Variations in Sexually Transmitted Infection Self-Testing Response Rates and Self-Sampling Submission Rates Among Men Who Have Sex With Men Recruited via Different Approaches: A Multi-Center Observational Study

Objective: Self-collection, self-testing, and telemedicine among high-risk populations were important strategies in increasing the accessibility of sexually transmitted infection (STI) services and facilitating their expansion. However, many previous studies have shown that the self-test kit usage and response rates are not high in the men who have sex with men (MSM) population. Different routes of recruitment may affect their response rates, however, limited evidence exists on how recruitment specifically influence STI self-testing participation among MSM populations. This study aims to analyze the differences in response rates of STI self-testing and submission rates of self-acquired samples from MSM recruited through an online platform, STI clinics, and non-governmental organizations (NGOs). Methods: Participants were enrolled via 3 different methods (STI clinics, “Aiyijian” online platform, and NGOs) from July to December 2022 in China. Self-testing kits for human immunodeficiency virus (HIV), Treponema pallidum , and hepatitis C virus, and self-sampling kits for Chlamydia trachomatis and Neisseria gonorrhea were provided to recruit MSM. The participant’s basic information was collected by using the questionnaire and the results of self-testing for HIV/syphilis and hepatitis C virus and self-sampling for Chlamydia trachomatis and Neisseria gonorrhoeae were collected. Multivariate logistic regression analysis was used to identify factors associated with self-test response rate and sample submission rates. Results: A total of 764 participants were recruited from 28 Chinese provinces. In the final analysis data, 670 participants reported their HIV self-testing results, while 644 participants mailed their self-acquired samples to the laboratory. Among the 670 participants, there were 51 patients infected with HIV, 31 infected with syphilis, and 2 infected with the hepatitis C virus. The total prevalences of Chlamydia trachomatis and Neisseria gonorrhea were 23.0% (176/637) and 7.6% (58/636), respectively. There was no significant difference among the willingness to self-test among participants recruited from 3 routines, while the HIV self-test response rate was significantly higher among participants recruited in STI clinics than among participants recruited through the “Aiyijian” platform (adjusted odds ratio [AOR] = 0.018, 95% confidence interval [ CI ]: 0.002–0.136) or NGOs (AOR = 0.054, 95% CI : 0.007–0.401). Compared to the participants recruited from STI clinics, the willingness of self-sample was significantly higher among participants recruited through the “Aiyijian” platform (AOR = 4.557, 95% CI : 1.445–14.271) and NGO (AOR = 2.391, 95% CI : 1.136–5.034), but the rectal sample submission rates were significantly lower among participants recruited by the “Aiyijian” platform (AOR = 0.014, 95% CI : 0.003–0.062) or NGOs (AOR = 0.062, 95% CI : 0.014–0.262). Conclusion: MSM recruited from the Aiyijian online platform and NGO were more willing to self-sample, while participants recruited from STI clinics had a greater test result response rate and self-sample submission rate than those recruited via the “Aiyijian” online platform and NGOs. In addition to STI clinics, online platforms and NGOs will play a very important role in recommending self-sampling for STIs among MSM population.