Preference and ability to perform blood-versus oral-fluid-based HIV self-testing in adolescents and young adults in Bangkok

Introduction: Adolescents and young adults (AYA) have limited access to HIV screening tests despite the risk of acquiring HIV infection. This study aims to understand AYA preferences and their ability to perform HIV self-tests (HIVST). Methods: A cross-sectional study looked at AYA preferences when offered a choice between blood-based (INSTI(R)) and oral fluid-based (OraQuick(R)) HIVST. Adolescents and young adult participants between 18 and 24 years-old who report inconsistent condom use or had a history of sexually transmitted diseases were enrolled. Participants were offered a choice between blood-based and/or oral fluid-based HIVSTs with explanations of the differences between two types. Then, written and short video instructions according to the chosen type were given before participants performed a test. The study seeks to understand test preference, ability to perform and interpret test results. Results: From March to April 2021, 87 AYA were enrolled with a median age of 20 years (interquartile range (IQR) 18-22). Of the participants, 54 (62.1%) were men who have sex with men (MSM), 25 (28.7%) were cisgender men or women and 8 (9.2%) were transgender women (TGW). There were 37 (42.5%) first-time HIV testers and 32 (36.8%) HIV PrEP users. There were 57 participants (65.6%, 95% CI 54.6%-75.4%) that preferred blood-based HIVSTs. Reasons for preferring blood-based testing were the rapid results (77.2%) and higher accuracy (66.7%). The ability to perform and interpret HIVST results were 89.5% and 98% among INSTI users and 93.3% and 100.0% among OraQuick(R) users. None was HIV-positive. Moreover, 13.8% of the participants initiated same-day pre-exposure prophylaxis (PrEP). Conclusions: Thai AYA preferred blood-based over oral fluid-based HIVSTs. Most AYAs were able to perform the HIVSTs and interpret results. Supervision and post-test counselling of HIVSTs should be implemented to ensure AYA gain benefits from HIVSTs.