/Ending HIV transmission: What is the impact of giving out free self-tests?

Ending HIV transmission: What is the impact of giving out free self-tests?

The results of a randomized clinical trial of over 2,600 people at risk of contracting HIV show that exposing people to self-test ads online and providing them with free self-testing kits drastically improves their chances of getting tested and may prevent HIV transmission.

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Providing free HIV self-tests may significantly prevent HIV transmission.

Between 2006 and 2013, the rate of new HIV diagnoses had decreased by almost a third in the United States due to the success of antiretroviral treatment and public awareness campaigns.

However, since 2013, the number of reported new infections has stayed roughly the same, rather than decreasing. The Centers for Disease Control and Prevention (CDC) estimate that 1.1 million people in the U.S. are currently living with HIV.

Consistent antiretroviral treatment can stop the transmission of HIV altogether. However, it is still possible to pass the virus on if people are unaware that they are HIV-positive or are not receiving effective treatment.

So, what can be done to slash the risk of HIV transmission? New research examines the effect of sending out free HIV self-tests in a population of men who regularly have sex with men.

Robin MacGowan, MPH, from CDC’s Division of HIV/AIDS Prevention in Atlanta, GA, is the lead author of the new study, which appears in JAMA Internal Medicine.

Conducting a randomized clinical trial

MacGowan and team tested the effects of Internet-delivered free HIV self-test kits on the “frequency of testing, diagnoses of HIV infection, and sexual risk behaviors” in this at-risk population sample.

As the authors mention in their paper, over two-thirds of people in the U.S. newly diagnosed with HIV are gay men, bisexual men, and other men who have sex with men. What is more, 1 in 6 people in this group is unaware that they have the virus.

The study was a longitudinal, randomized clinical trial that stretched over 12 months and consisted of two groups, summing up 2,665 participants.

Overall, the recruited participants were U.S. residents who were at least 18 years old and who reported having had sex with men in the past 12 months.

The researchers divided these participants into a control group and an intervention self-testing group. The researchers exposed the intervention participants to HIV self-testing advertisements by placing them on social media, music, and dating websites that are popular among men who have sex with men.

Those who clicked on the ads went to the study website, which screened the participants and asked eligible ones to fill in one baseline survey and four follow-up ones. Other requirements included giving a blood sample and reporting the results of the HIV self-test after the 12 months.

The impact of free self-tests

The results revealed that people in the intervention group tested significantly more than people in the control group.

In fact, 76.6% of the participants in the intervention group reported testing for HIV three or more times during the trial, compared with only 22% in the control group.

The intervention group also had more cases of newly-discovered HIV infections. Furthermore, the social media “friends” of people in the self-testing group had 34 newly identified cases of HIV infection among them. MacGowan and colleagues conclude:

Distribution of HIV self-tests provides a worthwhile mechanism to increase awareness of HIV infection and prevent transmission among [men who have sex with men].”

In a linked editorial, Drs. Julia M. Janssen and Mitchell H. Katz, from the Department of Medicine at the University of California, San Francisco, and the New York City Health and Hospitals, respectively, comment on the study’s findings.

They say, “The study demonstrated that self-testing facilitates HIV testing in a high-risk population when tests are free and convenient; distribution of self-testing kits to social contacts via social networks provide another avenue for making testing more accessible and acceptable.”

Preexposure prophylaxis and primary care

In the same issue, JAMA Internal Medicine has also published a “Special Communication,” which highlights the important role of “preexposure prophylaxis” in preventing HIV infection.

“Preexposure prophylaxis” refers to medication that at-risk people can take once daily to lower their chances of acquiring the virus.

Primary care physicians “will need to be at the center of any successful effort to leverage the power of, and destigmatize [preexposure prophylaxis] to end the HIV epidemic,” write Drs. Joshua Khalili and Raphael J. Landovitz, the authors of the special communication.