As
HIV remains a public health concern, increased testing among those at risk for
HIV acquisition is important. Men who have sex with men (MSM) are the most
important group for targeted HIV testing in Europe. Several new strategies have
been developed and implemented to increase HIV-testing uptake in this group,
among them the Swab2know project.
Sample
collection happened between December 2012 and April 2014 via outreach and
online sampling among MSM. Test results were communicated through a secured
website. HIV tests were executed in the laboratory. Each reactive sample needed
to be confirmed using state-of-the-art confirmation procedures on a blood
sample. Close follow-up of participants who did not pick up their results, and
those with reactive results, was included in the protocol. Participants were
asked to provide feedback on the methodology using a short survey.
During 17
months, 1071 tests were conducted on samples collected from 898 men. Over half
of the samples (553/1071, 51.63%) were collected during 23 outreach sessions.
During an 8-month period, 430 samples out of 1071 (40.15%) were collected from
online sampling. Additionally, 88 samples out of 1071 (8.22%) were collected by
two partner organizations during face-to-face consultations with MSM and male
sex workers. Results of 983 out of 1071 tests (91.78%) had been collected from
the website. The pickup rate was higher among participants who ordered their
kit online (421/430, 97.9%) compared to those participating during outreach
activities (559/641, 87.2%; P<.001). MSM participating during outreach
activities versus online participants were more likely to have never been
tested before (17.3% vs 10.0%; P=.001) and reported more sexual partners in the
6 months prior to participation in the project (mean 7.18 vs 3.23; P<.001). A
total of 20 participants out of 898 (2.2%) were confirmed HIV positive and were
linked to care. Out of 1071 tests, 28 (2.61%) with a weak reactive result could
not be confirmed, and were thereby classified as false reactive results. Most
of the 388 participants who completed posttest surveys (388/983, 39.5%) were
very positive about their experience. The vast majority (371/388, 95.6%) were
very satisfied, while 17 out of 388 (4.4%) reported mixed feelings.
Despite
a high yield and a considerable number of false reactive results, satisfaction
was high among participants. The project helped us to reach the target
population, both in numbers of tests executed and in newly diagnosed HIV
infections. Further optimization should be considered in the accuracy of the
test, the functionalities of the website (including an online counseling tool),
and in studying the cost effectiveness of the methodology.
Below: Flowchart of test results, confirmation, and follow-up for 1071 tests executed among MSM in the Swab2know study
1Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
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