The impact of community-based HIV self-testing dissemination on the HIV testing system at the county level

Abstract

Background

Ending the HIV epidemic requires increasing HIV testing among at-risk persons, including addressing the limitations of venue-based testing. Using a community-based intervention (My Test/My Choice; MT/MC), we delivered free oral HIV self-tests (OHSTs) through LGBTQ+ businesses in Multnomah County, OR. We examined if disseminating OHST negatively impacted other segments of the HIV testing system.

Methods

We compared dissemination rates for Multnomah County’s clinic-based and online HIV testing programs across three periods: (i) preintervention (July–September 2022), (ii) MT/MC intervention period (October 2022–March 2023), and (iii) postintervention (April–July 2023). We used analysis of variance to examine for changes in county programs during/after MT/MC. Data from all other Oregon counties were analyzed to distinguish county-specific and statewide changes in testing.

Results

MT/MC disseminated slightly more HIV tests (n = 2698; 50%/6 months) to the county system than clinic-based dissemination (n = 2561; 48%) and substantially more than online dissemination (n = 78; 2%). There were no significant changes in clinic-based dissemination over time in the county [F (2,10) = 1.83; P = 0.21]. Significant declines in online dissemination occurred in Multnomah County [F (2,10) = 5.95; P = 0.02] and other Oregon counties [F (2,10) = 4.5; P = 0.04], suggesting that statewide, an unknown factor negatively influenced online dissemination.

Conclusions

MT/MC positively impacted the local HIV testing system by adding new clients, rather than reducing the number of clients attending other testing programs. Our study provides unique data on the effects of disseminating a new health program on ongoing programs of a similar nature.

Lay Summary

Ending the HIV epidemic in the United States requires providing high levels of HIV testing among at-risk persons and addressing limitations of venue-based testing programs (e.g. HIV testing clinics). We developed a community-based intervention to disseminate free OHST kits through a network of local LGBTQ+ businesses in Multnomah County (Portland), Oregon. In this study, we compared HIV test dissemination through the intervention with dissemination through other HIV testing programs in the county (health department clinic and free online OHST program) over three periods: preintervention (July–September 2022), MT/MC intervention period (October 2022–March 2023), and postintervention (April–July 2023). During the intervention period, more HIV tests were disseminated through MT/MC (n = 2698) than through clinic-based (n = 2561) and online testing programs (n = 78). The MT/MC intervention contributed 50% of the total HIV tests performed in Multnomah County, and did not reduce the number of clients seeking testing through other county programs. We also analyzed similar data for other counties in Oregon and found that a common external (nonintervention) factor may have influenced online OHST dissemination across the state. Our study demonstrates that community-based OHST dissemination programs can successfully supplement local HIV testing systems without negatively influencing other HIV testing programs.

We examined how HIV self-test distribution through a community-based network of local LGBTQ+ businesses compared to clinic-based and online HIV testing programs in Multnomah County (Portland), Oregon, over a 6-month period. The community-based program contributed 50% of the total number of HIV tests disseminated in the county, and did not reduce the number of clients seeking HIV testing from other county programs.