Testing is critical to HIV and other sexually transmitted infections (STI) treatment and prevention. The MemoDepistages multicenter study is a novel French government-based comprehensive STI testing program, providing free postal self-sampling kits to high-risk MSM. We present here the baseline results from the Paris area, accounting for 60% of all participants.
The program was advertised by dating apps and social media. Inclusion criteria were: MSM aged over 18, ≥2 male sex partners in the last year, HIV-seronegative without PrEP. Test kits included 1 Microtainer Serum Separator Tube, lancets for the collection of 600µl capillary blood, 1 UriSwab collection tube, 2 PCR Dual Swab kits and pre-paid packaging to return samples. Serum was tested for HIV-1/2 EIA 4G serology, anti-HCV antibodies, HBs antigen (Architect, Abbott) and syphilis Tp and RPR (Bioplex, Biorad). Urine, throat and anal swabs were tested for Chlamydiae trachomatis (CT) and Neisseria gonorrhoeae (NG) DNA (Cobas 6800, Roche). Results were provided to the participants, as they chose, by community-based workers following text, phone or e-mail contact or by their family physician.
From April, 10th to June, 11th 2018, 4419 applicant men from the Paris area were eligible. Median age was 30 years, 13.0% had never been tested for HIV, they reported a median of 10 partners/year. 48.5% confirmed their inclusion and ordered the kit. As of August, 31st 2018, 1238 kits were returned to the core lab. 1.3% (13) of tested samples were positive for HIV, 0.5% (6) for anti-HCV antibodies, 0.3% (3) for HBs antigen and 1.8% (11) for active syphilis. Full serology testing was hindered by hemolysis and low blood volume (Table 1). Six HIV-positive participants were unaware of their infection (0.6%) and one sample revealed an acute primary infection, as confirmed by further sampling. NG was found in 11.2% of participants and CT in 9.4%. The most common bacterial STI was throat NG (8.2%). Community-based linkage to care was excellent and newly diagnosed participants sought counseling and treatment.
This is the first study of a postal viral and bacterial STI test in France. Enrollment was fast, highlighting the need for access to testing in the target population. Blood collection was feasible in most participants and laboratory-based serology allowed for the detection of acute and chronic HIV infections, HCV, HBV and syphilis. CT and NG were frequent and would not have been detected by a typical urine-only strategy.