Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries.

We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.

Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users.

We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users' (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs' willingness to pay 25-30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs' preferred place to obtain a self-test, which was in line with PUs' actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs' preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders' opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.

Potential of HIV Self-Sampling to Increase Testing Frequency Among Gay, Bisexual, and Other Men Who Have Sex With Men, and the Role of Online Result Communication: Online Cross-Sectional Study.

BACKGROUND: Late HIV diagnosis remains frequent among the gay, bisexual, and other men who have sex with men (GBMSM) population across Europe. HIV self-sampling could help remove barriers and facilitate access to testing for this high-risk population. OBJECTIVE: We assessed the capacity of HIV self-sampling to increase the testing frequency among GBMSM living in Denmark, Germany, Greece, Portugal, Romania, and Spain, and evaluated the role of new technologies in the result communication phase. METHODS: We analyzed a convenience sample of 5019 GBMSM with prior HIV testing experience who were recruited during 2016 through gay dating websites. We estimated the proportion of GBMSM who reported that the availability of self-sampling would result in an increase of their current testing frequency. We constructed a Poisson regression model for each country to calculate prevalence ratios and 95% CIs of factors associated with an increase of testing frequency as a result of self-sampling availability. RESULTS: Overall, 59% (between country range 54.2%-77.2%) of the participants considered that they would test more frequently for HIV if self-sampling was available in their country. In the multivariate analysis, the increase of testing frequency as a result of self-sampling availability was independently associated with reporting a higher number of unprotected anal intercourse events in all countries except for Greece. Independent associations were also observed among GBMSM who were not open about their sex life in Germany, Greece, Portugal, and Spain; those with a lower number of previous HIV tests in Denmark, Greece, Portugal, and Spain; and for those that took their last test more than 3 months previously in Germany, Portugal, Romania, and Spain. In addition, 58.4% (range 40.5%-73.6%) of the participants indicated a preference for learning their result through one-way interaction methods, mainly via email (25.6%, range 16.8%-35.2%) and through a secure website (20.3%, range 7.3%-23.7%). Almost two thirds (65%) of GBMSM indicated preferring one of these methods even if the result was reactive. CONCLUSIONS: Availability of HIV self-sampling kits as an additional testing methodology would lead to a much-needed increase of testing frequency, especially for the hidden, high-risk, and undertested GBMSM population. Online-based technologies without any personal interaction were preferred for the communication of the results, even for reactive results.

High risk men who have sex with men in Spain are reporting low intentions of actively seeking HIV testing: results from a cross-sectional study.

BACKGROUND: We analyse unprotected anal intercourses (UAI) self-reported by a sample of men who have sex with men (MSM), by their future testing intentions and past testing history to identify undertested subpopulations that could be contributing to onward transmission. METHODS: We recruited MSM through gay dating websites in Spain from September 2012 to April 2013. For MSM at risk of acquiring or unknowingly transmitting HIV (at risk hereafter) we calculate time at risk, number of UAI in the last 12 months and last 5 years by testing intention (low intention (LI), Medium intention (MI), high intention (HI)) and past testing history. For never testers we analyse the reasons for not having been tested. RESULTS: Of 3272 MSM at risk, 19.8% reported LI of testing. MSM with LI reported the longest period at risk (8.49 years (p < 0.001)) and reported 3.20 UAI/person in the last 12 months (vs. 3.23 and 2.56 in MSM with HI and MI (p < 0.001)) and 12.90 UAI/person in the last 5 years (vs. 8.07 and 9.82 in MSM with HI and MI (p < 0.001)). Those with LI accounted for 21 and 27% of all the UA acts occurring in the last 12 months and the last 5 years. Among never testers (40.6%), those with LI reported lower risk perception (p = 0.006). CONCLUSION: We identified a group of high risk and undertested MSM that could be behind a substantial proportion of the UAIs with potential of transmission/acquisition of HIV. Given their low willingness to seek an HIV test and low risk perception, they constitute a population that will probably require approaches other than client initiated strategies.

Short-term impact of particulate matter (PM(2.5)) on respiratory mortality in Madrid.

OBJECTIVES: This paper sought to quantify the particulate matter (PM(2.5)) pollutant's impact on short-term daily respiratory-cause mortality in the city of Madrid. METHODS: As our dependent variable, we took daily mortality registered in Madrid from 1 January 2003 to 31 December 2005, attributed to all diseases of the respiratory system as classified under heads J00-J99 of the ICD 10 and broken down as follows: J12-J18, pneumonia; J40-J44, chronic diseases of the respiratory system except asthma; J45-J46, asthma; and J96, respiratory failure. RESULTS: The relative risk (RR) for daily overall respiratory mortality was RR 1.0281 (1.0043-1.0520), with a proportional attributable risk (PAR) of 2.74%. This effect occurred in lag 1; respiratory failure, RR 1.0816 (1.0119-1.1512) and PAR 7.54% at lag 5; and pneumonia, RR 1.0438 (1.0001-1.0875) and PAR 4.19% at lag 6. CONCLUSIONS: Our results reflect the association that exists between PM(2.5) concentrations and daily respiratory-cause mortality.