JMIR Publications

ABSTRACT

Background:

Self-collection of specimens at home and their return by mail might help reduce some barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of Web-based sexual health studies. Testing self-collected hair samples for pre-exposure prophylaxis (PrEP) drug levels may also be a viable option to identify and support GBMSM facing adherence difficulties.

Objective:

Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged 18 to 34 years. The purpose of this manuscript is to describe key lessons learned from our study’s implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return.

Methods:

Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews that were conducted via a video conferencing platform. During the session, a semi-structured interview guide was used to discuss factors influencing decisions around returning self-collected specimens for laboratory processing. Transcripts were analyzed using template analysis.

Results:

University branding on Web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including pre-recorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to only include tests that they might be interested in completing at that time, adding real-time video conferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box.

Conclusions:

Our results offer valuable insights on aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and PrEP adherence testing.