High acceptability of HIV self-testing in a randomized trial among transgender women and men who have sex with men, Myanmar

ABSTRACT

HIV self-testing (HIVST) shows promise to improve HIV diagnosis among those seeking privacy and anonymity in HIV testing. This may include sexual and gender diverse populations, who experience disproportionately high burdens of stigma and HIV globally. To inform potential scale-up of HIVST in Myanmar, we implemented a community-led, mixed-methods randomized trial in Yangon. Adult trans-feminine individuals and cisgender men who have sex with men were recruited via respondent-driven sampling. Participants (N = 577) completed a baseline survey and were randomized to community-based HIV testing services (HTS) or HIVST. One-third of participants reported lifetime HIV testing. Over half (59.4%) returned for a second study visit to report their test result and test acceptability, which was lower among HTS-assigned participants compared to those assigned to HIVST (55.6% vs. 63.1%; p = 0.096). Participants reported that both HIVST and HTS were easy to access, test, and interpret/understand the results of their HIV test. Ninety percent of HTS-assigned participants indicated they would test regularly if they could access HIVST. Qualitative participants (N = 20) described that the convenience and privacy afforded by HIVST may increase the availability and coverage of testing. Taken together, these results suggest HIVST is an acceptable, low-barrier complement to community-based HTS for key populations in Myanmar.

KEYWORDS:

• HIV testing
• sexual and gender minorities
• community-led research
• Myanmar

Acknowledgements

The study team gratefully acknowledges the time and efforts of trans-feminine participants, gay men, and other MSM who participated in this study. The study team thanks the local partner community-based organizations (Aye Nyein Myitta, Phoenix Association, and Lotus) that have provided ongoing input, supported participant recruitment, and provided space for interviews and discussions. The authors are also grateful to James Case for developing, programming, and tailoring the participant randomization and tracking system for this study. We appreciate the assistance of Ariel Hansen, Courtney McQueen, and the Johns Hopkins University Editorial Assistance Services Initiative. CB, SN, SHHM, EC, KHT, AZP, AW collaborated in the design and oversight of the overall study. KHT, AZP, EKM oversaw data collection. AW conducted the quantitative analysis and wrote the initial drafts of this manuscript. JT and BJ conducted the qualitative analysis. All authors had full access to the data, reviewed and edited the manuscript, and all took responsibility for its integrity as well as the accuracy of the analysis.

Disclosure statement

Donated OraQuick HIV self-test kits were provided by OraSure. CD4 testing was performed on a FACSPresto machine donated by BD Biosciences. Neither OraSure nor BD Biosciences had a role in analysis or interpretation of the data. The authors have no competing interests to declare.

Additional information

Funding

This study was supported by amfAR, the Foundation for AIDS Research, through a GMT Implementation Science Research Grant [Grant Number 109067-57-HGMM]. Faculty from Johns Hopkins were also supported by the Johns Hopkins University Center for AIDS Research (National Institute of Allergy and Infectious Diseases) [Grant Number P30AI094189].