{"doi":"10.2196/46514","title":"Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study","abstract":"<jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P&lt;.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P&lt;.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration</jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206</jats:p>\n                  </jats:sec>","journal":"Journal of Medical Internet Research","year":2023,"id":615691,"datarank":0.4493598410330987,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.0,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":600730,"name":"Denise Pui Chung Chan","orcid":"0000-0002-0867-1322","position":1,"is_corresponding":false},{"id":625558,"name":"Samuel Yeung Shan Wong","orcid":"0000-0003-0934-6385","position":2,"is_corresponding":false},{"id":600732,"name":"Shui Shan Lee","orcid":"0000-0003-1448-765X","position":3,"is_corresponding":false},{"id":499547,"name":"Tsz Ho Kwan","orcid":"0000-0002-2855-5038","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study","abstract":"<jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P&lt;.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P&lt;.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration</jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":2.995732273553991,"endowment":2.995732273553991,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37099364","pmcid":"PMC10173037","openalex_id":"https://openalex.org/W4367047936","authors":[],"funders":[],"total_grants":0,"fwci":3.2059,"citation_percentile":0.92759339,"influential_citations":0,"citation_trend":[{"year":2023,"count":1},{"year":2024,"count":9},{"year":2025,"count":4},{"year":2026,"count":5}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://www.jmir.org/2023/1/e46514/PDF","host_type":"journal"},{"url":"https://www.jmir.org/2023/1/e46514/PDF","host_type":"publisher"},{"url":"https://www.jmir.org/2023/1/e46514","host_type":"publisher"},{"url":"https://doi.org/10.2196/46514","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37099364","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10173037","host_type":"repository"},{"url":"https://doaj.org/article/4d204645ac1c47ce8c6ed65b7193ee35","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC10173037","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC10173037?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["HIV/AIDS Research and Interventions","HIV Research and Treatment","HIV-related health complications and treatments","Male","Humans","Homosexuality, Male","Self-Testing","Cross-Sectional Studies","Sexual and Gender Minorities","HIV Infections","HIV Testing","Social Networking"],"mesh_terms":["Sexual and Gender Minorities","HIV Testing","Self-Testing","Cross-Sectional Studies","Humans","Male","HIV Infections","Homosexuality, Male","Social Networking"],"keywords":["Men who have sex with men","Medicine","Test (biology)","Social network (sociolinguistics)","Referral","Cross-sectional study","Odds ratio","Social support","Psychological intervention","Family medicine","Gerontology","Human immunodeficiency virus (HIV)","Psychology","Social media","World Wide Web","Social psychology","Computer science","Nursing","Internal medicine","HIV","virus transmission","Hiv Testing","Social Network","Hiv Self-test","Community-based Testing Service","Implementation Cascade"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"nct"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-02T20:45:41.188624Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}