title: Acceptability and intended usage preferences for six HIV testing options among internet-using men who have sex with men.
abstract: BACKGROUND
  Men who have sex with men (MSM) continue to be disproportionately impacted by the Human Immunodeficiency Virus (HIV) epidemic in the United States (US). Testing for HIV is the cornerstone of comprehensive prevention efforts and the gateway to early engagement of infected individuals in medical care. We sought to determine attitudes towards six different HIV testing modalities presented collectively to internet-using MSM and identify which options rank higher than others in terms of intended usage preference.
  
  
  METHODS
  Between October and November 2012, we surveyed 973 HIV-negative or -unknown status MSM and assessed their acceptability of each of the following services hypothetically offered free of charge: Testing at a physician's office; Individual voluntary counseling and testing (VCT); Couples' HIV counseling and testing (CHCT); Expedited/express testing; Rapid home self-testing using an oral fluid test; Home dried blood spot (DBS) specimen self-collection for laboratory testing. Kruskal-Wallis tests were used to determine whether the stated likelihood of using each of these modalities differed by selected respondent characteristics. Men were also asked to rank these options in order of intended usage preference, and consensual rankings were determined using the modified Borda count (MBC) method.
  
  
  RESULTS
  Most participants reported being extremely likely or somewhat likely to use all HIV testing modalities except DBS self-collection for laboratory testing. Younger MSM indicated greater acceptability for expedited/express testing (P < 0.001), and MSM with lower educational levels reported being more likely to use CHCT (P < 0.001). Non-Hispanic black MSM indicated lower acceptability for VCT (P < 0.001). Rapid home self-testing using an oral fluid test and testing at a physician's office were the two most preferred options across all demographic and behavioral strata.
  
  
  CONCLUSIONS
  Novel approaches to increase the frequency of HIV testing among US MSM are urgently needed. Combination testing packages could enable high risk MSM in putting together annual testing strategies personalized to their circumstances, and warrant due consideration as an element of combination HIV prevention packages.
authors.affiliation: Department of Epidemiology, Emory University Laney Graduate School, 1518 Clifton Road NE, Atlanta, GA 30322 USA ; Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA.
authors.forename: Rob B
authors.initials: RB
authors.lastname: Stephenson
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA.
authors.forename: Darcy
authors.initials: D
authors.lastname: White
authors.affiliation: Department of Epidemiology, Emory University Laney Graduate School, 1518 Clifton Road NE, Atlanta, GA 30322 USA ; Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
keywords: Combination prevention approaches; HIV testing preferences; Internet-using men who have sex with men; Rapid home HIV self-testing