The impact of community-based HIV self-testing dissemination on the HIV testing system at the county level

Ending the HIV epidemic requires increasing HIV testing among at-risk persons, including addressing the limitations of venue-based testing. Using a community-based intervention (My Test/My Choice; MT/MC), we delivered free oral HIV self-tests (OHSTs) through LGBTQ+ businesses in Multnomah County, OR. We examined if disseminating OHST negatively impacted other segments of the HIV testing system.

We compared dissemination rates for Multnomah County's clinic-based and online HIV testing programs across three periods: (i) preintervention (July-September 2022), (ii) MT/MC intervention period (October 2022-March 2023), and (iii) postintervention (April-July 2023). We used analysis of variance to examine for changes in county programs during/after MT/MC. Data from all other Oregon counties were analyzed to distinguish county-specific and statewide changes in testing.

MT/MC disseminated slightly more HIV tests (n = 2698; 50%/6 months) to the county system than clinic-based dissemination (n = 2561; 48%) and substantially more than online dissemination (n = 78; 2%). There were no significant changes in clinic-based dissemination over time in the county [F (2,10) = 1.83; P = 0.21]. Significant declines in online dissemination occurred in Multnomah County [F (2,10) = 5.95; P = 0.02] and other Oregon counties [F (2,10) = 4.5; P = 0.04], suggesting that statewide, an unknown factor negatively influenced online dissemination.

MT/MC positively impacted the local HIV testing system by adding new clients, rather than reducing the number of clients attending other testing programs. Our study provides unique data on the effects of disseminating a new health program on ongoing programs of a similar nature.