An innovative HIVST service model (HIVST-online) was developed for MSM in Hong Kong, which includes the online promotion of HIVST, delivery of free HIVST kits through mail/express, provision of online real-time instruction, and pre-test/post-test counseling for HIVST users via live chat application. Some researchers argued that the lack of counseling support is a key limitation of HIVST, which might delay linkage to care and treatment. There is a concern that HIVST users may skip counseling services. The WHO recommends that pre-test and post-test counseling services should be provided during HIV testing services. Users can call through a hotline or submit their testing results online to obtain counseling services. Most of these existing services provided optional post-test counseling to users. People can order HIVST kits and upload testing results via an online platform. In September 2019, the Hong Kong Department of Health also launched an HIVST program. Starting from 2015, several community-based organizations (CBOs) started to provide HIVST services to MSM. In Hong Kong, HIVST kits are available in registered pharmaceutical stores or through online purchase. At least 77 countries have adopted policies supporting HIVST. The WHO strongly recommends that HIVST should be offered as an additional approach to existing HIV testing services. HIV self-testing (HIVST) is a useful means to increase both the coverage and frequency of HIV testing among MSM. Very few MSM performed repeated testing (taking up two episodes of HIV testing 6 months apart) as recommended. It was estimated that only 80% of HIV-infected MSM were identified in Hong Kong. The coverage of HIV testing among MSM was low in Hong Kong. Therefore, international health authorities recommend MSM to take up HIV testing every 6 months. With counseling in place, HIV testing and counseling can both detect HIV cases and reduce risk behaviors. The high coverage of HIV testing among a high-risk population (e.g., MSM) is indispensable to achieve the 90–90–90 targets established by the Joint United Nations Program on HIV/AIDS (i.e., 90% of all people living with HIV know their HIV status, 90% of people with diagnosed HIV receive ART, and 90% of all people on an HIV treatment achieve viral suppression). Therefore, the World Health Organization (WHO) recommends ART to all people living with HIV, regardless of their CD4 T cell level. Antiretroviral therapy (ART) is highly effective in preventing HIV transmission (over 90%) under conditions of good adherence. HIV testing plays a crucial role in the era of “treat all”. MSM accounted for 59.6% of all the reported new HIV cases in 2018. In Hong Kong, the HIV prevalence among MSM was 6.54% in 2017. In China, the National Health and Family Planning Commission estimated the overall HIV prevalence among MSM to be 7.7%, and over a quarter of new HIV cases were attributed to MSM. Human immunodeficiency virus (HIV) is a serious public health threat among men who have sex with men (MSM). A larger scale implementation should be considered. Implementation of HIVST-online was helpful to improve HIV testing coverage and repeated HIV testing among Chinese MSM. The process evaluation of HIVST-online was positive. Four HIVST-online users were screened to be HIV positive and linked to the treatment. Ever-users were more likely to receive HIVST-online and any HIV testing as compared to new-users. Taking other types of HIV testing into account, 79.4% of ever-users and 58.6% of new-users being followed up at month 6 received any HIV testing during the project period. At month 6, 63.1% of ever-users and 40.4% of new-users received HIVST-online. The post-test evaluation was conducted 6 months after the pre-test survey. The number of HIVST-online sessions performed was documented by the administrators. Experienced HIVST administrators implemented HIVST-online by providing real-time instruction, standard-of-care pre-test and post-test counseling via live-chat application. A free oral fluid-based HIVST kit was sent to all the participants by mail. A community-based organization (CBO) recruited 122 MSM who had ever used HIVST-online (ever-users) and another 228 new-users from multiple sources and promoted HIVST-online. HIV self-testing (HIVST) with online real-time counseling (HIVST-online) is an evidence-based intervention to increase HIV testing coverage and to ensure linkage to care for men who have sex with men (MSM).
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