Variations in sexually transmitted infection self-testing response rates and self-sampling submission rates among men who have sex with men recruited via different approaches: A Multi-Center Observational Study
Authors: Han Yan , Yin Yue-Ping , Xiao Dong , Cao Ning-Xiao , Shi Mei-Qin , Chen Kai , Xu Wen-Qi , Jiang Ting-Ting , Park Kevin , Chen Xiang-Sheng 
Published: December 2024

Objective:
Self-collection, self-testing, and telemedicine among high-risk population were important strategies in increase the accessibility of STI services and facilitate their expansion. However, many previous studies have showed that the self-test kit usage and response rates are not high in the MSM population. Different routes of recruitment may affect their response rates. To analyze the differences in response rates of sexually transmitted infection (STI) self-testing and submission rates of self-acquired samples from men who have sex with men recruited through an online platform, STI clinics, and non-governmental organizations (NGOs).

Methods:
Participants were enrolled in this observational study via three different recruitment methods from July to December 2022. Self-testing kits for human immunodeficiency virus (HIV), Treponema pallidum, and hepatitis C virus, and self-sampling kits for Chlamydia trachomatis and Neisseria gonorrhea were provided to recruited men who have sex with men. The participant’s basic information were collected by using the questionnaire and the resluts of self-testing for HIV/ syphylis and HCV and self-sampling for Chlamydia trachomatis and Neisseria gonorrhea were collected. Multivariate logistic regression analysis was used to identify factors associated with self-test response rate and sample submission rates.

Results:
A total of 764 participants were recruited from 28 Chinese provinces. In the final analysis data, 670 participants reported their HIV self-testing results, while 644 participants mailed their self-acquired samples to the laboratory. Among the 670 participants, there were 51 patients infected with HIV, 31 infected with syphilis, and 2 infected with the hepatitis C virus. The total prevalences of C. trachomatis and N. gonorrhea were 23.0% (176/637) and 7.6% (58/636), respectively. There were no significantly difference among the willingness of self-test among paticipants recriuted from three rouitines , while the HIV self-test response rate was significantly higher among participants recruited in STI clinics than among participants recruited through the “Aiyijian” platform (adjusted odds ratio [AOR] 0.018, 95% confidence interval [CI] 0.002–0.136) or NGOs (AOR 0.054, 95% CI 0.007 – 0.401). Comparing to the participantd recruited from STI clinics, the willingness of self-sample was significantly higher among participants recruited through the “Aiyijian” platform (AOR 4.557,95% CI 1.445-14.271) and NGO (AOR 2.391, 95% CI 1.136-5.034), but the rectal sample submission rates were significantly lower among participants recruited by the “Aiyijian” platform (AOR 0.014, 95% CI 0.003 – 0.062) or NGOs (AOR 0.062, 95% CI 0.014 – 0.262).

Conclusion:
MSM recriuted from Aiyijian online paltform and NGO were more willing to self sample, while participants recruited from STI clinics had a greater test result response rate and self-sample submission rate than those recruited via the “Aiyijian” online platform and NGOs. In addition to STI clinics, online platform and NGOs will play a very important role in recommending self-sampling for STIs among MSM population.