Implementation of Unassisted and Community-Based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A Demonstration Study in Metro Manila, Philippines

ABSTRACT

ObjectiveThe study aimed to demonstrate the feasibility of an unassisted and community-based HIV self-testing (HIVST) distribution model and to evaluate its acceptability among men-having-sex-with-men (MSM) and transgender women (TGW). MethodsOur observational study focused on implementing the HIVST service in Metro Manila, Philippines. Convenience sampling was done with the following inclusion criteria MSM or TGW, at least 18 years old, and had no previous HIV diagnosis. Individuals taking HIV Pre-exposure Prophylaxis (PrEP), on Antiretroviral Therapy (ART), or female sex at birth were excluded. The implementation of the study was online using a virtual assistant and delivery system via courier due to COVID-19-related lockdowns. Feasibility was measured by the number of HIVST kits successfully delivered and utilized and the HIV point prevalence rate. Moreover, acceptability was evaluated by a 10-item system usability scale (SUS). HIV prevalence was estimated with linkage to care prioritized for reactive participants. ResultsOut of 1,690 kits distributed, only 953 (56.4%) participants reported their results. Overall HIV point prevalence was 9.8%, with 56 (60.2%) reactive participants linked to further testing. Furthermore, 27.4% of respondents self-reported, and 13.4% of the reactive participants were first-time testers. The HIVST service had an overall mean {+/-} standard deviation SUS score of 81.0 {+/-} 13.0, rendering the HIVST kits very acceptable. ConclusionsHIVST is acceptable and feasible to MSM and TGW. Online platforms are an innovative and effective way to deliver HIVST service during a pandemic. However, messaging to entice people to use the kit must be differentiated based on their age, gender identity and expression, and previous HIVST experience to offer the service efficiently to the target populations.