Award Title: PANTHEON 2: towards an HIV self-testing implementation action framework and toolkit
Funder: Department of Health and Social Care

Abstract: Background  The NIHR PANTHEON PG generated a substantial body of evidence on HIV Self Testing (HIVST), including social science evidence concerning development, implementation and evaluation of HIVST among men who have sex with men (MSM) and trans people in England and Wales. The SELPHI RCT, conducted as part of the PG, demonstrated that HIVST delivery is feasible, acceptable and increases testing uptake. Questions remain as to how HIVST meets the needs of a diverse MSM population and how it is best situated alongside multiple testing opportunities prior to national implementation.  Although there have been recent successes in increasing testing and reducing HIV incidence among MSM, these are not shared equitably. MSM are highly heterogenous with interconnected experiences of marginalisation related to ethnicity, migration status, educational attainment, social connectedness, gender and sexual identity. More nuanced understandings of need are required to support HIVST implementation in a way that responds to existing inequities while improving health.   Aims and objectives  Our aim is to contribute to improving the health equity in MSM in England and Wales by guiding and promoting the commissioning of HIVST.   Objectives:    Developing a nuanced understanding of the role of social networks, community norms and isolation in relation to HIV testing, and describe how this can be harnessed to optimise HIVST implementation and HIV prevention more broadly.  Exploring the role of HIVST in relation to the broader landscape of clinical services, in particular how marginalised MSM perceive HIVST in the context of other testing options.  Coalesce all the outputs from the PANTHEON PG with the new in-depth analysis conducted here into an implementation action framework and toolkit to facilitate HIVST rollout across England and Wales.   Development work plan  Substantial qualitative data collected during PANTHEON will be re-analysed supporting development and implementation of an HIVST rollout plan. Existing data includes 6 focus groups with 47 MSM, 95 in-depth interviews with SELPHI participants and 18 key informant interviews.   Work Package 1 will analyse accounts of social networks, community participation and isolation to explore how social ties and connections shape decisions, beliefs and behaviours regarding HIV testing generally, and HIVST in particular.   Work Package 2 will develop a better understanding of the utility of HIVST for MSM facing marginalisation based on ethnicity, migration status, educational attainment, social connectedness, gender and sexual identity by analysing accounts of HIV testing decision-making, including concerns about anticipated results and beliefs around test accuracy.  Work Package 3 will synthesise all previous outputs from the PANTHEON PG, published literature and outputs from work packages 1 & 2 into an implementation action framework and toolkit to support HIVST rollout across England and Wales. We will use the Consolidated Framework for Implementation Research to propose intervention adaptations to increase the reach of HIVST taking account of issues of marginalisation to meet the needs of those least likely to be engaged by testing services.   Anticipated impact and dissemination  This grant will support the rollout of HIVST to contribute to the elimination of HIV and the well-being of MSM in England and Wales.

Lay Abstract: Through our previous work we provided evidence about a new way of testing for HIV, where a person tests themselves for HIV and finds out their result on their own without a healthcare worker present. This is called HIV self-testing (HIVST). We focussed on gay men and trans people because they are at most at risk of HIV in the UK. They can also experience barriers to accessing health care (including HIV testing) due to stigma related to gender and sexual identity, as well as migration status, ethnicity, and social circumstances. Gay men and trans people need to be supported to test for HIV regularly to diagnose infections early as this enables access to HIV treatment for individual health benefit and to prevent onward transmission to others.       Our previous research found that gay men and trans people agreed that HIVST should be available as a testing option for them and that they found the test easy to do on their own. Our research also found through a large trial that giving gay men and trans people HIVST kits increased how often they tested for HIV over a 2-year period compared to not being given the HIVST kits. However, despite the evidence we provided there are no current plans to roll-out free HIVST to at-risk groups across England and Wales.       This new grant will look at how best to roll out national access to HIVST as an alternative to testing for HIV in health care settings. To do this, we will re-examine extensive data collected through our previous trial and our interviews with gay men and trans people. This will help us to understand better how gay men and trans people view HIV testing in general, and self-testing in particular, and how HIVST can bridge any gaps in testing access and encourage those at risk of HIV to test more regularly.   At the end of this study,  we will develop a strategy framework to guide policy makers and organisations who plan and fund services on how best to provide national HIV self-testing to reduce health inequalities for gay men and trans people. We will also produce 6 short videos for social media exploring the experiences of individuals who have HIV self-tested and services that provide HIV self-testing.   We will have an advisory group to guide the research which will include people living with HIV as well as policy makers. We expect our research to benefit gay men and trans people in England and Wales by providing information about how best to provide new HIV testing options to meet HIV testing needs. Increased use of HIVST will also free up resources and capacity in health care settings that provide face-to-face HIV testing.

Research Activity Codes: 4.3 INFLUENCES AND IMPACT
Health Categories: INFECTION