The effects of HIV self-testing on HIV incidence and awareness of status among men who have sex with men in the United States: Insights from a novel compartmental model

Abstract: The OraQuick In-Home HIV self-test represents a fast, inexpensive, and convenient method for users to assess their HIV status. If integrated thoughtfully into existing testing practices, accompanied by efficient pathways to formal diagnosis, self-testing could both enhance HIV awareness and reduce HIV incidence. However, currently available self-tests are less sensitive, particularly for recent infection, than gold-standard laboratory tests. It is important to understand the impact if some portion of standard testing is replaced by self-tests. We introduced a novel compartmental model to evaluate the effects of self-testing among gay, bisexual and other men who have sex with men (MSM) in the United States for the period 2020 to 2030. We varied the model for different screening rates, self-test proportions, and delays to diagnosis for those identified through self-tests to determine the potential impact on HIV incidence and awareness of status. When HIV self-tests are strictly supplemental, self-testing can decrease HIV incidence among MSM in the US by up to 10% and increase awareness of status among MSM from 85% to 91% over a 10-year period, provided linkage to care and formal diagnosis occur promptly following a positive self-test (90 days or less). As self-tests replace a higher percentage laboratory-based testing algorithms, increases in overall testing rates were necessary to ensure reductions in HIV incidence. However, such increases were small (under 10% for prompt engagement in care and moderate levels of replacement). Improvements in self-test sensitivity and/or decreases in the detection period may further reduce any necessary increases in overall testing. Our study suggests that, if properly utilized, self-testing can provide significant long-term reductions to HIV incidence and improve awareness of HIV status.