1. Benefits and Adverse Outcomes of HIV Self-Testing Among MSM In China: An Implementation Perspective Yilu Qin Case Western Medical School, Class of 2017 Fulbright-Fogarty Fellow 2015-2016 Mentor: Joseph Tucker, MD, PhD Director of UNC Project China

2. OUTLINE INTRODUCTION METHODS RESULTS DISCUSSION

3. INTRO: Definition of HIV self-testing (HIVST) 1 a process whereby a person who wants to know his or her HIV status collects a specimen, performs a test, and interprets the test result in private UNAIDS. A short technical update on self ‑ testing for HIV. Geneva, 2014.

4. INTRO: Benefits of HIVST convenient confidential personalized

5. Regulations for HIVST USA Jul 2012 Brazil Dec 2015 http://www.hivst.org/ China unclear (2013?) Australia July 2014 Illegal: Germany, Ukraine, Bostwana, Zambia Turkey 1997

6. HIV self-testing in the U.S. 1, 2 1996 = Home Access® HIV-1 kit 2002 = OraQuick Rapid HIV-1 Antibody test for healthcare settings 2012 = OraQuick oral swab approved for home-use if ≥17 years old Positively aware : the monthly journal of the Test Positive Aware Network 1996; 7(4): 8 Path to regulatory approval by the FDA 20 min 7 days

7. INTRO: Why China? 1)large number of MSM report history of HIVST; 2)permissive regulatory/legal environment; 3)extensive centralized, facility‐based testing that has not reached all key populations (missed opportunity) Han L, Bien CH, Wei C, et al. HIV Self-Testing Among Online MSM in China: Implications for Expanding HIV Testing Among Key Populations. J Acquir Immune Defic Syndr 2014; 67(2): 216-21.

8. INTRO: Barriers to Understanding HIVST in Implementation research settings have more resources that can minimize adverse outcomes violence coercion suicide research settings have more supervision that can ensure better linkage to care Positively aware : the monthly journal of the Test Positive Aware Network 1996; 7(4): 8 Tucker JD, Wei C, Pendse R, Lo YR. HIV self-testing among key populations: an implementation science approach to evaluating self-testing. J Virus Erad 2015; 1(1): 38-42.

9. METHODS: Nationwide Survey 1) s 2)s 3)correlates of first-time HIV test being a self-test http://www.danlan.org/ WeChat BenefitsAdverse Outcomes first-time testingcoercion increased testing freqviolence post-testing counsellingsuicidality confirmation

10. METHODS: Flow of Participants 7,8891,189647306 341 clicked the survey link completed survey ever took HIV test ever HIVST 200 447 28.7% MSM ever done HIVST 200 men reported that their first-time HIV test was a self-test rather than a facility test

11. RESULTS: Sociodemographics Table 1. overall

12. RESULTS: The HIVST Experience Frequency (% out of 341) Obtained online 171 (50) Fingerstickprick kit 242 (71.0) Positive HIVST result40 (11.7) Confirmed results at a facility 149 (43.7) Got counselling164 (48.1) More frequent testing77 (22.6) Adverse outcomes coercion31 (9.1) suicidality‡, n = 40 14/40 (35.0) violence‡, n = 40 2/40 (5.0) 31/40 (78.0%) positive 118/301 (39.4%) neg

13. RESULTS: The HIVST Experience Which type of HIVST do people use? blood-based or fingerstick type Where are people obtaining HIVST? most people obtain online e-commerce websiteWebsite of GZTZ* *a Guangzhou-based MSM community group

14. RESULTS: Benefits and Risks Frequency (%) Obtained online 171 (50) Fingerprick kit (versus oral) 242 (71.0) Positive HIVST result40 (11.7) Confirmed results at a facility 149 (43.7) Got counselling164 (48.1) More frequent testing77 (22.6) Adverse outcomes coercion31 (9.1) suicidality‡, n = 40 14/40 (35.0) violence‡, n = 40 2/40 (5.0) 31/40 (78.0%) positive 118/301 (39.4%) neg

15. RESULTS: Benefits and Risks adverse outcomes among 341 self-testers coercion = 31 feelings of suicidality = 14 violence = 2 40 positive (or reactive) HIVST results 78% sought confirmation (versus 39% of negatives)

16. aOR (95% CI)p Younger Age (years)0.945 (0.905 to 0.984)0.0053 Student status1.156 (0.704 to 1.888)0.5652 Not “out” to healthcare provider 2.244 (1.574 to 3.220)<.0001 Less likely internet to meet sex partners 2.420 (1.387 to 4.227)0.0020 Group sex1.881 (1.104 to 3.176)0.0204 200 first-time HIV self-testers multivariable logistic regression modelling RESULTS: Correlates of First-time HIVST

17. DISCUSSION: Summary Can HIVST can better reach people who otherwise don’t test? we saw a high proportion of first-time HIV testers (59%) tended to be young and not “out” Will it actually link people to care? Is it generating unsafe situations? coercion, suicidality, violence limitations