Background
The Together TakeMeHome program (TTMH) provides free HIV self-test kits (HIVSTs) by mail, allowing people at least 17 years old who may experience barriers to accessing other HIV testing services to test privately on their own time. Users can order one or two HIVSTs. Our goal was to use nationally representative survey data to estimate the need for annual HIV testing in each state and what percentage of that need is being met by TTMH.
Methods
TTMH order data from March 2023 to July 2024 were used to calculate the number of orders and test kits mailed to each state. Among US adults who self-reported behaviors that increase the chances of getting or transmitting HIV and, we estimated the proportion that have (1) never tested for HIV and (2) not been tested in the past year (including never testers) with 2016-2022 data from the Behavioral Risk Factor Surveillance System, a nationally representative telephone survey of adults in the US. An estimated range of met need percentage for the two estimates was generated, assuming that the tests were used by people with behaviors similar to those reported in BRFSS. The lower bound was calculated by dividing the number of orders by the estimates for each state, assuming the individual used both test kits. The upper bound, calculated by dividing the number of test kits by each state estimate, assumes that all ordered tests were used and by different individuals, allowing for possible diffusion of kits to others in the user’s social network.
Results
As of July 2024, TTMH distributed 586,099 HIVSTs through 315,710 orders across all 50 states, the District of Columbia, and Puerto Rico. Overall, 5.4% of US adults engaged in behaviors with elevated HIV risk in the past year. Among those, 50.0% had never been tested for HIV (range: 26.6% in DC to 61.8% in UT), and 67.8% had not tested in the past year or ever (range: 43.4% in DC to 77.9% in SD). For those who have never been tested for HIV, likely met need estimates ranged from a low of 2.2%-4.0% (WY) to a high of 21.0%-39.6% (DC). For those who have not been tested in the past year, met need estimates ranged from a low of 1.2%-2.1% (WY) to a high of 7.1%-13.8% (PR).
Conclusions
Many in the US who could benefit from annual HIV testing are not being served by existing services. TTMH is meeting some of this need, with percentage of met need varying widely by state.