title: Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation.
abstract: An estimated one in eight men who have sex with men (MSM) in London lives with HIV, of which 16% are undiagnosed. It is a public health priority to minimise time spent undiagnosed and reduce morbidity, mortality and onward HIV transmission. 'Dean Street at Home' provided an online HIV risk self-assessment and postal home HIV sampling service aimed at hard-to-reach, high-risk MSM.
  
  
  
  This 2-year service evaluation aims to determine the HIV risk behaviour of users, the uptake of offer of home sampling and the acceptability of the service.
  
  
  
  Users were invited to assess their HIV risk anonymously through messages or promotional banners on several gay social networking websites. Regardless of risk, they were offered a free postal HIV oral fluid or blood self-sampling kit. Reactive results were confirmed in clinic. A user survey was sent to first year respondents.
  
  
  
  17 361 respondents completed the risk self-assessment. Of these, half had an 'identifiable risk' for HIV and a third was previously untested. 5696 test kits were returned. 121 individuals had a reactive sample; 82 (1.4% of returned samples) confirmed as new HIV diagnoses linked to care; 14 (0.25%) already knew their diagnosis; and 14 (0.25%) were false reactives. The median age at diagnosis was 38; median CD4 505 cells/µL and 20% were recent infections. 61/82 (78%) were confirmed on treatment at the time of writing. The post-test email survey revealed a high service acceptability rate.
  
  
  
  The service was the first of its kind in the UK. This evaluation provides evidence to inform the potential roll-out of further online strategies to enhance community HIV testing.
authors.affiliation: HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Elliot
authors.affiliation: HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.affiliation: HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: McCormack
authors.affiliation: HIV/GUM directorate, Chelsea and Westminster Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: McOwan
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D003955:Diagnostic Tests, Routine; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D057566:Self Report; D012747:Sexual Partners / Q000523:psychology; D061108:Social Media; D060756:Social Networking; D011795:Surveys and Questionnaires
keywords: DIAGNOSIS; GAY MEN; HIV TESTING; PUBLIC HEALTH; SERVICE DELIVERY