HIV home testing in Poland - an underappreciated approach despite huge potential : an implementation study

HIV testing faces barriers worldwide and little progress in systematically implementing new approaches has been made so far, especially in Europe. Testing sites (VCTs) and clubs have been the only large-scale venues in Poland to offer anonymous tests for key populations. They are located exclusively in large cities leaving large areas without any real access. We wanted to see if home tests might fill the gaps. Between November 2022 and February 2023 free Simplitude ByMe HIV home-tests were sent out to parcel lockers with orders made opportunistically by patients on the TyToTu.pl webpage. The clients were asked to fill out a short epidemiological online questionnaire (age, gender, sexual orientation, nationality, residence: provincial city/smaller city/village, previous testing) before the order and were asked to give e-feedback afterwards. Statistical analysis was performed for 887 returned questionnaires. 1473 home tests were dispensed. 76.6% of recipients reported heterosexual, 11.7% homosexual and 10.6% bisexual contacts. 57% came were from large provincial cities (p < 0.0001) and for 80% of them it was their first test ever, especially if they reported heterosexual contacts (p < 0.0001) or were older (OR 0.9736; 95% CI: 0.9507, 0.9971). If heterosexual clients had tested before then in the more distant past by 745 days (95% CI: 411-1096). Five tests were reported back as positive (all among heterosexual clients) translating to 0.34% prevalence, 91 negative (6.17% return rate) and 9 invalid (0.61%). Home testing has been underutilized in Poland despite huge interest. Barriers still exist especially for clients reporting heterosexual contacts. HIV home tests should be freely available, especially among older and heterosexual clients as well as immigrants. We urge local and national bodies to fund such testing as it may help include more people in treatment earlier.