CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1178 National HIV Self-Test Distribution Program: HIV Testing, Diagnosis, and Treatment, 3/2023 - 5/2024 Allison Lale 1 , Robin J. MacGowan 1 , Avery Bourbeau 1 , Patrick S. Sullivan 2 , Revae S. Downey 1 , Kevin Delaney 1 1 Centers for Disease Control and Prevention, Atlanta, GA, USA, 2 Emory University, Atlanta, GA, USA Background: Approximately 13% of people with HIV are unaware of their HIV status. Distribution of HIV self-tests (HIVSTs) to populations most affected by HIV increases awareness of infection, and may facilitate initiation of treatment. Previous work has described HIVST distribution programs, but not confirmation of diagnosis or engagement in antiretroviral therapy (ART). Methods: A national CDC-funded HIVST distribution program was launched in 3/2023. People ≥ 17 years old who reside in the US or Puerto Rico ordered 1 or 2 HIVSTs online. Program participants were asked to complete a short post-order survey. Participants who consented to future communications were emailed survey links 10 and 60 days after the HIVSTs were mailed. Data included demographic information, prior HIV testing and diagnosis, HIVST results, subsequent provider testing and ART initiation. Surveys were not compensated. Results: From March 2023 through May 2024, 250,083 people placed their first order for one (15%) or two (85%) HIVSTs; 78% responded to the post-order survey. Survey response rates were: 3.5% on the 10-day and 1.9% on the 60-day, with 0.6% answering both. Among the 12,037 who answered 10- or 60-day survey questions, most responded within 2 days, 294 (2.4%) reported a prior HIV diagnosis in the post-order survey, of whom 154 later used the HIVST. Among the remaining 11,743, 201 (1.7%) reported a positive HIVST; most of whom were male (65%) and <35 years of age (54%). Among 138 people with a new positive HISVT on the 10-day survey, 68 sought testing from a medical provider, of whom 44 reported the test result; 40 (91%) were confirmed positive, and 33 of 40 (83%) initiated ART (Fig 1a). On the 60-day survey, there were 87 respondents reporting a new positive HIVST, including 24 who also completed a 10-day survey. Sixty-one were tested by a provider ≤30 days of using the HIVST, 52 reported the result, of whom 41 (79%) were confirmed positive, and 36 of those 41 (88%) initiated ART (Fig 1b). Integrating data from both timepoints, among the 201 people with a new positive HIVST, 121 were tested by a provider, 75 were confirmed to have HIV, and 63 initiated ART. Conclusions: HIVST programs increase awareness of HIV infection. This limited program evaluation illustrates that many participants with positive HIVSTs followed up with provider testing. Strengthening messaging on the need for laboratory testing may be required. Among people with a confirmatory diagnosis, most initiated ART, preventing further HIV transmission.

time from infection to diagnosis and the percentage of those whose infection was diagnosed within 1 year remained stable over the analysis period. In multivariable analyses, factors associated with longer diagnosis delays were male sex, age 35-44 years, self-reported injection drug use, and being covered under universal health coverage (p<0.001). Conclusions: Diagnosis delay varied by age and population group and showed no improvement from 2014 to 2021. Addressing the time from infection to diagnosis and the disparities across population groups may enhance overall public health outcomes and help end HIV as a public health threat. 1177 Expanding HIV Self-Test Reach: Comparative Outcomes Across Facility, Community, and Online Channels Thi Thi Win 1 , Moe Kyaw Kyaw 1 , Yin Min Thaung 1 , Linn Htet 1 , Kyaw Phyo Naing 1 , Sai Lone Tip 2 1 Community Partners International, Yangon, Myanmar, 2 United States Agency for International Development (USAID) Burma, Yangon, Myanmar Background: HIV self-testing (HIVST) has emerged as a critical strategy for expanding HIV testing, especially among populations that may not use traditional services. However, optimizing distribution channels to maximize access and uptake remains a challenge. This study evaluates implementation and effectiveness of HIVST across three distinct models: facility-based, community-based, and online platform, aiming to identify the most effective approach for reaching key populations (KP). Methods: HIVST kits were distributed through three channels under HIV/ TB Agency, Information and Services (AIS) project in Myanmar: facility-based distribution at four healthcare centers, five community-based outreach services, and online platform in collaboration with pharmacies, aiming to reach KPs such as men who have sex with men (MSM), sex workers (SW), and people who inject drugs (PWID). Data were collected from May 2022 to September 2024, using pre defined variables across all channels via Sate Cha online platform. Descriptive and statistical analyses were conducted to assess key variables. Data on barriers to previous testing were also gathered from participants. Results: A total of 5,882 HIVST were distributed: 57% through facility-based, 35% via community outreach, and 8% through online platform. MSM accounted for 64% of users, followed by SW (20%) and PWID (14%). The median age was 26 years, with 80% male and 20% female users, though only 7% of online users were female. First-time testers comprised 54%, with 56% of them testing via community outreach. Result reporting was highest in facilities (100%), with lower rates online (81%). Reactive rate was 6% among 4,468 results reported, with 81% of 247 reactive cases confirmed positive. Barriers to HIV testing included confidentiality (35%), accessibility (43%), and fear of testing (22%). Conclusions: This study demonstrates overall effectiveness of facility-based, community-based, and online distribution channels in promoting HIVST among KPs. Each channel contributed uniquely to reaching diverse groups: facility based services excelled in result reporting, community-based approaches engaged a higher proportion of first-time testers, and online platforms provided discreet access to testing. However, challenges remain in optimizing online engagement and result reporting, particularly among female users. Future strategies should focus on enhancing the strengths of each channel, improving online reporting mechanisms, and strengthening linkages to confirmatory testing.

Poster Abstracts

CROI 2025 386