Background: Knowledge of HIV status is essential for accessing antiretroviral therapy and effective prevention services. Providing HIV rapid diagnostic tests (RDTs) for self-testing to persons at risk of HIV infection, such as men who have sex with men (MSM), could increase frequency and timeliness of HIV testing. The “Evaluation of HIV self-testing among MSM Project” (eSTAMP) is a 12-month randomized controlled trial (RCT) that evaluates the impact of this strategy.
Methods: MSM in the US were recruited online from March through August 2015 and enrolled into eSTAMP. Participants were asked to complete online surveys at baseline, 3, 6, 9, and 12 months. The intervention group was mailed 4 RDTs at baseline with the option of replenishing the ones used after interim assessments. At the end of the study, all participants who completed the 12-month survey were mailed 2 RDTs and a dried blood spot (DBS) card. We compare the percentage of participants who tested 3 times, mean number of all HIV tests, percentages who accessed clinic-based HIV testing services, mean number of sex partners over 12 months, and newly identified cases of HIV infection by intervention and control groups.
Results: We randomly assigned 2665 MSM to the Intervention (n=1325) and Control (n=1340) arms. Mean age was 30.4 years; 58% were white, 10% black, 23% Hispanic, and 9% other or mixed race; 17% had never been tested for HIV. 72% completed at least one follow-up survey; retention rate at 12 months was 58%. There was significantly more HIV testing in the intervention group. 42 cases of HIV infection were identified, 21 were linked to care.

Results over 12 month follow-up periodInterventionControlP value
Number of newly identified HIV cases*, n/N (%)25**/966 (2.6%)11**/958 (1.2%)0.03
MSM reporting ≥3 HIV tests, n/N (%)761/965 (79%)217/958 (22%)< 0.01
Number of HIV testsa, mean (SD)5.3 (3.6)1.5 (1.8)< 0.01
MSM reporting clinic-based HIV tests, n/N (%)395/966 (41%)614/958 (64%)< 0.01
Number of sex partners, mean (SD)9.1 (17.0)9.7 (19.7)0.57
*includes RDT and clinic-based testing among study participants. **Additional cases (Intervention: n=3, Control: n=3) were identified from the DBS testing after the 12 month survey.
[Table 1]

Conclusions: Implementing internet-based HIV screening programs with free HIV RDT increased HIV testing and diagnosis among MSM, including those who have not previously accessed traditional HIV testing services.