CEEISCAT shares the results of the TÉSTATE project on HIV and hepatitis C

Two studies have evaluated an online HIV and HCV self-testing strategy, demonstrating that it is effective and safe

In the last week of December, two articles by the Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT), a group of the Germans Trias i Pujol Research Institute (IGTP), were published. They provide advances in the approach to screening strategies for HIV and other sexually transmitted infections (STIs) based on the online offer of self-sampling.

On the one hand, a study published in the Journal of Community Health proposes a system for collecting HIV samples taken by users themselves from their homes, using telematic tools and postal mail. On the other hand, a study published in the Journal of Evidence-Based Medicine details the same system applied to hepatitis C.

TÉSTATE HIV

The TÉSTATE HIV project has designed and evaluated an online HIV self-sampling strategy aimed at gay, bisexual, other men who have sex with men and transgender dating app users in Spain. Its aim was to find ways to reduce the workload in diagnostic centres and make testing more accessible to these populations, which are the most affected by HIV and STIs in Spain.

The intervention, conceived by CEEISCAT with Dr Cristina Agustí as the principal investigator and doctoral candidate Héctor Martínez-Riveros, involved sending a saliva self-sampling kit and a return envelope to the participants' homes. The participants would then send their sample back to the laboratory by mail. The self-sampling kits came with detailed instructions on how to correctly collect the samples, and the participants could contact the project researchers via phone or WhatsApp. This pilot test was conducted between November 2018 and December 2021. The participants were able to consult their results confidentially on the TÉSTATE website.

The project received over three thousand samples, with 87 testing positive, 76 of which were confirmed to be HIV positive. These cases were referred for specific treatment and have been kept under follow-up. Later, a satisfaction survey was conducted among users, highlighting the ease and privacy of the process.

The study "An Online HIV Self-Sampling Strategy for Gay, Bisexual and Other Men Who Have Sex with Men and Trans Women in Spain" has demonstrated that such an intervention is perfectly feasible in our context, given its good acceptability among participants and its high degree of effectiveness in terms of reactivity, confirmation, and linkage to healthcare services.

TÉSTATE Hepatitis C

Following the success of the initiative against HIV, TÉSTATE has been adapted for other infections such as hepatitis C. It has similarly yielded effective and viable results, as detailed in the article "An online hepatitis C virus self-sampling strategy for gay, bisexual, and other men who have sex with men and trans women: TESTATE C PLUS 2020-2021". The project, named TÉSTATE C PLUS, also conceived at CEEISCAT with Dr Agustí and PhD candidate Martínez-Riveros leading, has involved collaboration with IGTP’s group in Pathogen Diagnostics and Genomic Epidemiology and the Microbiology Service of the University Hospital Germans Trias i Pujol (HUGTiP) in sample analysis; and with the Public Health Agency of Barcelona and NGOs STOP, Gays Positivos, and Gtt-VIH, which have played a crucial role in recruiting participants: gay, bisexual, other men who have sex with men (GBHSH), and trans women.

The intervention, similar to TÉSTATE HIV, involved sending home self-sampling kits for hepatitis C - consisting of dry blood sample collection - and the return of these samples by mail to the laboratories, followed by the confidential online publication of each participant's results. Between October 2020 and November 2021, over 300 samples were received, 306 of which were negative and 5 positive. The positive cases were referred to specialists to begin treatment, and TÉSTATE followed up with calls to check if they had started treatment (two months after diagnosis) and its effectiveness (six months after diagnosis).

TÉSTATE C PLUS also enjoyed a positive reception and high user satisfaction, especially for its convenience, free nature, and privacy. It has also reached individuals who had never been tested for hepatitis C before (45% of participants), demonstrating that easier access increases user numbers, thereby benefiting the health control of the infection. The success of both TÉSTATE HIV and TÉSTATE C PLUS could be extended to other infections such as chlamydia, gonorrhea, or human papillomavirus, as well as applied to the follow-up of patients on HIV Pre-Exposure Prophylaxis (PrEP). Both projects have received support from the Department of Health of the Generalitat de Catalunya, the Instituto de Salud Carlos III (ISCIII), ViiV Healthcare, and Gilead Sciences.

Reference

Martínez-Riveros H, Díaz Y, Montoro-Fernandez M, Moreno-Fornés S, González V, Muntada E, Romano-deGea P, Muñoz R, Hoyos J, Casabona J, Agustí C. An Online HIV Self-Sampling Strategy for Gay, Bisexual and Other Men Who Have Sex with Men and Trans Women in Spain. J Community Health. 2023 Dec 23. DOI: 10.1007/s10900-023-01311-8.

Martínez-Riveros H, Martró E, Montoro-Fernandez M, Diaz Y, Muntada E, Romano-deGea P, Moreno-Fornés S, Mora R, Villegas L, Mena J, Roqueta Q, Hernández J, Vázquez M, Rius C, Román F, Not A, Muntané L, Colom J, Casabona J, Agustí C. An online hepatitis C virus self-sampling strategy for gay, bisexual, and other men who have sex with men and trans women: TÉSTATE C PLUS 2020-2021. J Evid Based Med. 2023 Dec 25. DOI: 10.1111/jebm.12566.