HIV SELF-TESTING UNCOVERS HIGH BURDEN of HIDDEN INFECTIONS in INDIA

ABSTRACT

Background: The number of undiagnosed persons globally remains a barrier to achieving UNAIDS 95-95-95 goals. While nearly 80% are aware of their status, there is much variability by age and geography. Many of those undiagnosed are not engaging in traditional HIV services and do not visit physical locations;novel strategies are needed to overcome structural barriers. We implemented an online, HIV self-testing (HIVST) service for vulnerable populations in India. Methods: An integrated web-based platform for HIVST www.safezindagi. net/selftesting was implemented across 24 Indian states in July 2021. Virtual outreach workers (vORWs) contacted clients on dating apps and social media platforms, provided counseling, and directed interested clients to HIVST via a platform that allowed for home delivery or pick up at a community site. HIVST could be assisted or unassisted with pre/post-test counseling from vORWS. Linkage to confirmatory testing/ART and PrEP was provided as needed. Descriptive statistics were used to characterize outcomes. Results: Between June 30-October 21, 2021, 2,234 clients registered and 1,356 (61%) clients ordered an HIVST kit. Median age of the 1,356 clients was 27 years;74% were male and 66% self-identified as MSM. Ten percent self-identified as transgender. In the prior 6 months, 67% reported condomless sex, 51% multiple partners, 13% transactional sex, 7% STIs, and 4% injection drug use. 1,190 clients (88%) received their kits within 3 days;44% used a courier service and 56% picked up from a community site. Of 1,070 (90%) results uploaded, 43 (4%) were positive with geographical variability (5 states had >4% positivity). The median age of the positive clients was 30 years and 74% were male. Of importance, 65% reported condomless sex with multiple partners in prior 6 months and none were previously tested for HIV. 19 (44%) were linked to confirmatory testing of whom 16 (84%) were confirmed positive and 14 (88%) initiated ART at public centers (see Figure). Conclusion: These data highlight the role of an HIVST platform to reach first time test-takers in a population with high risk behaviors and identified HIV burden >16 times the general population. With increasing online engagement and uptake of telemedicine globally, as well as continuing disruptions due to COVID-19, HIVST offers a critical approach to reach high-risk individuals, identify PLHIV, and link them to care and treatment.