scholarly journals Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales

Author(s):  
T. Witzel ◽  
Peter Weatherburn ◽  
Adam Bourne ◽  
Alison Rodger ◽  
Chris Bonell ◽  
...  

SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features.

Author(s):  
Juan Hoyos ◽  
Juan-Miguel Guerras ◽  
Tomás Maté ◽  
Cristina Agustí ◽  
Laura Fernández-López ◽  
...  

We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users’ (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs’ willingness to pay 25–30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs’ preferred place to obtain a self-test, which was in line with PUs’ actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs’ preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders’ opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.


2021 ◽  
Author(s):  
Xia Jin ◽  
Zhenxing Chu ◽  
Xiangjun Zhang ◽  
Tianyi Lu ◽  
Jing Zhang ◽  
...  

BACKGROUND Men who have sex with men (MSM) have high HIV incidence and prevalence burdens but relatively low HIV testing rates. Literature showed insufficient evidence on the efficacy of Social media (WeChat) based HIV self-testing (HIVST) kits distribution approaches among MSM and their sexual partners. OBJECTIVE This study evaluated an Social media (WeChat) based HIVST distribution intervention in increasing HIV testing uptake among MSM and their sexual partners in China. METHODS The study used a 12-month stepped-wedge randomized controlled trial design and an online survey mode. MSM who were HIV-negative or with unknown HIV status were recruited through social media marketing and outreaches by community opinion leaders between August and December 2018 in Shenyang, Beijing, Chongqing, and Shenzhen. Participants were randomly allocated to four groups, which were intervened by sequence. The intervention group received free HIVST kits on top of the control condition that participants received standard education and care. Participants were followed up from January to December 2019. Generalized linear models were used to assess HIV testing coverage and frequency difference between the intervention and the control stage. RESULTS Each group enrolled 140 eligible MSM with a total of 560 participants. Twelve participants were diagnosed with HIV infections, and 4 of them were in the follow-up period. Participants in the intervention stage were nine times likely to receive an HIV test than in the control stage (85.6% vs. 39.2%, risk ratio [RR]=9.21, 95%CI 5.92~14.33). The intervention also increased participants’ HIV testing frequency (1.48 vs. 0.59 times, risk difference [RD]=0.89, 95%CI 0.82~0.96). Moreover, the intervention increased HIV testing proportion (49.0% vs. 30.1%, RR=2.23, 95%CI 1.46~3.40) and mean HIV testing frequency (0.69 vs. 0.35 times, RD=0.26, 95%CI 0.15~0.38) among participants sexual partners who received HIVST through secondary distribution. CONCLUSIONS An Social media (WeChat) based HIVST distribution intervention effectively increased HIV testing coverage and frequency in MSM and their sexual partners. Future programs could apply this approach in HIV education and testing efforts to reduce HIV incidence. CLINICALTRIAL This study was registered at the Chinese Clinical Trials website (http://www.chictr.org.cn/index.aspx) with the registration tracking number of ChiCTR1800019453 on November 12, 2018. INTERNATIONAL REGISTERED REPORT RR2-10.2196/17788


2018 ◽  
Vol 78 (5) ◽  
pp. 505-512 ◽  
Author(s):  
David A. Katz ◽  
Matthew R. Golden ◽  
James P. Hughes ◽  
Carey Farquhar ◽  
Joanne D. Stekler

2013 ◽  
Vol 13 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Paul J Birrell ◽  
O Noel Gill ◽  
Valerie C Delpech ◽  
Alison E Brown ◽  
Sarika Desai ◽  
...  

2007 ◽  
Vol 84 (2) ◽  
pp. 212-225 ◽  
Author(s):  
Susan E. Manning ◽  
Lorna E. Thorpe ◽  
Chitra Ramaswamy ◽  
Anjum Hajat ◽  
Melissa A. Marx ◽  
...  

2021 ◽  
Author(s):  
Li Shangcao ◽  
Jing Zhang ◽  
Xiang Mao ◽  
Tianyi Lu ◽  
Yangyang Gao ◽  
...  

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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