HIV self-testing programs to men who have sex with men delivered by social media key opinion leaders and community-based organizations are both effective and complementary: a national pragmatic study in China.

BACKGROUND: Social media key opinion leaders (SMKOL) and community-based organizations (CBOs) are two leading delivery strategies for HIV self-testing (HIVST). This study compared respondent characteristics, linkage to care, antiretroviral treatment (ART), and cost of HIVST among MSM recruited via SMKOLs and CBOs in China. METHODS: Between January and December 2018, SMKOLs distributed HIVST advertisements to MSM through WeChat public platforms, Simultaneously, CBOs distributed HIVST program messages to local MSM. All participants were required to pay a deposit to apply for HIVST kit and had their deposit refunded after completing an online survey and uploading HIVST results. Trained staff provided HIV referral services by telephone and WeChat. RESULTS: 1743 (63.0% [1743/2766]) and 1023 (37.0% [1023/2766]) individuals met criteria via SMKOLs and CBOs, respectively. MSM reached by SMKOLs had a lower HIV seropositive rate (2.1% [33/1561] vs. 12.5% [100/803]) and higher proportion received ART (94.4% [31/33] vs. 29.0% [29/100]) compared to CBO-recruited MSM (all p < 0.05). The average number of HIVST respondents recruited by each investigator in SMKOL-strategy was higher than that of CBO-strategy (290 vs. 49). The SMKOLs had lower cost of per person tested (USD 13.18 vs. USD 101.21) and per newly identified HIV infection case (USD 632.66 vs. USD 812.70). CONCLUSIONS: SMKOL has lower cost of per person tested while CBOs can reach MSM subpopulations with higher HIV seropositive rates. Both recruitment methods are efficient and should be utilized as complementary HIVST delivery strategies to address low HIV testing coverage among Chinese MSM.