HIV self-testing increases test uptake and frequency in trans people

HIV self-testing could reduce the time between HIV infection and HIV diagnosis among trans people compared to conventional testing services, suggests a new study in EClinicalMedicine.

The project was a collaboration between the London School of Hygiene & Tropical Medicine (LSHTM), University College London (UCL), and the Medical Examination Council’s Clinical Trials Unit. It involved more than 100 trans men and trans women in England and Wales, making it the largest reported HIV self-test in this community.

Participants were initially randomized into two groups, one was self-tested for HIV, the other group was offered a link to find routine testing services, and there were no self-tests. Some arm self-tests were randomized a second time and either a self-test was repeated (additional self-testing every three months) or routine testing services. They were followed for two years.

More than 93% of participants in the self-test group tested for HIV compared with 26% in the standard care group. The frequency of HIV testing was also increased threefold in the repeat test group. Importantly, there were no adverse effects on the STI test, but uptake of these services was very low across all arms in the trial.

Qualitative research with the London School of Hygiene & Tropical Medicine revealed that the main reason for the popularity of HIV self-testing is that most sexual health services do not meet the needs of trans people. It was reported that services were often set up and run in a way that did not recognize their specific needs.

Trans people are at greater risk for HIV and poor sexual health compared to other groups. They tend to test less frequently and have worse clinical results when diagnosed with HIV.

The researchers say that wider self-testing and making it accessible to trans people will increase HIV test rates, and that staff will need training aimed at improving trans people’s experiences when they have access to sexual health services.

Charles Witzel from LSHTM who led the qualitative study said: “HIV has changed dramatically. Thanks to effective treatment, people with HIV can now live long and full lives. However, stigma and services are inextricably designed. Appropriateness remains a major barrier for individuals to get tested, an urgent first step towards treatment for those with undiagnosed HIV and an important prevention opportunity for those who are HIV negative.

“Despite increased vulnerability for trans people, they are rarely included in an HIV or prevention study, and when they have their data it is rarely presented separately from priority groups. such as gay and bisexual men. Our research aimed to shed new light on how best to meet the HIV testing needs of trans men and trans women. “

HIV self-testing was legalized in the UK in 2014 but has not been widely disseminated to the NHS. Instead, self-testing was usually delivered in concordance and started through pilot projects run by the voluntary sector and through a large clinical trial in England and Wales.

The HIV Self-Test Public Health Intervention (SELPHI) study was a large randomized trial of HIV self-testing in England and Wales that employed men (cis and trans) and trans women, who everyone who has sex with men.

The trial assessed whether free self-testing would increase the uptake and frequency of HIV testing, and whether it had any effect on STI testing.

Acceptance of the HIV self-test tool was very high: 97% thought the guide was easy to understand, 97% thought the test was easy to use and 100% said the experience was generally good.

The qualitative study of peer interviews found additional insights into trans people’s experiences when accessing HIV testing services, including HIV self-testing. He found that staff working in sexual health clinics often mistaken them or providing stigma care that did not respect their gender identity and / or sexual orientation.

However, participants who had access to sexual health services designed specifically for and with trans people said that these services were excellent.

Alison Rodger from UCL who co – directed the trial said: “Taken together, the results of our study clearly show that HIV self – testing must meet some of the immediate HIV testing requirements for men. trans and trans women. This could mean more people with HIV receiving earlier treatment that will benefit their health and reduce transmission. “

It is vital that sexual health clinics adapt to be more inclusive, welcoming and to ensure that they meet the diverse needs of these groups. Trans people need to be involved in these ventures in order to be successful. “

Talen Wright, Researcher

The authors acknowledge the limitations of the study, noting that the main test did not include non-humans, and their experiences while access to HIV testing remains an important research gap. Finding out the decisions about inappropriately designed services, sexual health research and future service improvement initiatives for non-biologists is a critical priority.