We developed an innovative home-based HIV self-testing (HIVST) service that included mailing of a free HIVST kit, and providing online real-time instructions and pre-test/post-test counseling (HIVST-OIC). The present parallel-group and non-blinded randomized controlled trial was conducted to evaluate the efficacy of promoting HIVST-OIC in increasing HIV testing rate among 430 men who have sex with men (MSM), with access to online live-chat applications in Hong Kong. At month 6, as compared to the control group, the intervention group reported significantly higher prevalence of HIV testing of any type (89.8 vs. 50.7%; relative risk (RR): 1.77; p < 0.001). Among those who have taken up any HIV testing in the last six months, significant between-group difference was found in multiple male sex partnerships (34.2 vs. 47.7%, RR: 0.72; p = 0.021). HIVST-OIC has a strong potential in increasing prevalence of HIV testing and reducing sexual risk behaviors. Implementation research is warranted.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
WHO. Global health sector strategy on HIV/AIDS 2011-2015. 2011. http://www.hoint/hiv/en/.
World Health Organization (WHO), UNAIDS. Guidance on provider-initiated HIV testing and counselling in health facilities. Switzerland. 2007. http://www.who.int/hiv/pub/guidelines/9789241595568_en.pdf.
CfDCaP (CDC). HIV testing among men who have sex with men–21 cities, United States, 2008. MMWR. 2011;60(21):694–9.
Rotheram-Borus MJ, Newman PA, Etzel MA. Effective detection of HIV. J Acquir Immune Defic Syndr. 2000;25(Suppl 2):S105–14.
Hao C, Huan X, Yan H, Yang H, Guan W, Xu X, et al. A randomized controlled trial to evaluate the relative efficacy of enhanced versus standard voluntary counseling and testing on promoting condom use among men who have sex with men in China. AIDS Behav. 2012;16(5):1138–47.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.
World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. 2015. http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/.
UNAIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf.
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2013.
Hong Kong Department of Health. Virtual AIDS office of Hong Kong: HIV surveillance and epidemiology. 2014. www.infogovhk/aids/english/surveillance/aidssurveilhtm.
Virtual AIDS Office of Hong Kong. Press meeting 27 May 2014. 2014. http://www.infogovhk/aids/english/indexhtm.
Gu J, Lau JT, Tsui H. Psychological factors in association with uptake of voluntary counselling and testing for HIV among men who have sex with men in Hong Kong. Public Health. 2011;125(5):275–82.
Wong HTH, Lee SS, Wong KH, Lee KCK. Trends and patterns of HIV prevalence and risk behaviours among MSM captured in three consecutive community-based surveys in Hong Kong. [Abstract]. Presented at 7th IAS Conference on HIV pathogenesis, treatment and prevention. 30 June–July 3, 2013. Kuala Lumpur, Malaysia. 2013. http://pag.ias2013.org/Abstracts.aspx?AID=1235.
Wang Z, Mo PK, Lau JT, Lau M, Lai CH. Acceptability of HPV vaccines and perceptions related to genital warts and penile/anal cancers among men who have sex with men in Hong Kong. Vaccine. 2013;31(41):4675–81.
Gu J, Lau JT, Tan X, Wang Z. Empathy of service providers mediates the association between perceived discrimination and willingness to take up HIV antibody testing again among men who have sex with men. PLos One. 2014.
Nuwaha F, Kabatesi D, Muganwa M, Whalen CC. Factors influencing acceptability of voluntary counselling and testing for HIV in Bushenyi district of Uganda. East Afr Med J. 2002;79(12):626–32.
UTWGoMaHAB. Enabling effective voluntary counselling and testing for men who have sex with men: Increasing the role of community based organizations in scaling up VCT services for MSM in China. Beijing, China: UNDP China and World Health Organization; November 2008. 2008.
World Health Organization, UNAIDS. A short technical update on self-testing for HIV. 2014. http://files.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2014/JC2603_self-testing_en.pdf.
World Health Organization. Guidelines on HIV self-testing and partner notification. Supplement to consolidated guidelines on HIV testing services. 2016. http://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/. Accessed 8 July 2017.
Gottfried TD, Mink RW, Phanuphak P. Calypte AWARE HIV-1/2 OMT antibody test using oral fluid: special challenges of rapid HIV testing in the developing world. Expert Rev Mol Diagn. 2006;6(2):139–44.
FDA. Approval letter—OraQuick In-Home HIV Test. 2012. http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm310592.htm.
Pebody R. Market constraints and uncertainties may limit the scale-up of HIV self-testing. 2016. http://www.aidsmap.com/Market-constraints-and-uncertainties-may-limit-the-scale-up-of-HIV-self-testing/page/3073263/.
McDaid LM, Hart GJ. Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy? Sex Transm Infect. 2011;87(3):221–4.
Torjesen I. Licensed home tests will be introduced to reduce undiagnosed HIV. BMJ. 2011;343:d7943.
Home HIV. Testing: why not in Canada? CMAJ. 2000;162(11):1545, 7.
Southern African HIV Clinicians Society, Treatment Action Campaign, SECTION27. How we can improve HIV testing and counselling. Society News 2012. http://www.sahivsoc.org/newsroom/society-news.
Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015;19(11):1949–65.
Hurt CB, Soni K, Miller WC, Hightow-Weidman LB. Human immunodeficiency virus testing practices and interest in self-testing options among young, black men who have sex with men in North Carolina. Sex Transm Dis. 2016;43(9):587–93.
Yan H, Yang H, Raymond HF, Li J, Shi LE, Huan X, et al. Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China. AIDS Behav. 2015;19(3):485–91.
