Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales

EClinicalMedicine

Talen Wright¹  Mitzy Gafos²  Denise Ward³  Chris Bonell³  David D. Dunn⁴  Leanne McCabe⁴  T. Charles Witzel⁴  Alison J. Rodger⁴  Yolanda Collaco-Moraes⁵  Peter Weatherburn⁶  Andrew N. Phillips⁶  Roy Trevelion⁶  Michelle M. Gabriel⁷  Justin Harbottle⁷  Sheena McCormack⁷  Fiona C. Lampe⁷  Aedan Wolton⁷  Fiona M. Burns⁷  Andrew Speakman⁸ 

[1] Corresponding author.;56T, Chelsea and Westminster NHS Hospital Foundation Trust, 56 Dean Street, London W1D 4PR, United Kingdom;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom;Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom;HIV i-base, 107 The Maltings, 169 Tower Bridge Road, London SE1 3LJ, United Kingdom;Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom;Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom;SH:24, 35a Westminster Bridge Road, South Bank, London SE1 7JB, United Kingdom;

关键词: Trans men;    Trans women;    HIV self-testing;    New prevention technologies;    Randomised controlled trial;    Process evaluation;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Globally, trans people are disproportionately affected by HIV, but research on strategies to increase testing are limited. SELPHI is a randomised-controlled-trial (RCT) of 10,135 cis men, trans men, and trans women reporting lifetime anal intercourse with male partners (cis or trans), evaluating whether the offer of free HIV self-testing (HIVST) increases diagnosis. This subgroup analysis from the SELPHI RCT aims to describe key HIVST outcomes and HIVST acceptability for trans people. Methods: SELPHI recruited using social networking and trans focused social media. Participants were randomised 60/40 to baseline HIVST (Biosure™) (BT) vs no baseline HIVST (nBT); and at 3-months (if completed the survey and reported recent CAI) 50/50 to 3-monthly HIVST (RT) vs no repeat HIVST (nRT). Outcomes were self-reported through online surveys. We conducted a qualitative study of semi-structured peer-led participant interviews (n = 20) exploring HIVST motivations and experiences. These were analysed using a framework approach. Findings: SELPHI recruited and randomised 118 trans men and trans women (94 trans men, 24 trans women), of whom 20 (16 trans men, 4 trans women) underwent the second randomisation. Median age at baseline was 29 (IQR: 22, 37), 79% were white, 79% were UK born, 37% had degree level education, and 31% had never tested for HIV. 62% (n = 59) of trans men completed the 3-month survey, but survey completion by trans women in nBT was too low (1/11) for randomised comparison. In trans men HIV testing uptake by 3 months was significantly higher in BT (95% 36/38) vs nBT (29%, 6/21) (RR=3.32 (1.68, 6.55) p<0.001). Trans people randomised to RT reported 3 times higher rate of HIV testing compared to nRT during the two-year follow-up (IRR 3.66 (1.86, 8.01) p<0.0001). STI testing frequency (mean number of tests during each 13 week period/ 2-year follow-up) was not significantly different across interventions: RT (0.03) and nRT (0.01) (IRR=1.86 95%CI; 0.77, 5.15; p = 0.15). Social harms were rare. Acceptability was very high in BT: 97% (38/39) found instructions easy to understand, 97% (37/38) found the HIVST simple to use and 100% (39/39) reported good overall experience. In interviews, reported HIVST benefits included increased autonomy, privacy, convenience and avoidance of health care providers perceived to be discriminatory and services that increased dysphoria. Minor lancet and test processing issues were reported. Interpretation: HIVST significantly increased testing uptake and frequency in trans men and trans people overall, although recruitment and retention of trans women was low. HIVST acceptability was high and indicates easy access to this novel technology may increase HIV testing access for this key population.

【 授权许可】

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