Effectiveness and Patient Acceptability of a Self-Testing Intervention for STI in an HIV Primary Care Setting

Background: STI screening in HIV care settings is suboptimal.  In 2013, we implemented a self-testing intervention for men who have sex with men (MSM) at a large HIV clinic and assessed yield and acceptability. The intervention consisted of establishing a dedicated room for self-testing with instructional posters, a new protocol, and provider education.

Methods: From January - March 2013, we educated clinicians and facilitated project implementation. We then compared screening coverage and infection rates among MSM attending ≥1 primary care visit between two six-month periods: pre-intervention (July-December 2012) and intervention (April–September 2013). Data were extracted from electronic medical records.  Patient acceptability was determined through survey offered after self-testing. 

Results: Pre-intervention, providers screened 30% of 1138 MSM for gonorrhea or chlamydia at any anatomic site at least once (19.9% pharynx, 17.3% rectum, 20.7% urethra; 9.9% all sites).  In the intervention period, 230 MSM completed self-testing, including 51(22%) who self-referred.  Screening coverage following the intervention among 1067 MSM attending at least one primary care visit increased 20.6% overall, with 29.1% increase at pharynx, 30.0% at rectum and 48.3% at urethra.  There was no change in syphilis screening rates, or in test positivity between the two time periods:  7.3% and 11.4% of men tested positive for gonorrhea and chlamydia respectively pre-intervention, and 6.7% and 13.2% post-intervention. Urethral chlamydia positivity increased 153% post-intervention from 1.7% of 235 tested MSM, to 4.3% of 328 tested men (p=0.08). Of the 77 (33.5%) men completing feedback surveys, 92% rated their overall experience with self-testing as “good” or “very good” and 83% reported the instructional posters to be “extremely helpful.”  

Conclusions: Offering self-testing in HIV primary care settings increases screening coverage and the likelihood of detecting STI among MSM. The acceptability of this screening approach in HIV primary care settings was very high.