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MSM want access to self-tests

MSM want access to self-tests. Tim Greacen Laboratoire de recherche Maison Blanche Hospital Paris 22 July 2012. Self-tests, not authorised in France, but easily available online. Online self-tests. Packaged :  2 Tests/Box Time to Result :  5 Minutes, or less

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MSM want access to self-tests

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  1. MSM want access to self-tests Tim Greacen Laboratoire de recherche Maison Blanche Hospital Paris 22 July 2012

  2. Self-tests, not authorised in France, but easilyavailable online

  3. Online self-tests • Packaged: 2 Tests/Box • Time to Result: 5 Minutes, or less • Procedure: Simple • Specimen Type: Whole Blood, Serum or Plasma • Screen For: HumanImmunodeficiency Virus • Storage: 18 months, at room temperature 15-30°C (59-86°F) • Method: Micro Lateral Flow • Specificity: 100% (overall) • Sensitivity: 99% (overall)

  4. Years of debate • Home Sample Collection (HSC) Kits since 1996 in USA • Spielberg et al (2003): More than a one in three Californians would use an instant home HIV test if a reliable one were available. • The internet social, dating & sex network revolution same ‘revolution’ isbeingused to promote and sell self-tests • FDA envisagingauthorisingrapid self-test since 2005 • Generalisation of rapid test (WHO 2006) • FDA authorises oral self-test July 2012

  5. Advantages • HSC kits (Branson, 1998) • High call back rate: 97% • Usersappreciaterapidity, convenience, discretion • Brings in previouslyuntested people: 49% of thosetesting positive = their first test • No need to talk about personal life, to risk stigmatisation and discrimination because of possible HIV+ status / homosexuality / sexualrisk-taking • If people know they are HIV+ • Theycanaccessearly care • Theycanprotecttheirpartners • Empowerment, autonomy

  6. Disadvantages • Risk of inexact results due to incorrect usage • Lee et al. (2007): 350 subjects • 85% used the test incorrectly • 56% inexact results • 12% incapable of interpreting the resultscorrectly: 2% false negatives and 7% false positives • No counselling • Seroconversiondelay • Suicide risk, depression • Prevention • Accessingtreatment • More difficult to monitor epidemic

  7. The Webtest Project • Objectives • Are Internet-using MSM aware of existence of unauthorised online self-test? • Are theyusingthem? • Are reasons for use similar to thoseidentified in studies of HSC kits • 3 mars au 29 avril 2009 (8 weeks) • Questionnaire visited 119 326 times 14 022 visitorsclicked on ‘Continue’ at end of information page 9 169 completed questionnaire (23 minutes)

  8. The questionnaire: 2 main sections • Part 1: Use and attitudes with regard to self-test • Awareness of existence of self-test • If aware, access to and use of self-test • Attitudes towards self-test • Part 2: • Demographic questions • Lifestyle • Internet use • Etc.

  9. Whoanswered? • 89% connected via dating sites, 8% from gay information sites or HIV/AIDS health sites • Medianage 35 • 83% gay / homosexuel, 13% bi • 35% live in Ile-de-France, 61% provinces, 3% other countries • 53% live alone, 26% with a man, 8% withtheir parents • 61% single, 32% in couple or PACS with man, 4% withwoman • 49% hadhadsuicidalthoughts (lifetime) • 59% have universitydiploma or equivalent • 78% have a job • Median 20h per week on computer, 12h on internet

  10. Who are they? Risks and tests • 64.6% are VIH-, 14.3% don’t know, 11.3% no longer certain of stillbeing VIH-, 9.7% VIH+ • 52% have done a test in the last 12 months, 13% never • 38.4% have had UAI with a casualpartner in the last 12 months (43.6% of thosehavinghadcasualpartners) • 45.5% of thosehavinghad UAI with a casualpartner in the last 12 months have not done the test since.

  11. Awareness of existence of self-test • 30.0% (n=2748) declaredbeingaware of the existence of these online self-tests beforereading the questionnaire. • Compare Greensides et al (2003) for authorised HSC kits in the US: 73% MSM aware of existence • But withsamplerecruited in gay bars, face to face interviews Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74.

  12. Twopathways • Thensampledividesintotwopathways: • Thosewhohad not heard of itbefore(N = 6 421) • Thosewhohad (N = 2 748) • Beforecoming back to one unique pathway for demographic and lifestyle questions

  13. Pathway 1 • Thosewhowereunaware of the existence of the online self-test (n=6421) • Interested? • Not interested?

  14. Are thosewhohadneverheard of the test interested in accessingit? If this sort of test, one thatyoucouldbuy on Internet and do by yourselfat home, wereauthorised in France (withouthaving to have a doctor’s prescription, withouthhaving to go to a screening centre), wouldyoubeinterested in accessingit? • 6421 unaware • Of whom 513 already HIV+ • 5109/5908 = 86.5% are interested in accessing self-test • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7.

  15. Whywouldyoubeinterested? • Open question • 4362 men responded • Manygiveseveralreasons • Hugetask of thematiccategorisation • Three main motivations  • Convenience, accessibility, no need to go anywhere (31.5%) • Rapidity (28.5%) • Discrete, anonymous(23.2%) • Theseresultsconfirmthose of Greensides et al (2003) for HSC kits. And in the sameorder. • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7.

