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Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study

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An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depth interviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94 % reported the test easy to use; 93 % said results were easy to read; and 91 % would recommend it to others. Most participants (68 %) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services.


Se estima que de una de cada cuatro mujeres transexuales (mujeres trans) en los Estados Unidos están infectadas con VIH. El uso de la prueba de VIH no es proporcional con el nivel riesgo de transmisión de la enfermedad, y son necesarias estrategias alternativas para su detección y atención temprana. Exploramos la viabilidad y aceptabilidad de la auto-prueba de VIH (HIVST por sus siglas en inglés) con 50 mujeres trans no portadoras del VIH en San Francisco. Las participantes recibieron tres kits de auto-prueba para usar una vez al mes. Encuestas de aceptabilidad y comportamiento fueron realizadas al igual que 11 entrevistas en profundidad (IDI por sus siglas en inglés). Entre las 50 participantes, 44 reportaron haber utilizado la HIVST al menos una vez; 94 % mencionaron que las pruebas fueron fáciles de usar; 93 % dijeron que los resultados fueron fáciles de leer; y el 91 % mencionó que recomendarían las pruebas a otras personas. La mayoría de las participantes (68 %) prefirió la auto-prueba a las pruebas hechas en clínicas, aunque su precio fue una limitante para su utilización. IDIs revelaron el conflicto entre el deseo de privacidad y el apoyo que se recibe en las clínicas. HIVST para mujeres trans fue aceptada y factible y requiere una cuidadosa consideración de como vincularla con los servicios de salud correspondientes.

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We would like to express our gratitude to the study participants for their willingness to share their time and personal stories with our study team. Without their gracious participation, this study would not have been possible. We would also like to thank Enzo Patouhas for assisting with survey programming and study data collection. OraSure Technologies, Inc. donated the test kits, but did not participate in study design, analysis, or interpretation of the data. This research was supported by a grant from the National Institutes of Health, University of California, San Francisco-Gladstone Institute of Virology & Immunology Center for AIDS Research, P30-AI027763.

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Correspondence to Sheri A. Lippman.

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Lippman, S.A., Moran, L., Sevelius, J. et al. Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study. AIDS Behav 20, 928–938 (2016).

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