HIV self-testing increases uptake without reducing link to care or STI testing
06 Feb 2023
New results from the SELPHI trial show that offering free HIV self-tests ordered online is acceptable and increases uptake in men, trans men and trans women who have sex with men, and it does not reduce linkage to care or STI testing. These results were published in The Lancet HIV last December.
Expanding and normalising HIV testing are important steps towards the goal of eliminating HIV. A promising approach to increase HIV testing in the UK is to provide free self-tests which are easy to use and can be done at home. They offer a more private, quicker, and more convenient option than visiting a clinic. However, there are concerns that those who test positive might not seek medical care for HIV infection after being self-diagnosed. This step, known as linkage to care, is crucial to access HIV treatment.
SELPHI is the largest HIV self-testing trial in a high-income country; the trial evaluated if offering free self-testing increased the clinical diagnosis of HIV infections and linkage to care in men, trans men and trans women who have sex with men.
It was an internet-based study where participants signed up online. To join, they had to be a man (including transgender man), or a trans woman, aged 16 years or older, have had intercourse with another man in the past, not have been diagnosed HIV positive and be currently living in England or Wales. They enrolled to the trial between February 2017 and March 2018.
The study recruited a total of 10,111 participants, who were randomly allocated to two groups. One received a free HIV self-test, and the other didn’t receive a test. Information about their diagnosis and link to care was obtained from the national HIV register.
SELPHI found that only 34 men of the total number of participants (10,111) had a confirmed HIV diagnosis within 3 months of enrolment, showing they had linked to care. However, when comparing the number of HIV diagnoses between groups, there was no evidence of a difference.
Although the trial did not demonstrate a difference in new HIV diagnoses between those who had a free HIV self-test and those who did not, there were also no differences in linkage to care or STI testing between the two groups. Another key finding from SELPHI was the decreasing incidence of HIV in the UK, which was lower than anticipated when the trial started. Thus, to confirm that self-testing does not result in more HIV diagnoses, a much larger study is required.
Finally, the study reported high rates of testing in the group that received the self-test, with 97% of men taking any HIV test within 3 months of enrolment. This shows that participants were willing to do the self-testing, which is an attractive testing option for a large group of men, trans men and trans women who have sex with men.
The SELPHI trial was funded by the National Institute for Health Research (NIHR).