  16. Independent variables associated with interest in accessing online self-tests • Living their sex-lives with men in absolute secrecy (1.65) and yet often to try to make a date to see their sex partners again (1.55) • Having had casual sex partners in last year but on average not more than once a week (1.32), having taken sexual risks with these partners (1.74) • Never having done the standard HIV test (1.84) or not in last year (1.57) • Living in smaller towns (OR 1.55), living in a conventional family with their parents or their wife and family (1.42), having a job (0.76) but not tertiary education (0.84), being younger (0.97) • No association with having had thoughts of suicide • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7.

  17. Those not interested: Why not?(1/2) • N=799 • 4 main reasons stand out • Satisfied with your current testing method via your doctor or in a screening centre (65.6%) • Concerned that test results might be less accurate (45.5%) • Would not like to discover the results alone at home (44.4%) • Afraid of not using it correctly (26.5%) • Compare Greensides et al (2003) (but with MSM whoknew of existence of HSC kits): first 3 reasonsidentical : preference for standard test (60%), concernedthat test resultsmightbelessaccurate (44%), wants face to face counseling (42%). • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7.

  18. 799 not interested: why not? (2/2) • Being able to pay for the test is not a frequentlygivenreason (but important for thosewhodon’t have the means!) • it’s more expensivethanothertestingmethods (9.7%) • It costs money and you do not have any (8.3%) • You neverbuythings on internet (8.0%) • Then • No need to do the test (8,2%) • Cannotmakeyourself do the test, toostressful (5,2%) • Don’twant to do the test (2,5%). • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7.

  19. Pathway 2 • Thosewhowereaware of the existence of the online self-test (n=2748) • Accessed: why? • Used? • Not accessed: why not?

  20. 82 hadaccessed the self-test • 82 hadaccessed self-test (3.5% of thoseaware) • 63 boughtit for themselves • 8 had not usedit, 31 once, 24 several times • For 17, someoneelsehadboughtit for them • 12 usedit, 5 did not • 2 boughtit for someoneelse (not a sexpartner) ; bothhadalsoused one themselves • 69 hadusedit • 42 once, 27 more than once • Self-test not authorised in France: usersmay not have admitted use or not answered questionnaire • Questionnaire longer for self-test users; higher drop-out. Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74.

  21. Concerning the 69 users • 62 negativeresults • 29 (47%) sinceconfirmedthisresult • 24 in screening centre, 5 with second self-test • 3 positive • 1 confirmedwith 2nd self-test, 1 disconfirmed in screening centre, 1 called hotline but had not yet gone to seedoctor • None hadsinceseen a doctor • 4 uncertain • 3 did not understand how to read the results • 1 not sure to have useditcorrectly • 2 hadsince gone to screening centre (of which 1 did not go back to get the results); the 2 othershaddonenothing Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74.

  22. Independent variables associatedwith use of self-test • living sex-life with men in absolute secrecy (3.9; 1.7-8.8) • using doping products in last 12 months (3.5; 1.6-8) • knowing of the self-tests via a sex partner (3.4; 1.4-8.4) or an Internet search engine (2.2; 1.3-3.7) but not through the general (0.2; 0.1-0.4) or the gay press (0.3; 0.2-0.7) • using self-tests for other diseases (2.7; 1.4-4.9) • using poppers in last 12 months (2.2; 1.4-3.7) • never having had suicidal thoughts (0.5; 0.3-0.9) • having had UAI with casual partner in last year (1.9; 1.2-3.1) • having done standard HIV test but not in last year (1.9; 1.1-3.3) • living in the provinces (1.8; 1.0-3.3) Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74.

  23. 2666 MSM aware of existence of self-test but who have not accessed one • Order of principlereasonsidentical to thosegiven by MSM unaware of existence of self-test and not interested • Onlydifference: Fear of not doingitcorrectlyis a lot lower on the list. Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74.

  24. Summary of main results • MSM wantaccess to online self-tests (86.5%) • The reasonstheygive: convenience, rapidity, discretion • Variables associatedwithinterest: lives MSM sex-life in absolutesecrecy, takesrisks, untested, smalltown, conventionalfamily, job, not collegeeducation, younger • Of the 30% aware of existence, few (3.5%) hadaccessed one • Who are they? Lives MSM sex-life in absolutesecrecy, uses doping products and poppers, uses self-tests for otherillnesses, takesrisks, not recentlytested, lives in provinces • MSM not interested: satisfiedwithcurrentmethod, doubts self-test isreliable, does not want to discoverresultsaloneat home

  25. Be careful! • This MSM sampleis not representative of the whole population, nor of all MSM • MSM who chose to answer a questionnaire about self-tests are probablymorellikely to beinterested in the question. • Maybethey look afterthemselvesbetter as well? • Thenagain, maybeactual use wasunder-declaredbecause the online self-test is not authorised in France.

  26. References • Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by Internet-using French-speaking men who have sex with men. Sexually Transmitted Infections, 2012, 88(5):368-74. • Greacen T, Friboulet D, Blachier A, Fugon L, Hefez S, Lorente N, Spire B (2012). Internet-using Men who have Sex with Men would be interested in accessing authorised online HIV Self-tests. Aids Care, 2012, Jun 7. [Epub ahead of print]

  27. Thanks • To the Agence nationale de recherche sur le sida et les hépatites (ANRS) • To Sidaction for organisingtoday’s session • To the Etablissement public de santé Maison Blanche • To the people whoanswered the questionnaire • To the websitesthatacceptedbanners for the questionnaire • To myco-authors • And to all of you for listeningthrough to the end!

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