TY  - JOUR
AU  - Kwan, Tsz Ho
AU  - Chan, Denise Pui Chung
AU  - Wong, Samuel Yeung-shan
AU  - Lee, Shui Shan
PY  - 2023
DA  - 2023/4/26
TI  - Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study
JO  - J Med Internet Res
SP  - e46514
VL  - 25
KW  - community-based testing service
KW  - cross-sectional study
KW  - HIV self-test
KW  - HIV testing
KW  - HIV
KW  - implementation cascade
KW  - men who have sex with men
KW  - social network
KW  - virus transmission
AB  - Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e46514
UR  - https://doi.org/10.2196/46514
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37099364
DO  - 10.2196/46514
ID  - info:doi/10.2196/46514
ER  -