Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

Introduction: HIV self-testing (HIVST) offers an alternative to facility-based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment. Methods: A cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick (R) HIV antibody test) distribution to eligible MSM followed by a 3-month follow-up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits. Results: The median age of the participants was 25 years, 88.7% were literate and 17.9% were first-time testers. Of the 257 participants (80.7% retention) who completed the three-month follow-up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self-reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three-month survey. Conclusions: HIVST distribution through KOLs was feasible and oral self-testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self-testing, this study showed that linkage to treatment can be achieved with active follow-up and access to a trusted MSM-friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.