Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 25, 2020
Date Accepted: Jul 26, 2020
Adherence of HIV self-testing among men who have sex with men in China: a longitudinal study
ABSTRACT
Background:
WHO recommended HIV self-testing (HIVST) for those who often have unsafe sexual behaviors, but the adherence to HIV testing has not been reported.
Objective:
In this study, we attempted to show the adherence to HIVST among men who have sex with men (MSM), as well as impact factors and potential effects of their adherence.
Methods:
We conducted a longitudinal study among MSM in Harbin, Heilongjiang province, China from Jul 01, 2017 to Jun 30, 2018. A mobile application (app) system was used to provide the “Mailing rapid test reagent kit” for HIVST service. The proportion of those who adhered to HIV testing every three months was calculated. Logistic regression was used to explore the impact factors related to adherence to HIV testing. Rate of HIV infection between MSM who adhered to HIV testing (AHT) and who did not (NAHT) were compared using Cox proportional hazards regression. Changes of the condom use behaviors of the two groups were also observed and compared using Chi-square test.
Results:
A total of 1,315 MSM received the HIVST service through the app were included. Ten percent of MSM were observed to adhere to HIVST. Adherence of HIVST was associated with marital status (adjusted OR[unmarried vs married] 2.27, 95% CI 1.12-4.61) and the number of HIVST they received (AOR[3 times vs 2 times or below] 3.22, 95% CI 1.92-5.41; AOR[4 times or above vs 2 times or below] 7.22, 95% CI 4.61-11.33). Twenty HIV seroconversions were observed during one-year follow-up. The rate of HIV infection in AHT group (17.10 per 100 person-years, 95% CI 8.80-30.84) was significantly higher than that in NAHT group (4.80 per 100 person-years, 95% CI 2.77-7.88) (adjusted HR 3.50, 95% CI 1.42-8.60). Those who adhered to HIV testing were more likely to improve condom use behaviors, though the finding was not statistically significant.
Conclusions:
Regular HIV testing was necessary for early detection of HIV infection among MSM. Given the poor adherence, a new Internet-based management paradigm for MSM to raise their health awareness is needed to optimize the implementation of HIVST.
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