Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil

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Abstract

Background

Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result.

Methods

Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times).

Results

For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability.

Conclusions

The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.

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Most cited references 60

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Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

Alison J. Rodger, Valentina Cambiano, Tina Bruun … (2016)

A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex.

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Global epidemiology of HIV infection in men who have sex with men.

Steven Goodreau, Suwat Chariyalertsak, Andrea L Wirtz … (2012)

Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Is Open Access

Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis

Cheryl Johnson, Caitlin Kennedy, Virginia Fonner … (2017)

Abstract Introduction: HIV self-testing (HIVST) is a discreet and convenient way to reach people with HIV who do not know their status, including many who may not otherwise test. To inform World Health Organization (WHO) guidance, we assessed the effect of HIVST on uptake and frequency of testing, as well as identification of HIV-positive persons, linkage to care, social harm, and risk behaviour. Methods: We systematically searched for studies comparing HIVST to standard HIV testing until 1 June 2016. Meta-analyses of studies reporting comparable outcomes were conducted using a random-effects model for relative risks (RR) and 95% confidence intervals. The quality of evidence was evaluated using GRADE. Results: After screening 638 citations, we identified five randomized controlled trials (RCTs) comparing HIVST to standard HIV testing services among 4,145 total participants from four countries. All offered free oral-fluid rapid tests for HIVST and were among men. Meta-analysis of three RCTs showed HIVST doubled uptake of testing among men (RR = 2.12; 95% CI: 1.51, 2.98). Meta-analysis of two RCTs among men who have sex with men showed frequency of testing nearly doubled (Rate ratio = 1.88; 95% CI: 1.17; 3.01), resulting in two more tests in a 12–15-month period (Mean difference = 2.13; 95% CI: 1.59, 2.66). Meta-analysis of two RCTs showed HIVST also doubled the likelihood of an HIV-positive diagnosis (RR = 2.02; 95% CI: 0.37, 10.76, 5.32). Across all RCTs, there was no indication of harm attributable to HIVST and potential increases in risk-taking behaviour appeared to be minimal. Conclusions: HIVST is associated with increased uptake and frequency of testing in RCTs. Such increases, particularly among those at risk who may not otherwise test, will likely identify more HIV-positive individuals as compared to standard testing services alone. However, further research on how to support linkage to confirmatory testing, prevention, treatment and care services is needed. WHO now recommends HIVST as an additional HIV testing approach.

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Author and article information

Contributors

Laio Magno:

ORCID: http://orcid.org/0000-0003-3752-0782

laiomagnoss@gmail.com

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 19 November 2020

Publication date PMC-release: 19 November 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 865

Affiliations

[1 ]GRID grid.442053.4, ISNI 0000 0001 0420 1676, Department of Life Sciences, , Bahia State University, ; Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000 Bahia Brazil

[2 ]GRID grid.8399.b, ISNI 0000 0004 0372 8259, Institute of Collective Health, Federal University of Bahia, ; R. Basílio da Gama, s/n - Canela, Salvador, 45760-030 Bahia Brazil

[3 ]GRID grid.8532.c, ISNI 0000 0001 2200 7498, Sociology Department, , Universidade Federal do Rio Grande do Sul, ; Porto Alegre, Brazil

[4 ]GRID grid.8532.c, ISNI 0000 0001 2200 7498, Department of Social Medicine, , Universidade Federal do Rio Grande do Sul, School of Medicine, ; Porto Alegre, Brazil

[5 ]GRID grid.8430.f, ISNI 0000 0001 2181 4888, Department of Preventive and Social Medicine, , Federal University of Minas Gerais, ; Belo Horizonte, Brazil

[6 ]GRID grid.428481.3, ISNI 0000 0001 1516 3599, Universidade Federal de São João Del-Rei, ; Divinópolis, Brazil

[7 ]GRID grid.419014.9, ISNI 0000 0004 0576 9812, Santa Casa de São Paulo School of Medical Sciences, ; São Paulo, Brazil

[8 ]GRID grid.265219.b, ISNI 0000 0001 2217 8588, Tulane School of Public Health and Tropical Medicine, ; New Orleans, USA

[9 ]GRID grid.8395.7, ISNI 0000 0001 2160 0329, Department of Community Health, Federal University of Ceará, ; Fortaleza, Brazil

[10 ]GRID grid.8536.8, ISNI 0000 0001 2294 473X, Federal University of Rio de Janeiro, ; Rio de Janeiro, Brazil

[11 ]GRID grid.418068.3, ISNI 0000 0001 0723 0931, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, ; Recife, Brazil

Author information

Laio Magno http://orcid.org/0000-0003-3752-0782

Article

Publisher ID: 5589

DOI: 10.1186/s12879-020-05589-0

PMC ID: 7678175

PubMed ID: 33213389

SO-VID: fa744793-15f9-4de9-b8e3-3ed5dd589ee7

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 7 April 2020

Date accepted : 4 November 2020

Funding

Funded by: Brazilian Department of Chronic Conditions and Sexually Transmitted Infections of the Health Surveillance Secretariat of the Ministry of Health

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv self-test,acceptability,hiv testing,men who have sex with men,respondent-driven sampling,brazil

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hiv self-test, acceptability, hiv testing, men who have sex with men, respondent-driven sampling, brazil

Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil

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HIV Self-Testing

Most cited references 60

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

Global epidemiology of HIV infection in men who have sex with men.

Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis

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