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Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial


Author
Jamil et al.

Publication year
2017

Country

Type of approach
Dual

Type of assistance
Unassisted

Specimen
Oral-fluid

Study population
Key population: Men who have sex with men

Study design
Trials

Sample size
362

UNAIDS HIV prevalence (2017)
0.2 [0.2 - 0.2]

Methodology
In this randomised trial, HIV-negative high-risk gay and bisexual men who reported condomless anal intercourse or more than five male sexual partners in the past 3 months were recruited at three clinical and two community-based sites in Australia. Enrolled participants were randomly assigned (1:1) to the intervention (free HIV self-testing plus facility-based testing) or standard care (facility-based testing only). Participants completed a brief online questionnaire every 3 months, which collected the number of self-tests used and the number and location of facility-based tests, and HIV testing was subsequently sourced from clinical records. The primary outcome of number of HIV tests over 12 months was assessed overall and in two strata: recent (last test less than 2 years ago) and non-recent (>2 years ago or never tested) testers. Study period: from December 1, 2013 to February 5, 2015.

Summary of findings
182 men were randomly assigned to self-testing, and 180 to standard care. The analysis population included 178 (98%) men in the self-testing group (174 person-years) and 165 (92%) in the standard care group (162 person-years). Overall, men in the self-testing group had 701 HIV tests (410 self-tests; mean 4.0 tests per year), and men in the standard care group had 313 HIV tests (mean 1.9 tests per year); rate ratio (RR) 2.08 (95% CI 1.82-2.38; p<0.0001). Among recent testers, men in the self-testing group had 627 tests (356 self-tests; mean 4.2 per year), and men in the standard care group had 297 tests (mean 2.1 per year); RR 1.99 (1.73-2.29; p<0.0001). Among non-recent testers, men in the self-testing group had 74 tests (54 self-tests; mean 2.8 per year), and men in the standard care group had 16 tests (mean 0.7 per year); RR 3.95 (2.30-6.78; p<0.0001). No serious adverse events were reported during follow-up.

Acceptability
0.9

Acceptability details
90% (95/106) would recommend self-testing to other men.

Willingness to pay
US$ 23

Willingness to pay details
74% (78/106) were willing to pay up to US$22.96 (AUS$30) for a self-test.

Sensitivity
n/a

Specificity
n/a

Concordance
n/a

HIV positivity
1.7% (3/178)

Accuracy details
n/a

Social harm
No serious adverse events were reported during follow-up.

Linkage to prevention, care and treatment
100% (3/3). All diagnosed men were linked to care.

Source

Study status
Completed