Abstract:
Background: Men who have sex with men continue to experience disproportionate HIV risk in India, with barriers to conventional testing driven by stigma, confidentiality concerns, and fear of discrimination. Repeat HIV testing is central to early diagnosis, timely linkage to care, and interruption of transmission. Oral HIV self-testing offers a confidential, non-invasive, and community-deliverable strategy to improve testing frequency among key populations.
Objective: To assess whether oral HIV self-testing improves repeat HIV testing among MSM compared with standard-of-care HIV testing in an urban Indian setting.
Methods: A cluster randomized trial was conducted among MSM in Delhi-NCR, India, recruited through targeted intervention partners registered under the National AIDS Control Programme. Eligible participants were adult males who reported oral or anal sex with males or hijras in the preceding month and were not known to be living with HIV. Participants were randomized to receive either oral HIV self-testing or standard-of-care HIV testing. In the intervention arm, participants were offered oral HIVST at baseline and during follow-up, with options for supervised or unsupervised use. Testing uptake and repeat testing behaviour were documented during the study period.
Results: At baseline, 273 of 276 participants in the intervention arm opted for oral HIV self-testing, indicating high initial uptake. During follow-up, 235 participants continued to opt for oral HIVST, of whom 120 conducted the test completely unsupervised and 115 under direct observation. The intervention demonstrated strong acceptability for repeated use; among those who used oral HIVST during the study period, 99.6% expressed willingness to conduct oral HIVST again and 99.6% were willing to recommend it to friends. Participants perceived HIVST as more private, convenient, and less stigmatizing than conventional testing.
Conclusion: Oral HIV self-testing is a promising public health intervention to improve repeat HIV testing among MSM in India. Its integration into targeted interventions may strengthen early diagnosis among key populations, particularly when combined with counselling, confirmatory testing pathways, and linkage-to-care mechanisms.
Biography:
Dr. Sanjay Kumar Rai is Professor at the Centre for Community Medicine, AIIMS New Delhi, and a distinguished public health expert with internationally recognized contributions to epidemiology, infectious diseases, vaccines, and health systems. He served as Editor of the WHO South-East Asia Journal of Public Health (2021-2025) and National President of the Indian Public Health Association (2019-2023). He is a Member of the EPC under the National Health Mission and serves on the Institute Body and Standing Selection Committee of JIPMER Puducherry. With over 250 publications, 50 research projects, and his contribution as Principal Investigator of vaccine safety (phase 1&2), and effectiveness (Phase3) trial, helped timely release of COVAXINTM vaccine nationally as well as globally.
