JMIR Publications

ABSTRACT

Background:

Globally, China has one of the most rapidly expanding epidemics of HIV in men who have sex with men (MSM), paralleled only by reports from Thailand and Kenya. Only half of Chinese MSM have ever been tested for HIV, despite a national free testing program and recent scale-up efforts by health authorities. With the country’s explosive internet growth, activities such as socializing and partner seeking among MSM has also moved online through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM including those who rarely access traditional, offline testing facilities.

Objective:

To assess the feasibility of the Easy Test model, an internet-based self-testing service, in increasing access and uptake of HIV testing and treatment services among MSM in China. To identify demographic and behavioral predictors of program uptake to inform future implementation.

Methods:

A feasibility study of the Easy Test model was conducted from October to December 2017 in 14 Chinese Provinces. The web-based service consisted of an online application through which participants requested a free HIV self-test kit to be home delivered to their residence. Applicants who provided informed consent completed a self-administered questionnaire and submitted a $5 USD monetary deposit to request the free test kit. Orders were then received, processed, and posted by volunteers of local community-based organizations specializing in LGBT services. Instructions included with each kit informed applicants of proper testing technique as well as procedures for uploading an image of the completed test kit to study staff via a secure online portal. Upon receipt of the image the $5 USD deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow up medical services. χ2 trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: 1) never having tested for HIV and 2) receiving an HIV positive results.

Results:

A total of 879 individuals submitted online requests for test kits and completed the questionnaire. Their median age was 28 (IQR, 24-34 years), 69.3% had at least a college education, and 51.5% had a monthly income between 450–750 US dollars. 77.7% (683/879) of the applicants submitted images of their test results to study staff, among whom 98 (14.3%) had an HIV positive result. Among the 42.9% (293/683) who were first time testers the HIV prevalence was 18.8% (55/293). Nearly three quarters (72.4% or 71/98) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first time testers, having multiple sexual partners (2-3 sexual partners: aOR=2.44, 95%CI: 1.08-5.50; 4 or above sexual partners: aOR=3.55, 95%CI: 1.18-10.68) and reporting inconsistent condoms use in the prior 3 months (aOR=7.95, 95%CI: 3.66-17.26) were both associated with an HIV positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ2trend=54.98, p<0.0001).

Conclusions:

The online Easy Test model reached a larger portion of first time testers, many who report higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China. The model should be expanded, as evidenced by high HIV prevalence of MSM who have never test for HIV.