Background: Online technology has high potential to enhance access to HIV counseling and testing among members of key populations whose HIV status is undiagnosed. We evaluated HIV-positive/reactive rates and confirmed successful linkage to antiretroviral treatment (ART) among MSM and TGW in an implementation research study (''Online Supervised HIV Self-Testing'') in Thailand.
Methods: During December 2015-June 2017, MSM and TGW self-selected to enroll into 1 of 3 groups:
1) clinic-based HIV testing and counseling (Offline group);
2) online pre-test counseling and clinic-based HIV testing (Mixed group); and
3) online pre-test counseling and supervised HIV self-testing (Online group).
Linkage to ART was provided immediately after HIV-positive/reactive test results were known. Online retention and support were provided to the Mixed and Online groups only. Sociodemographic data, beliefs and experiences around stigma and discrimination related to HIV and/or being MSM or TGW, sexual and drug use behaviors, perceived barriers and facilitators for access to HIV testing were collected by self-administered questionnaires. Factors associated with unsuccessful linkage to ART were identified using binary logistic regression method.
Results: Of 564 participants (465 MSM and 99 TGW), 200 selected the Offline group, 156 selected the Mixed group, and 208 chose the Online group. Mean (±SD) age was 27.9 (7.2) years. Baseline HIV-positive/reactive result was higher in the Offline (13.0%) and Online (14.4%) groups, compared to the Mixed group (3.2%), p=0.001. Linkage to ART, however, was least successful in the Online group (52.8%), compared to the Offline (83.9%) and Mixed (75.0%) groups, p=0.02. Being in the Online group (aOR=8.54, 95%CI 1.08-67.59, p=0.04), aged < 17 years at first sex (aOR=13.16, 95%CI 1.62-107.08, p=0.02), and having single partner (aOR 12.61, 95%CI 1.52-104.9, p=0.02) increased risk for unsuccessful linkage to ART. Stigma and discrimination experiences did not reduce the chance of successful ART linkage.
Conclusions: Offering online supervised HIV self-testing successfully engaged MSM and TGW with high HIV-reactive yield into HIV testing service. Linking clients tested HIV-reactive online to come out for offline HIV confirmation and ART initiation proved to be a real challenge. Innovative methods to support transition of these clients from online to offline services are urgently needed.

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