JMIR Publications

ABSTRACT

Background:

The World Health Organization recommends dual HIV/syphilis testing, but this approach has not been examined in many low- and middle-income countries. Dual HIV/syphilis self-testing may accelerate secondary distribution of self-test kits.

Objective:

We aimed to evaluate dual HIV/syphilis self-testing among MSM in China.

Methods:

We conducted a pragmatic three-arm randomized controlled study in the Guangxi Zhuang Autonomous Region, China. MSM aged 18 or older and HIV-negative were enrolled and randomly assigned (1:1:1) to the standard of care (SOC) group (n=110), single HIV self-testing (SST) group (n=110), and dual HIV/syphilis self-testing (DST) group (n=110). Participants in the SST and DST groups received free finger-prick-based HIV self-testing or HIV/syphilis self-testing kits at enrolment and during the 12-month follow-up. The primary outcome was the mean number of social network members motivated by the participant and the mean frequency of HIV tests per participant within a 3-month period. The data were analyzed using an intention-to-treat analysis.

Results:

A total of 330 MSM were recruited. 319 (96.7%) of them initiated at least one follow-up survey and were subsequently included in the analysis. 245/319 (77.0%) had college education or above. Compared to social network members in the SOC group, those in the intervention SST and DST groups were more likely to motivate others for HIV testing within 3-month average duration (SST 0.42 versus SOC 0.20, mean difference [MD]=0.22, 95% confidence [CI]: 0.12-0.33, P<0.001; DST 0.51 versus SOC 0.20, MD=0.32, 95% CI: 0.20-0.43, P<0.001). The mean frequency of total HIV tests per participant in the SST group (1.33) was higher than that in the SOC group (0.87; MD=0.46, 95% CI: 0.31-0.62, P<0.001) over three months. The mean number of HIV tests per participant in the DST group (1.43) was higher than that in the SOC group (0.87; MD=0.57, 95% CI: 0.41-0.73, P<0.001) in a three month period. Four people (1.3%) had a new HIV positive result. Eleven (3.4%) people had a new syphilis positive result. All individuals who had positive self-test results underwent laboratory-based confirmation tests. There were no adverse events reported.

Conclusions:

Our data demonstrate the secondary distribution strategy of HIV/syphilis self-testing proves to be an effective means of expanding HIV testing coverage by encouraging the distribution of testing kits within the social networks of MSM. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2100050898).