JMIR Publications

ABSTRACT

Background:

Thailand continues to experience a concentrated HIV epidemic among key populations despite the availability of effective HIV prevention and treatment. Although HIV self-testing (HIVST) can reduce structural and stigma-related barriers to facility-based testing, less is known about how online supervision influences users' experiences of HIV self-testing and subsequent engagement with HIV prevention and care.

Objective:

To explore the acceptability, feasibility, and psychosocial experiences of HIV self-testing with online supervision (HIV STOS) among Thai men who have sex with men (MSM), transgender women (TGW), male sex workers (MSW), and transgender women sex workers (TGSW), and to identify implementation factors that support engagement with HIV testing and linkage to care.

Methods:

We conducted a qualitative study consisting of eight focus group discussions (n=47) to inform the design of an HIV STOS pilot, followed by in-depth exit interviews with 64 participants who completed the intervention. Discussions explored participants' experiences with online supervision, privacy and confidentiality, linkage to HIV services, and barriers and facilitators to implementation. Data were analyzed thematically.

Results:

Among 111 participants (mean age 26 years), HIV STOS was widely perceived as acceptable, convenient, and private. More importantly, participants described online supervision as reducing anxiety, fostering trust, and providing reassurance throughout the testing process. Rather than serving solely as technical support, online counselors helped participants navigate uncertainty, interpret HIV test results, and access confirmatory testing, HIV treatment, and HIV prevention services. Participants valued the respectful and nonjudgmental relationships they developed with counselors, often describing interactions as resembling conversations with trusted friends or older siblings. These supportive relationships strengthened participants’ confidence in HIV self-testing and were perceived as supporting continued testing and timely linkage to care. Participants also identified implementation considerations, including discreet packaging, reliable test kits, flexible delivery options, and sustained online communication to support retention.

Conclusions:

The value of HIV STOS extends beyond expanding access to HIV testing. Our findings suggest that online supervision can transform the experience of HIV self-testing into a digitally mediated psychosocial intervention that supports emotional well-being, fosters trust, and facilitates linkage to HIV prevention, treatment, and care. As HIV self-testing continues to expand, implementation efforts should focus not only on increasing access to self-test kits but also on preserving the relational aspects of counseling that participants viewed as central to a positive testing experience. These findings have important implications for the design and scale-up of digitally supported HIV services in Thailand and other settings seeking to integrate HIV self-testing into routine care.