay ◽

...

Keyword(s):

Willingness To Pay ◽

The United States ◽

Casual Sex ◽

Health Clinic ◽

Testing Strategy ◽

Multiple Partners ◽

Self Testing ◽

History Of ◽

At Risk Populations ◽

Self Test

Background.A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional testing. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data on self-testing is nonexistent. We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students.Methods.Between September 2011 and May 2012, we recruited 145 students from a student health clinic of a large Canadian university. Feasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Self-test conduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional. Other metrics were measured on a survey.Results.Participants were young (median age: 22 years), unmarried (97%), and 47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex with multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness to pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages.Conclusion.An unsupervised self-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform Canadian policy.

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Evaluatiing the Effects of HIV Self-testing used Professional Rapid Test Kits among MSM in Some Areas of China.

10.21203/rs.3.rs-1019127/v1 ◽

2021 ◽

Author(s):

Xiaoxia He ◽

Yanan Ren ◽

Zhonghui Ma ◽

Wenhui Guo ◽

Cong Jin ◽

...

Keyword(s):

Hiv Testing ◽

Theoretical Basis ◽

Rapid Test ◽

Education Level ◽

Rapid Hiv Testing ◽

Self Testing ◽

Hiv Test ◽

Rapid Hiv Test ◽

Self Test ◽

Accuracy Rates

Abstract With rapid expanding of HIV self-testing (HIVST) among unprofessional people has many unknown hidden dangers. This research for the first to survey the feasibility of urine, oral mucosal transudate (OMT) and finger blood rapid HIV testing kits were used for HIVST by non-professionals MSM in China. Total 274 valid questionnaires were received from 313 MSM participants, including 263 completed urine HIVST, 61 completed OMT HIVST and 17 completed blood HIVST. The average age of participants was under 30, about 80% were unmarried, more than 80% with an education level above Grade 9 but more than 50% people had never heard of the rapid HIV test. There were significant differences in the key information understanding accuracy between HIVST. The accuracy rates were 18.0–80.6%. When the HIVST result was positive, more than 80% chose to seek confirmation. When the test was negative, 60.5% (159/263) participants of urine self-test and 32.8% (20/61) of OMT self-test chose regular retesting. When the test was ineffective, more than 80% chose to retest. In addition, 54.1% of the 146 voluntary participants to accept blood HIVST, followed by 15.8% accept blood and urine HIVST and 14.4% accept only urine HIVST. The main reason for choosing blood HIVST was "accuracy", while the main reason for choosing urine HIVST was "convenience". This findings lays a scientific theoretical basis for further carring out HIVST in China.

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The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study

BMC Public Health ◽

10.1186/s12889-020-09976-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

J. Hoyos ◽

J. M. Guerras ◽

K. Koutentakis ◽

L. de la Fuente ◽

J. Pulido ◽

...

Keyword(s):

Online Survey ◽

Linkage To Care ◽

Care Process ◽

Cross Sectional ◽

Know How ◽

The Past ◽

Self Testing ◽

Hiv Test ◽

Self Test ◽

Sex With Men

Abstract Background We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. Methods We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. Results Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all. Conclusion HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result.

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Analytical Performance of the Exacto Test HIV Self-Test: A Cross-Sectional Field Study in the Democratic Republic of the Congo

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa554 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Serge Tonen-Wolyec ◽

Jérémie Muwonga Masidi ◽

Luc Ferdinand Kamanga Lukusa ◽

Gaetan Nsiku Dikumbwa ◽

Angèle Sarassoro ◽

...

Keyword(s):

Field Study ◽

Democratic Republic ◽

Analytical Performance ◽

Viable Option ◽

Excellent Performance ◽

Cross Sectional ◽

Performance Sensitivity ◽

Self Testing ◽

Republic Of The Congo ◽

Self Test

Abstract The Democratic Republic of the Congo (DRC) has begun implementing HIV self-testing to boost the first “95” of the UNAIDS 95-95-95 targets by 2025. This study aims to assess the performance and usability of the Exacto Test HIV (Biosynex, Strasbourg, France) self-test in the lab and in the field. The Exacto Test HIV self-test demonstrated high virological performance (sensitivity, 99.6%; specificity, 100%) in the lab and in the field in the hand of untrained users (sensitivity, 100%; specificity, 98.9%). Taken together, the excellent performance and usability characteristics of the Exacto Test HIV (Biosynex) self-test make the kit a viable option for HIV self-testing in the DRC.

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Acceptability and correlates of HIV self-testing among university students in northern Nigeria

International Journal of STD & AIDS ◽

10.1177/0956462420920136 ◽

2020 ◽

Vol 31 (9) ◽

pp. 820-831

Author(s):

Zubairu Iliyasu ◽

Radeeyah B Kassim ◽

Bilkisu Z Iliyasu ◽

Taiwo G Amole ◽

Nafisa S Nass ◽

...

