Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 15, 2023
Date Accepted: Mar 16, 2023
Implementation cascade of a social network-based HIV self-testing approach for men who have sex with men: a cross-sectional study
ABSTRACT
Background:
HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network-based approaches for distributing HIV self-tests are recommended by the World Health Organization, its implementation consists of multiple steps that need to be properly evaluated.
Objective:
This study aimed to assess the implementation cascade of a social network-based HIV self-test approach for MSM.
Methods:
This is a cross-sectional study. Seed MSM participants were recruited through different online channels who in turn invited their peers to participate in this study. Participants could request for an oral fluid or fingerprick HIV self-test after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the online training. Characteristics of participants completing each of these steps were evaluated.
Results:
Totally 463 MSM were recruited including 150 seeds. Participants recruited by seeds were less likely to have previously been HIV tested (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.06-3.04, P=.027) and have a lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (98%) MSM who completed the questionnaire requested for a self-test, of whom 82% had uploaded their test results. Participants requesting support were new in self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (61%) of the eligible participants initiated the referral process by attempting the online training with a passing rate of 93%. They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.017), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.0022). They also gave higher usability scores along the implementation cascade (81 vs 75, P=.0033).
Conclusions:
Social network approach was effective in diffusing HIV self-tests in the MSM community and reaching non-testers. Support is essential to address users’ needs when delivering self-tests and user experience is vital to transform a tester into a promoter. Clinical Trial: ClinicalTrials.gov NCT04379206
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