The HIV self-test for gay men: a mixed methods exploratory study for intervention development

Abstract

Objective: To explore preparedness for the HIV self-test amongst men who have sex with men (MSM) and those involved in prevention and care. Methods: A mixed methods exploratory research design was employed, detailing awareness and willingness to use the self-test and the perceived barriers and facilitators to implementation. Quantitative and qualitative data collection and analysis were completed in parallel. Descriptive and inferential analysis of cross-sectional bar-based survey data collected from MSM through 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, NHS staff, community organisations, entrepreneurs and activists. Findings were subsequently combined and assessed for synergies. Results: Amongst MSM self-test awareness was moderate (55%). Greater awareness was associated with increased educational attainment and previous history of STI testing. Willingness to use the test was high (89%) and associated with meeting sexual partners online. Experts highlighted overall acceptability of self-testing; it was understood as convenient, discreet, accessible, and with low burden to services. However, some ambivalence to self-testing was reported; it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk. Conclusions: Self-testing represents a major opportunity to reduce barriers to HIV testing and enhance prevention and access to care amongst MSM. Levels of awareness are moderate but willingness to use is high, but health inequalities could affect implementation of self-testing.