Keyword(s):

University Students ◽

Cross Sectional Study ◽

Consistent Condom ◽

Consistent Condom Use ◽

Cross Sectional ◽

Logistic Regression Models ◽

Program Of Study ◽

Self Testing ◽

Self Test ◽

Testing And Counseling

Concerns about stigma and confidentiality limit the uptake of HIV testing and counseling (HTC) among young adults. HIV self-testing has been offered as a youth-friendly alternative to conventional HTC. We conducted a cross-sectional study to assess HTC uptake, willingness to self-test, and their predictors among university students ( n = 399) in Kano, Nigeria. Anonymous self-administered questionnaires were provided to participants. Adjusted odd ratios were generated for predictors with logistic regression models. The results showed that only 35.8% ( n = 143) of participants had previous HTC.Most respondents (70.4%, n = 281) were willing to self-test. HTC was associated with year of college (500 Level vs. 100 Level), adjusted odds ratio (AOR, [95% Confidence Interval (CI)] = 0.44 (0.19–0.97), campus residence (off- vs. on-campus, AOR = 0.45; 95%CI: 0.28–0.73), sexual activity in the past six months (AOR = 0.39; 95%CI: 0.24–0.64), willingness to self-test (AOR = 0.38; 95%CI: 0.22–0.66), and consistent condom use (AOR = 4.45; 95%CI: 1.41–14.08). Students who were older (≥ 30 vs. <20 years, AOR = 0.20; 95%CI: 0.05–0.90) and female (AOR = 0.56; 95%CI: 0.32–0.98) were less likely to be willing to self-test, whereas students who were more senior (500 Level vs. 100 Level, AOR = 5.24; 95%CI: 1.85–14.84), enrolled in clinical science programs (vs. agriculture, AOR = 4.92; 95%CI: 1.51–16.05) or belonging to “other” ethnic groups (vs. Hausa–Fulani, AOR = 2.40; 95%CI: 1.11–5.19) were more willing to self-test. Overall HTC uptake was low, but acceptability of self-testing was high. College seniority, age, ethnicity, and program of study were associated with willingness to self-test. Our findings support the feasibility of scaling up HIV self-testing among university students in Nigeria.

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

International Journal of STD & AIDS ◽

10.1177/0956462416641556 ◽

2016 ◽

Vol 28 (3) ◽

pp. 242-249 ◽

Cited By ~ 9

Author(s):

Catherine E Oldenburg ◽

Katie B Biello ◽

Amaya G Perez-Brumer ◽

Joshua Rosenberger ◽

David S Novak ◽

...

Keyword(s):

Confidence Interval ◽

Hiv Testing ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Intention To Use ◽

Self Testing ◽

Hiv Test ◽

Self Test ◽

Testing Practices ◽

Sex With Men

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.

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A Study to Evaluate the Accuracy, Usability, and Acceptance of A Blood-Based HIV Self-Test Performed by Observed Intended Users in Canada

10.21203/rs.3.rs-89494/v1 ◽

2020 ◽

Author(s):

Jason Lo Hog Tian ◽

Richard A. Galli ◽

Michelle Sumner-Williams ◽

Kristin McBain ◽

Emal Stanizai ◽

...

Keyword(s):

Hiv Testing ◽

Cross Sectional ◽

Efficacy Analysis ◽

Percent Agreement ◽

Self Testing ◽

Simple Alternative ◽

Self Test ◽

Cross Sectional Design ◽

Priority Populations ◽

Health Canada

Abstract Background: Self-Testing for HIV (“HIVST”) is an emerging targeted intervention with the potential to increase the access, uptake and frequency of HIV testing and more effectively reach the undiagnosed especially in priority populations. The study objectives of this study were to (1) evaluate the INSTI HIV-Self-Test (HIV-ST) performance compared with laboratory reference testing, (2) document if intended users can perform the steps to use the HIV-ST device, and (3) document if intended users can successfully interpret contrived positive, negative, and invalid results. Study was intended to be submitted to Health Canada for review for license purposes.Methods: The study used a cross-sectional design and recruited consenting adults from four community sites across Ontario, Québec, and Manitoba between August 2019 and March 2020. The results of the observed HIV-ST were compared with results of the Abbott Architect HIV Ag/Ab Combo test.Results: Primary efficacy analysis on 678 completed HIV-ST revealed a positive percent agreement of 100% and a negative percent agreement of 99.5% with the comparator method. The overall percent agreement of results interpretation between participant and observer was 93.5%. Of the 708 participants who took part in the usability study, 92.4% of participants successfully performed the steps determined to be “critical” for successful completion of the test, 96.7% of participants found the instructions easy to follow, and 95% of participants indicated that they would use the test again. Of the 404 participants who interpreted the strong positive, weak positive, negative and invalid contrived results, successful interpretation ranged from 90.6% (for weak positive) to 99.3% (for negative).Conclusions: The addition of this very first self-test into the Canadian HIV testing landscape could significantly increase HIV testing rates. An approved blood-based HIV self-test in Canada can offer an accurate, acceptable and simple alternative to facility-based HIV testing, particularly when impacted by Coronavirus pandemic restrictions.

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