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HIV self-testing implementation action framework and tool-kit v1.0.pdf (3.16 MB)

An HIV self-testing implementation action framework and tool-kit for cisgender gay, bisexual and other men who have sex with men, trans and gender diverse people in England and Wales

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posted on 2024-06-18, 09:49 authored by T. Charles Witzel, Peter Weatherburn, Fiona M BurnsFiona M Burns, Isaac YH Chu, Phil Samba, Alison J. Rodger

Background

Strong evidence suggests that HIV self-testing is highly acceptable to cisgender gay, bisexual and other men who have sex with men (GBMSM), trans and gender diverse people in England and Wales, and that this novel technology can make a meaningful difference to HIV testing behaviours. HIV self-testing is feasible to deliver at large scale, can increase testing uptake and frequency without negatively impacting on linkage to care or testing for sexually transmitted infections (STIs). Question remain as to how best to deliver HIV self-testing in a way that responds to entrenched health inequalities. This Implementation action framework and tool-kit has been produced to facilitate and promote HIV self-testing service delivery in England and Wales with the key goal of improving health equity.

Methods

To produce this guidance, we synthesised key studies from England and Wales using the consolidated framework for implementation research as a structure. Evidence supporting innovative HIV self-testing implementation includes a large randomised controlled trial conducted in England and Wales (SELPHI) and extensive social science research conducted through the NIHR funded PANTHEON programme grant, PANTHEON 2 programme development grant, and the wider academic literature. Community and sexual health sectoral engagement shaped and refined our recommendations.

Implementation action framework and tool-kit

The implementation context in England and Wales is favourable for HIV self-testing. Those planning services, or seeking funding to do so, can harness this context by emphasising the need to continue to expand testing to meet the goal of HIV elimination by 2030. Concerns around linkage to care and surveillance can be addressed by highlighting the importance of respecting patient choice and autonomy.

This guidance establishes a standard level of support that should be provided with HIV self-testing interventions. This includes an optional result reporting system, clear information on linkage to care, inclusion of a helpline as well as clinical follow-up for those who report reactive HIV self-testing results but have not linked to care. Potential intervention adaptations which can address health inequalities between groups of GBMSM, trans and gender diverse people include innovative approaches to HIV self-testing kit delivery, additional tests (e.g. for bacterial STIs) that can be provided in interventions, demand generation activities and the provision of additional support for those requiring it, including the most marginalised.

Within organisations, HIV self-testing champions can highlight the importance of implementing this new technology and ensure buy-in of key organisational actors. When implementing, organisations should define the broad intervention and the components that will accompany it and engage with potential beneficiaries to optimise proposed approaches. Early, formative evaluation can help refined interventions, and summative evaluation can demonstrate outcomes to commissioners.

Examples of best practice include trial infrastructure developed during the SELPHI RCT of HIV self-testing, intervention approaches from SH:24 and the Terrence Higgins Trust and advertising used during the English National HIV testing week campaign.

Conclusion

This framework will be an invaluable resource for those seeking to plan and implement HIV self-testing among GBMSM, trans and gender diverse people in England and Wales. This guidance is not meant to be prescriptive, but rather provides an implementation roadmap detailing innovative approaches, and the evidence underpinning them, that can be used to improve health equity among the most marginalised.

Funding

This report presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Development Grants programme PANTHEON 2 (towards an HIV self-testing implementation action framework and toolkit, NIHR203298). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

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