Wong HT, Tam HY, Chan DP, Lee SS. Usage and acceptability of HIV self-testing in men who have sex with men in Hong Kong. AIDS Behav. 2014.
Tao J, Li MY, Qian HZ, Wang LJ, Zhang Z, Ding HF, et al. Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs. PLoS ONE. 2014;9(7):e102812.
Woods WJ, Lippman SA, Agnew E, Carroll S, Binson D. Bathhouse distribution of HIV self-testing kits reaches diverse, high-risk population. AIDS Care. 2016;28(Suppl 1):111–3.
Huang E, Marlin RW, Young SD, Medline A, Klausner JD. Using Grindr, a smartphone social-networking application, to increase hiv self-testing among black and latino men who have sex with men in Los Angeles, 2014. AIDS Educ Prev. 2016;28(4):341–50.
Maksut JL, Eaton LA, Siembida EJ, Driffin DD, Baldwin R. A test of concept study of at-home, self-administered hiv testing with web-based peer counseling via video chat for men who have sex with men. JMIR Public Health Surveill. 2016;2(2):e170.
Lippman SA, Moran L, Sevelius J, Castillo LS, Ventura A, Treves-Kagan S, et al. Acceptability and feasibility of HIV self-testing among transgender women in San Francisco: a mixed methods pilot study. AIDS Behav. 2016;20(4):928–38.
Katz D, Golden M, Hughes J, Farquhar C, Stekler J. HIV self-testing increases HIV testing frequency among high-risk men who have sex with men: a randomized controlled trial. In: IAS 2015. 8th Conference on HIV Pathogenesis, Treatment and Prevention. July 19–22, 2015. Vancouver. Abstract MOPDC0103. 2015.
Pant Pai N, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, et al. Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Med. 2013;10(4):e1001414.
Kao E. 96% of Hongkongers use their smartphone to go online everyday. 2013. http://www.scmp.com/news/hong-kong/article/1298330/hong-kong-smartphone-use-doubles-two-years.
Sweat M, O’Donnell C, O’Donnell L. Cost-effectiveness of a brief video-based HIV intervention for African American and Latino sexually transmitted disease clinic clients. AIDS. 2001;15(6):781–7.
Chiasson MA, Shaw FS, Humberstone M, Hirshfield S, Hartel D. Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21(9):1081–9.
Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1–47. http://heb.sagepub.com/content/11/1/1.short.
Miller WR, Rollnick SR. Motivational interviewing: preparing people for change. 2nd ed. New York: The Guilford Press; 2000.
D’Amico EJ, Miles JN, Stern SA, Meredith LS. Brief motivational interviewing for teens at risk of substance use consequences: a randomized pilot study in a primary care clinic. J Subst Abuse Treat. 2008;35(1):53–61.
Bernstein J, Heeren T, Edward E, Dorfman D, Bliss C, Winter M, et al. A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking. Acad Emerg Med. 2010;17(8):890–902.
Macdonell K, Brogan K, Naar-King S, Ellis D, Marshall S. A pilot study of motivational interviewing targeting weight-related behaviors in overweight or obese African American adolescents. J Adolesc Health. 2012;50(2):201–3.
Hettema J, Steele J, Miller WR. Motivational interviewing. Ann Rev Clin Psychol. 2005;1:91–111.
Narrative approaches. http://www.narrativeapproaches.com/?page_id=16.
Lau JT, Lee AL, Tse WS, Mo PK, Fong F, Wang Z, et al. A randomized control trial for evaluating efficacies of two online cognitive interventions with and without fear-appeal imagery approaches in preventing unprotected anal sex among Chinese men who have sex with men. AIDS Behav. 2016.
Lau JT, Wang Z, Lau M, Lai CH. Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in Hong Kong. Arch Sex Behav. 2014;43(4):789–800.
Wong HT, Tam HY, Chan DP, Lee SS. Usage and acceptability of HIV self-testing in men who have sex with men in Hong Kong. AIDS Behav. 2015;19(3):505–15.
Bilardi JE, Walker S, Read T, Prestage G, Chen MY, Guy R, et al. Gay and bisexual men’s views on rapid self-testing for HIV. AIDS Behav. 2013;17(6):2093–9.
Thirumurthy H, Masters S, Obonyo B, Napierala Mavedzenge S, Maman S, Omanga E, Agot K. Promoting male partner and couples HIV testing through secondary distribution HIV self-tests: a randomized trial. Oral presented in AIDS 2016 conference, Durban, South Africa, July 22, 2016. 2016.
Yeo TE, Fung TH. Between ‘0’ and ‘1’: safer sex and condom use among young gay men in Hong Kong. Cult Health Sex. 2016;18(3):294–307.
Lau JT, Mo PK, Gu J, Hao C, Lai CH. Association of situational and environmental factors with last episode of unprotected anal intercourse among MSM in Hong Kong: a case-crossover analysis. AIDS Educ Prev. 2016;28(1):26–42.
Cartwright N. Are RCTs the gold standard? BioSocieties. 2007;2(1):11–20.
This study was funded by the Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region (Project Ref: #11120791).
Conflict of interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Survey and Behavioural Research Ethics Committee, the Chinese University of Hong Kong and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Wang, Z., Lau, J.T.F., Ip, M. et al. A Randomized Controlled Trial Evaluating Efficacy of Promoting a Home-Based HIV Self-Testing with Online Counseling on Increasing HIV Testing Among Men Who Have Sex with Men. AIDS Behav 22, 190–201 (2018). https://doi.org/10.1007/s10461-017-1887-2
- Home-based HIV self-testing
- Online real-time instructions and pre-test/post-test counseling
- Health promotion
- Randomized controlled trial
- Men who have sex with men