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Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study

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Abstract

An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depth interviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94 % reported the test easy to use; 93 % said results were easy to read; and 91 % would recommend it to others. Most participants (68 %) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services.

Resumen

Se estima que de una de cada cuatro mujeres transexuales (mujeres trans) en los Estados Unidos están infectadas con VIH. El uso de la prueba de VIH no es proporcional con el nivel riesgo de transmisión de la enfermedad, y son necesarias estrategias alternativas para su detección y atención temprana. Exploramos la viabilidad y aceptabilidad de la auto-prueba de VIH (HIVST por sus siglas en inglés) con 50 mujeres trans no portadoras del VIH en San Francisco. Las participantes recibieron tres kits de auto-prueba para usar una vez al mes. Encuestas de aceptabilidad y comportamiento fueron realizadas al igual que 11 entrevistas en profundidad (IDI por sus siglas en inglés). Entre las 50 participantes, 44 reportaron haber utilizado la HIVST al menos una vez; 94 % mencionaron que las pruebas fueron fáciles de usar; 93 % dijeron que los resultados fueron fáciles de leer; y el 91 % mencionó que recomendarían las pruebas a otras personas. La mayoría de las participantes (68 %) prefirió la auto-prueba a las pruebas hechas en clínicas, aunque su precio fue una limitante para su utilización. IDIs revelaron el conflicto entre el deseo de privacidad y el apoyo que se recibe en las clínicas. HIVST para mujeres trans fue aceptada y factible y requiere una cuidadosa consideración de como vincularla con los servicios de salud correspondientes.

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References

  1. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Edwards JW, Fisher DG, Reynolds GL. Male-to-female transgender and transsexual clients of HIV service programs in Los Angeles County, California. Am J Public Health. 2007;97(6):1030–3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nemoto T, Operario D, Keatley J, Han L, Soma T. HIV risk behaviors among male-to-female transgender persons of color in San Francisco. Am J Public Health. 2004;94(7):1193–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nemoto T, Operario D, Keatley J, Villegas D. Social context of HIV risk behaviours among male-to-female transgenders of colour. AIDS Care. 2004;16(6):724–35.

    Article  CAS  PubMed  Google Scholar 

  5. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(1):1–17.

    Article  PubMed  Google Scholar 

  6. Schulden J, Song B, Barros A, et al. Rapid HIV testing in transgender comunities by community-based organizations in three cities. Public Health Rep. 2008;123(Supplement 3):101–14.

    PubMed  PubMed Central  Google Scholar 

  7. Schwarcz S, Scheer S. HIV testing behaviors and knowledge of HIV reporting regulations among male-to-female transgenders. J Acquir Immune Defic Syndr. 2004;37(2):1326–7.

    Article  PubMed  Google Scholar 

  8. Gates GJ. How many people are lesbian, gay bisexual, and transgender? Los Angeles: The Williams Institute. UCLA School of Law. 2011. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf.

  9. Johnson C, Baggaley R, Forsythe S, et al. Realizing the potential for HIV self-testing. AIDS Behav. 2014;18(Suppl 4):S391–5.

    Article  PubMed  Google Scholar 

  10. Lurie S. Identifying training needs of health-care providers related to treatment and care of transgendered patients: a qualitative needs assessment conducted in New England. Int J Transgenderism. 2005;8:93–112.

    Article  Google Scholar 

  11. Nemoto T, Operario D, Keatley J. Health and social services for male-to-female transgender persons of color in san francisco. Int J Transgenderism. 2005;8:5–19.

    Article  Google Scholar 

  12. Grant JM, Mottet LA, Tanis J, Herman JL, Harrison J, Keisling M. National Transgender Discrimination Survey Report on Health and Health Care. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2010.

  13. Carballo-Dieguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49(4):379–87.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mackellar DA, Hou SI, Whalen CC, et al. Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis. 2011;38(5):419–28.

    Article  PubMed  Google Scholar 

  15. Sharma A, Sullivan PS, Khosropour CM. Willingness to take a free home HIV test and associated factors among internet-using men who have sex with men. J Int Assoc Physicians AIDS Care (Chic). 2011;10(6):357–64.

    Article  PubMed Central  Google Scholar 

  16. Kearns AJ, O’Mathuna DP, Scott PA. Diagnostic self-testing: autonomous choices and relational responsibilities. Bioethics. 2010;24(4):199–207.

    Article  PubMed  Google Scholar 

  17. US Food and Drug Administration (USFDA). OraQuick In-Home HIV Test. July 3, 2012. http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm310436.htm.

  18. Brennan J, Kuhns LM, Johnson AK, et al. Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health. 2012;102(9):1751–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  PubMed Central  Google Scholar 

  20. King N. Template analysis. In: Symon G, Cassell C, editors. Qualitative Methods and Analysis in Organizational Research. London: Sage; 1998. p. 118–34.

    Google Scholar 

  21. Ulin P, Robinson E, Tolley E. Qualitative Methods in Public Health: A Field Guide for Applied Research. San Francisco: Jossey-Bass; 2005.

    Google Scholar 

  22. Miles M, Huberman M. Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed. London: Sage Publications; 1994.

    Google Scholar 

  23. Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13:735.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pant Pai N, Sharma J, Shivkumar S, et al. Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Med. 2013;10(4):e1001414.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ng OT, Chow AL, Lee VJ, et al. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS ONE. 2012;7(9):e45168.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Grant J, Mottet L, Tanis J, Harrison J, Herman J, Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

  28. Poteat T, Reisner SL, Radix A. HIV epidemics among transgender women. Curr Opin HIV AIDS. 2014;9(2):168–73.

    Article  PubMed  Google Scholar 

  29. Sevelius JM, Keatley J, Gutierrez-Mock L. HIV/AIDS programming in the United States: considerations affecting transgender women and girls. Womens Health Issues. 2011;21(Suppl 6):S278–82.

    Article  PubMed  Google Scholar 

  30. Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5–16.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Reisner SL, White JM, Bradford JB, Mimiaga MJ. Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health. 2014;1(3):177–84.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We would like to express our gratitude to the study participants for their willingness to share their time and personal stories with our study team. Without their gracious participation, this study would not have been possible. We would also like to thank Enzo Patouhas for assisting with survey programming and study data collection. OraSure Technologies, Inc. donated the test kits, but did not participate in study design, analysis, or interpretation of the data. This research was supported by a grant from the National Institutes of Health, University of California, San Francisco-Gladstone Institute of Virology & Immunology Center for AIDS Research, P30-AI027763.

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Authors and Affiliations

  1. Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA

    Sheri A. Lippman, Lissa Moran, Jae Sevelius, Leslie S. Castillo, Angel Ventura & Sarah Treves-Kagan

  2. University of California, Berkeley, School of Public Health, Berkeley, CA, USA

    Leslie S. Castillo

  3. San Francisco Department of Public Health, Bridge HIV, San Francisco, CA, USA

    Susan Buchbinder

Authors
  1. Sheri A. Lippman
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  2. Lissa Moran
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  3. Jae Sevelius
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  4. Leslie S. Castillo
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  5. Angel Ventura
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  6. Sarah Treves-Kagan
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  7. Susan Buchbinder
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Correspondence to Sheri A. Lippman.

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Lippman, S.A., Moran, L., Sevelius, J. et al. Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study. AIDS Behav 20, 928–938 (2016). https://doi.org/10.1007/s10461-015-1236-2

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