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In the UK, rapid result HIV self-test kits became legally available in April 2014, and subsequently (April 2015) commercial products became available. However, rapid result HIV self-tests (or “home tests”) may offer new ways of reducing barriers to testing. Yet, recommendations regarding the frequency of testing are not being followed 12 and significant barriers to HIV testing endure 2. In this way, getting men at high risk to test, to test regularly, and, if they test positive, to remain in care with controlled HIV is central to HIV prevention. Furthermore, currently within the UK we know that most undiagnosed infections have occurred recently 1, and the proportion of new diagnoses associated with recent transmission has increased in some parts of the UK between 2011 to 2013 from 23% to 30% 6. Mathematical modelling suggests that increased testing, linkage to care and early treatment could significantly reduce the HIV incidence in MSM 11. Given that men living with HIV who are taking effective antiretroviral therapy are highly unlikely to transmit HIV 9, it is clear that undiagnosed infection, particularly primary infection (when individuals are most infectious), is responsible for most new infections 10. Delayed diagnosis is associated with poorer health outcomes and treatment response, increased mortality and health care costs, and increased levels of onward transmission 7, 8. UK data show there were 3250 new HIV diagnoses in MSM in 2013 (1) and an estimated one in five HIV positive MSM remain undiagnosed 6 with approximately 1000 late diagnoses each year 1. Scottish data for 2005–2009 showed a relatively stable incidence rate among MSM of around 15.3/1000 person-years 5. HIV testing rates amongst MSM overall have increased 1, 2 and increasing the frequency of testing to 3-monthly for men at higher risk of HIV infection is recommended in UK national guidelines 3, 4. In 2013, they represented 54% of all new diagnoses. Gay and other men who have sex with men (MSM) are the group at highest risk of acquiring HIV infection within the UK. Self-testing may amplify health inequalities. Levels of awareness are moderate but willingness to use is high. Self-testing represents an opportunity to reduce barriers to HIV testing and enhance prevention and access to care. However, some ambivalence towards self-testing was reported it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk. Experts highlighted the overall acceptability of self-testing it was understood as convenient, discreet, accessible, and with a low burden to services. Willingness to use the test was high (89%) and associated with meeting sexual partners online (unadjusted odds ratio 1.96 95% CI 1.31–2.94 P < 0.001). Greater awareness was associated with increased educational attainment and previous history of sexually transmitted infection (STI) testing (adjusted odds ratio 1.63 95% CI 1.11–2.39 P = 0.01). ResultsĪmong MSM, self-test awareness was moderate (55%). Findings were subsequently combined and assessed for synergies.
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Descriptive and inferential analysis of cross-sectional bar-based survey data collected from MSM through a self-completed questionnaire and oral fluid specimen collection ( n = 999) was combined with qualitative, thematic, analysis of data collected through 12 expert focus groups ( n = 55) consisting of gay men, National Health Service (NHS) staff, community organizations, entrepreneurs and activists. Quantitative and qualitative data collection and analysis were completed in parallel.
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MethodsĪ mixed methods exploratory research design was employed, detailing awareness and willingness to use the self-test and the perceived barriers and facilitators to implementation. The aim of the study was to explore preparedness for the HIV self-test among men who have sex with men (MSM) and those involved in HIV prevention and care.