Latent profiles of male peers returning HIV self-test results after secondary distribution by men who have sex with men in Zhuhai, China

Abstract

BACKGROUND: Secondary distribution of HIV self-testing (HIVST) can extend testing through social and sexual networks of men who have sex with men, but the peer subgroups reached by this approach remain insufficiently understood. We aimed to identify latent profiles of peers who returned HIVST results, and assess index-peer factors associated with peer class membership. METHODS: We conducted a secondary analysis of pooled HIVST secondary distribution studies and program phases among men who have sex with men in Zhuhai, China, from October 2019 to December 2023. Peers received HIVST kits from indexes and returned valid results online. Latent class analysis used four indicators, with assignment by highest posterior probability: previous HIV testing, two or more recent male partners, recent condomless anal intercourse (CAI) and disclosure of sexual orientation or same-sex behavior. Exploratory multinomial logistic regression with cluster-robust standard errors accounting for clustering by index examined index-peer associations. RESULTS: Among 611 unique indexes, 259 successfully distributed kits to 584 peers. Three peer classes were identified: recent-CAI, lower-disclosure peers (17.0%), no-recent-CAI, lower-testing peers (64.2%) and previously tested, higher-disclosure peers (18.8%). Compared with the previously tested, higher-disclosure class, index disclosure was inversely associated with membership in the other two classes. Index CAI was positively associated with recent-CAI, lower-disclosure membership and inversely associated with no-recent-CAI, lower-testing membership. CONCLUSIONS: Peers who returned HIVST results comprised groups with distinct testing histories, recent sexual behaviors and disclosure patterns. These findings characterize heterogeneity among result-returning peers and may inform future evaluation of differentiated follow-up strategies.