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HIV self-testing among transgender women in San Francisco - a pilot
- 1. HIV self-testing among transgender women in San Francisco – a pilot study Aim: To explore potential for HIV self- testing (HIVST) among trans women – acceptability and feasibility. Method: 50 participants provided with OraQuick kits • Asked to test once a month for three months. • Survey data were collected at baseline, 1 mo, and 3 mos. OraQuick Oral Fluid In-Home HIV Test • IDIS with 11 participants at their final visit Study population: • Median age was 42 (22-63) • 30% AA; 22% W; 20% H; 8% A • 48% reported homelessness in the past year • 68% reported prior incarceration
- 2. Results – HIVST feasible and acceptable • 88% returned at least once; 100% returning at 1 mo used the test at least once • 72% returned at 3 months; all but 1 used the tests again (most 2 times) • Approximately 25% used the test kit with others present Confident used correctly98% Collection was easy*94% Results easy to read93% Instructions easy to follow91% Tests were easy to use95% * 2 people said it was “emotionally difficult” Recommend to others91% Self-Test68% Clinic/Medical Provider18% No Preference14% Preference for next test
- 3. Conclusions • HIVST is feasible and acceptable for trans women • The current price is too high for trans women, who would need free/low-cost distribution to make this an option. (though many said they would pay up to $20) • Need for HIVST strategies to enhance linkage to social and resource support – desire for privacy but need for support. • Interest in enhanced opportunities for partner testing • Further research among trans women with fewer trans- friendly services available are needed to explore how HIVST might extend the testing mix. Poster # MOPDC0104: Lippman, Moran, Ventura, Castillo, Buchbinder, Treves-Kagan, Sevelius
Editor's Notes
- While HIV self-testing has been studied extensively over the past several years among MSM, the extent to which that information translates for transgender women is unknown. HIV ST offers a number of potential benefits for populations that are uncomfortable in health care environments – primarily, privacy, concerns about encountering stigma, and fear of discrimination. We conducted a pilot study among trans women in San Francisco in order to explore the potential for HIV ST in this population, including uptake, feasibility and acceptability. 50 HIV-negative women were provided with test kits and asked to test once a month for three months. We used the OraSure OraQuick Oral test that is FDA approved for self-use in the united states. The counselor demonstrated the self-test at the enrollment visit and answered any questions before the participant left the study venue
- Overall, we found that self HIV testing was feasible for our study population. Over 90% of participants were confident that they used the test correctly, thought the tests were easy to use, thought collection was easy, thought the results were easy to read and that the instructions were easy to follow. Over 90% of the women in the study would recommend self-testing to others and would prefer self-testing for their next HIV test. That is assuming they could get the self test for a reasonable price – or for free. Also – among the 50 transwomen enrolled, 88% of them returned at least once and everyone who returned used the test. Important to note that ¼ of the sample used the test kits with someone else present.
- To our knowledge – this pilot is the first study HIV self-testing feasibility and acceptability among trans women specifically. We learned that it is feasible and acceptable, but also learned that the current price is too high. In our baseline behavioral survey results showed that: 80% of our participants reported insufficient income, defined as not having enough money to cover daily living expenses, such as rent or food. If we want to use self-testing as tool to improve early detection among transwomen, we’ll need to find a way to provide them through NGOs/free at clinics. We also found that women in our study were interested in both privacy afforded by the kits but also support in the form of a counselor or friend. It was interesting that this translated into 25% of the women in the study using the kits with someone else there. In fact – in IDIs there was a lot of interest in partner testing, both as a harm reduction tool and as a way to have support through the testing process. I want to mention that while the women in our study in many ways represent the transgender women across the US (high rates of IPV, incarceration, homelessness, and unemployment), they also report being much more engaged in health care than transwomen outside of San Francisco. So this was a population that is already testing (92% had tested for HIV in the past year). That said, further research is needed to understand how and where to safely insert HIVST into the testing mix for transwomen – including where to distribute the kits and what kind of support services can be offered to ensure their safe and continued use.