Efforts to improve HIV diagnosis rely on innovative interventions, particularly for key populations. The HIV epidemic in Myanmar is concentrated among men who have sex with men (MSM) and transgender women (TW) and national efforts now focus on improving engagement in HIV testing and care. This implementation science study tested the acceptability and use of HIV self-testing (HIVST) to address care continuum losses by increasing HIV testing uptake to aid early diagnosis of infection.
We implemented a randomized trial in which HIV-uninfected MSM and TW were recruited via respondent-driven sampling in Yangon. Participants completed a baseline survey and were randomized to standard, voluntary counseling and testing (VCT) or to HIVST. To mitigate stigma, VCT-assigned participants were referred for testing at community-based organizations (CBO) serving MSM and TW. Biologic specimens were collected for confirmatory testing. Participants were asked to return to the study to report their HIV test result and the acceptability of their assigned testing method.
A total of 577 MSM (84.7%) and TW (15.3%) participants were enrolled and randomized to VCT or HIVST between November 2015-July 2017. Self-reported HIV risk behavior was high: 29.8% had engaged in sex work (last 6 mo.); condom use at last sex was less than 30.0% for all partner types; and 32.8% had ever been tested for HIV. 342 (59.3%) returned for the second study visit to report test acceptability. VCT-assigned participants were marginally less likely to return, compared to HIVST participants (45.9% vs. 54.0%; p=0.055). HIVST participants were more likely to agree that, overall, their testing method was easy to implement and understand (98.4% vs. 95.4%; p=0.002). The majority (88.8%) of VCT-assigned participants to indicated they would test regularly if they could access HIVST. HIVST participants were more likely to report that HIVST would be the preferable testing modality for future HIV testing; HIVST was also favored for future testing by VCT participants (55.4%), followed by CBO clinics (36.3%) and government facilities (7.0%). HIVST identified 29 previously undiagnosed infections (9.9%) compared to 15 identified by VCT (5.3%; p<0.001).
HIVST is an acceptable, alternative testing modality compared to community-based VCT for MSM and TW in Myanmar. Likely, HIVST may have greater acceptability and effectiveness compared to testing in government facilities, where stigmatization of key populations is common.