2023-05-23 19:39:18
This document outlines strategies for distributing human immunodeficiency virus (HIV) self-tests to priority populations. It aims to support the reflections of decision-makers, key actors and actresses to organize their distribution in a targeted manner in order to reach people living with HIV who are unaware of their serological status in Quebec.
A rapid review was conducted and identified seven distribution strategies:
- Distribution to sexual partners or the social network;
- The use of vending machines;
- The use of coupons redeemable in pharmacies;
- Online ordering and mailing to home or collection site;
- Free mailing with online support and counselling;
- Behavioral intervention with peer support;
- Distribution in emergency rooms to people who refuse on-site screening.
The results provide a better understanding of the acceptability, feasibility, impacts and challenges of these strategies. These would increase the rate and/or frequency of HIV testing among people who do not get tested regularly for HIV or who have never been tested and who have less safe sex practices. They would make it possible to detect new infections and some would be complementary to the services already in place.
The implementation of the strategies identified must take into account certain issues: the cost of self-tests, free or not; the confidentiality of users of vending machines and coupons redeemable in pharmacies; finding a reactive outcome in isolation and without immediate support for strategies not involving the provision of counselling, support or accompaniment; access to technologies to benefit from online ordering strategies; coercion and potential violent reactions during distribution to the sexual or social network; the reduction of the accessibility of self-tests to people who do not wish to receive them if accompanied by other services.
The practical implications of the results for Quebec must take certain limitations into account. In all studies, the self-tests are distributed free of charge. In the majority of studies: Participant recruitment targeted African-American or Latino men who have sex with men and trans women; the results relate to saliva self-tests and are self-reported; the number of participants is small. More data would be needed to evaluate the strategies with other priority populations, to decide on the effectiveness of certain ones and to measure the complementarity between various strategies.
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