Despite the progress made battling HIV since it first appeared in the United States over 50 years ago, the virus continues to affect tens of thousands of people who contract it every year in the United States. The majority of new infections are diagnosed in men who have sex with men (MSM), with a disproportionate impact on African American and Latino populations.
Among the roughly 1.2 million people in the U.S. currently living with HIV, approximately 13% do not know they are positive. This lack of awareness can lead to risky sexual behaviors and new infections among unsuspecting partners.
Routine testing is the most effective way to increase awareness and curb the spread of the disease. But MSM can be reluctant to get clinically tested, impeded by concerns over privacy, confidentiality and mistrust in the medical establishment.
A new study led by Tyler Wray, associate professor of behavioral and social sciences in the Brown University School of Public Health, explores at home self-testing as a way to increase HIV testing availability and facilitate earlier HIV diagnoses. Self-tests for HIV (HIVST), which work much the same way as at-home COVID-19 tests, deliver near-immediate results without having to visit a clinic.
From January 2019 to April 2022, Wray and his team sent one of the following to the 811 participants in the study: a text message reminder to get tested for free at a local clinic, an HIVST kit with access to a free help line, or an HIVST kit with counseling provided within 24 hours of opening the kit.
The results were significant. Out of the eight new cases of HIV discovered during the study, seven were revealed through the mailed, at-home self-testing kits.
“The results showed that directly mailing HIV self-testing kits to those who are at high-risk for HIV at regular intervals increases regular testing substantially,” Wray said. “It also showed that all but one new HIV case was diagnosed with an HIV self-test versus just referring patients for free clinic testing, suggesting that self-testing could help diagnose new infections earlier than relying on clinic testing alone.”
The one caveat is this: Calling self-test users to provide counseling shortly after they use the tests does not appear to increase engagement with other important prevention services, such as testing for other sexually transmitted diseases or using HIV pre-exposure prophylaxis, a medication that can prevent infection. Follow-up counseling may have, however, reduced sexual risk behavior by as much as 27%.
“One of the most important goals is to detect new HIV cases as early as possible, so we can get people on treatment and virally suppressed, so they don’t transmit to others,” Wray said. “To do that, we need high-risk individuals to test every six months. Our results show that regularly sending kits to people automatically—that is, without requiring patients to request them themselves—increases regular testing a great deal. This stands in contrast to our usual approach, which involves sending people to local clinics to get free testing.”