{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:26:31Z","timestamp":1791203191297,"version":"4.2.0"},"reference-count":39,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n 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\u2013based 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 \n Objective<\/jats:title>\n This study aimed to assess the implementation cascade of a social network\u2013based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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 \n Results<\/jats:title>\n 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<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.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 \n Conclusions<\/jats:title>\n 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\u2019 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 \n Trial Registration<\/jats:title>\n ClinicalTrials.gov NCT04379206; https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04379206<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/46514","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T11:01:03Z","timestamp":1682506863000},"page":"e46514","source":"Crossref","is-referenced-by-count":21,"title":["Implementation Cascade of a Social Network\u2013Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study"],"prefix":"10.2196","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2855-5038","authenticated-orcid":false,"given":"Tsz Ho","family":"Kwan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0867-1322","authenticated-orcid":false,"given":"Denise Pui Chung","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0934-6385","authenticated-orcid":false,"given":"Samuel Yeung-shan","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1448-765X","authenticated-orcid":false,"given":"Shui Shan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30196-1"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-8000-x"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2015.0049"},{"key":"ref4","unstructured":"Understanding fast-track: accelrating action to end the AIDS epidemic by 2030Joint United Nations Programme on HIV\/AIDS20152023-03-23https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/201506_JC2743_Understanding_FastTrack_en.pdf"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0130445"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11948-6"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1506-7"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2020.1718554"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.12809\/hkmj198030"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25795"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-017-1978-0"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2018-053932"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1177\/09564624211060824"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01835-z"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003928"},{"key":"ref16","unstructured":"WHO recommends social network-based HIV testing approaches for key populations as part of partner services packageWorld Health Organizaion20192023-03-23https:\/\/www.who.int\/publications\/i\/item\/WHO-CDS-HIV-19.32"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03259-z"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001726"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1177\/23259582221143672"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.2196\/32156"},{"key":"ref21","unstructured":"Creating HIV prevention cascades: operational guidance on a tool for monitoring programmesThe Joint United Nations Programme on HIV\/AIDS20212023-03-23https:\/\/www.unaids.org\/en\/resources\/documents\/2021\/20211125_creating-hiv-prevention-cascades"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2019.0119"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab029"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.2196\/28508"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-004574"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236141"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227741"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10804-x"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.2196\/35869"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-6007-3"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18020729"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001414"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.5222"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.101059"},{"key":"ref35","unstructured":"Quality assurance guidelines on HIV voluntary counselling and testing services in community settingsHong Kong Advisory Council on AIDS20092023-03-23https:\/\/www.chp.gov.hk\/files\/pdf\/vaog211.pdf"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001601"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.736440"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21594"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-021-00565-y"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jmir.org\/2023\/1\/e46514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:53:10Z","timestamp":1782841990000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2023\/1\/e46514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":39,"URL":"https:\/\/doi.org\/10.2196\/46514","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.46514","asserted-by":"object"}]},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,26]]}}}