Participants and Recipients in Social Network Distribution of HIV Self-Testing Kits Among Men Who Have Sex With Men in China.

Background: Secondary distribution of HIV self-testing (HIVST) kits offers a promising strategy to expand testing among marginalized MSM. We compared characteristics of kit distributors (index participants) and recipients, and identified predictors of HIV testing and kit distribution.

Methods: We analyzed data from a randomized controlled trial among MSM in Zhuhai, China (2019-2020). Regression models identified predictors of HIV testing and kit distribution.

Results: A total of 303 index participants and 264 recipients were included. Index participants were more likely than recipients to have previously tested for HIV (84.5% vs. 62.5%), report recent (past 3 months) male-male anal intercourse (83.2% vs. 60.6%), and have multiple male partners (52.8% vs. 40.6%). Among index participants, HIV testing was associated with older age (per year increase, aOR = 1.14; 95% CI: 1.05-1.24), higher education (college vs. high school or below, aOR = 4.71; 95% CI: 1.94-11.6), and condomless sex (aOR = 3.90; 95% CI: 1.37-12.9). Among recipients, higher income ($451-750, aOR = 2.58; 95% CI: 1.11-6.00; $751-1200, aOR = 2.35; 95% CI: 1.04-5.36, vs. <$450) was linked to prior testing. Approximately 45% of index participants distributed HIVST kits to recipients. Distribution was positively associated with older age (IRR = 1.03; 95% CI: 1.00-1.07), graduate education (vs. high school or below, IRR = 2.18; 95% CI: 1.05-4.54), and number of sexual partners (IRR = 1.09; 95% CI: 1.02-1.17).

Conclusions: Tailored HIVST interventions using social network-based distribution can enhance HIV testing coverage among MSM. This strategy may improve testing uptake in low- and middle-income countries but requires further investigation.