HIV Self-Testing Programs to Improve Testing Uptake and Increase Diagnoses

More than 160,000 Americans with HIV are unaware they have the virus because they have not been tested and diagnosed. Yet we know that early diagnosis and treatment with ART are associated with better health outcomes for those with HIV. There are profound prevention benefits as well—a CDC analysis found that the nearly 15% of people with HIV whose infections are undiagnosed account for 38% of all HIV transmissions in the U.S. By finding ways to help more people get tested, we can prolong lives and prevent further transmissions.

That’s why HIV testing is a key strategy in Ending the HIV Epidemic: A Plan for America (EHE), the nation’s plan to reduce new HIV infections in the U.S. by 75% by 2025 and by 90% by 2030. The first of the Plan’s four strategies calls for diagnosing all people with HIV as early as possible after infection so they can begin care and treatment that can protect their health and prevent transmission of the virus to their partners.

Stakeholders across the country are exploring innovative ways to pursue this EHE strategy and seeking to make HIV testing more available to previously unreached populations, such as those who live far from the nearest testing site or who are concerned about confidentiality. One innovative model includes HIV self-testing programs, sometimes called “home HIV test giveaways.” These are programs in which city or state health departments advertise free self-test kits via the internet and/or dating apps, and distribute the kits by mail so that users can perform their own HIV tests in private.

In a recent NASTAD webinarExit Disclaimer, two health jurisdictions highlighted their experiences with this testing modality.

• The Virginia Department of Health implemented a self-testing program focused on individuals who cannot or are reluctant to get tested in traditional health care settings for a variety of reasons, including geographic isolation, stigma, a desire for privacy, etc. The Department advertised the availability of free self-test kits on Facebook. Interested individuals answered brief online eligibility surveys and received their self-test kits by mail along with literature about confirmatory testing and linkage to care. Eligible clients could receive a test kit every 90 days.
• Under a grant from the Arizona Department of Health, the community-based organization Aunt Rita’s Foundation administers a statewide self-testing program. The organization markets the availability of self-test kits via social media, dating apps, posters, billboards, and other means. Interested individuals visit a website, provide contact information, and receive a box in the mail that includes a self-test kit as well as contact information for a linkage to care specialist, treatment information, condoms, and information about PEP and PrEP.

Both jurisdictions found that the programs helped them reach individuals who had never been tested or had not recently been tested and in some cases, they succeeded in reaching a higher positivity rate than traditional testing strategies. In Virginia, 88% of those who tested positive were linked to care within 30 days.

In addition, Building Healthy Online CommunitiesExit Disclaimer (BHOC), a consortium of public health leaders and gay dating website and app owners who are working together to support HIV and STI prevention, has developed Take Me Home, a national self-test kits program. Take Me Home is a national platform for ordering and distributing self-test kits that helps public health departments offer access to HIV testing to those who might be hesitant to walk into a clinic. The kits are promoted by the dating apps and can be customized with local resource/care information. For the Take Me Home initiative, BHOC is partnering with NASTAD and Emory University.  

Studies by Emory researchers have highlighted the need for novel approaches to HIV testing among some populations and provided an evidence base for tailored self-testing initiatives. For example, the 2019 American Men’s Internet Survey found that 22% of gay, bisexual and other men who have sex with men (MSM) who use dating apps reported that they had never tested for HIV. The CDC-supported Evaluation of HIV Self-Testing Among Men who have Sex with Men Project (eSTAMP) demonstrated the success of home-based HIV self-testing with rapid diagnostic tests among MSM. This study found that mail distribution of HIV self-tests effectively increased testing frequency and diagnosis of HIV infection among gay and bisexual men and identified infections among their social network members.

The three examples above are just some of the many ways health departments, health centers, and other stakeholders can innovatively expand HIV testing opportunities to help achieve EHE goals. It is important during this time of social distancing that we think creatively and work diligently to reach those who may not otherwise be accessing HIV testing or may not be testing as frequently as is recommended. Together we can reduce testing barriers and help more individuals to know their status and connect to appropriate prevention or care services.