Swab2Know by Euro HIV EDAT: An HIV-testing approach using oral fluid samples and online communication of test results in Europe. (Preprint)

BACKGROUND HIV remains a public health concern in Europe. Increased testing among key populations is considered an integral part of combination HIV-prevention. Epidemiological patterns differ throughout Europe, reflecting different key populations. In order to diagnose people unaware of their infection, swab2know offered free testing for HIV in various settings. OBJECTIVE In this project, we aim to assess the feasibility and effectiveness of an HIV-testing approach using oral fluid samples and Web-based delivery of test results for different key populations throughout Europe. METHODS Online and outreach self-sampling was offered between September 2015 and September 2017. Samples were processed in a laboratory, and validated test results were communicated through a secured website. In case of a reactive test result, the participant needed to confirm this result using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who did not pick up their results, and those with reactive results, was integrated in the project’s methodology. RESULTS During 24 months, 3613 samples were collected among 3037 participants. Most samples (N = 2253; 62.4%) were collected during outreach activities, and 1360 (37.6%) via online ordering of sampling kits. The majority of samples was collected among MSM (N=2789; 77.2%), followed by migrants (N=292; 8.1%) and sex workers (N=532; 14.7%). Testing history (ever tested before), number of sexual partners and successful delivery of test results varied strongly between countries and key populations. Overall, the vast majority of participants received their test result (3025/3613; 83.7%). Participants who ordered a sampling kit online were more likely to receive their test result compared to people participating during outreach actions (96.1% vs. 76.3%). Of 3613 samples, 3485 (96.5%) tested negative, 61 (1.7%) weak reactive, 55 (1.5%) reactive, and 12 (0.3%) invalid. In total, 35 participants were newly diagnosed with HIV, representing 1.2% (35/3037) of all participants. Twenty-six of them (74.3%) were successfully linked to care. CONCLUSIONS We demonstrated a successful implementation of an HIV testing approach collecting oral fluid samples during outreach and online activities, and remote online result communication. The yield of the project was high in terms of the number of participants, and in reaching the right people. Improving linkage to care, and reducing the number of false reactive test results should be emphasized. This HIV testing approach should be used primarily among key populations, and collected information should be shared with public health administrations for reliable monitoring and evaluation.