Background: The rapid human immunodeficiency virus (HIV) self-test in the United States has expanded opportunities for HIV testing in nonclinical settings which may increase early diagnosis of HIV infection. However, broad application may be limited by the cost of the test and concerns that self-testers who test positive will not seek timely HIV care.
Methods: We used data from HIV partner services program to compare the sociodemographic characteristics, transmission risk, and clinical stage of persons diagnosed with HIV by report of rapid self-test. Among self-tested persons, we assessed timeliness of seeking definitive testing after self-test and linkage to care.
Results: From January 2013 to August 2016, 8032 HIV-positive persons were interviewed. Compared with the 7905 persons who did not self-test, self-tested persons were significantly (all P = <0.0001) male (96% vs 78%), white/non-Hispanic (46% vs 16%), men who have sex with men (92% vs 58%), college educated (67% vs 35%), and residing in medium-high income NYC neighborhoods (51% vs 44%). Higher proportions of self-tested (91%) than non-self-tested persons (81%) linked to care within three months of diagnosis. Significantly (P = <0.0001) more persons that self-tested positive (39/44, 89%) than persons that self-tested negative (14/36, 39%) sought laboratory-based HIV test within 1 month of last self-testing; and negative than positive self-tested persons were diagnosed with acute HIV infection (44% vs. 9%, P = <0.0001).
Conclusions: Our findings suggest that men who have sex with men sought timely HIV confirmatory testing and linkage to care after self-test. However, the cost of self-test kit may be an important barrier to its wide adoption across sociodemographic groups.
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