Abstract
HIV self-testing (HIVST) must lead to engagement in the HIV status neutral continuum to maximize its benefits. The objective of this research was to determine the reach of a public health HIVST program, characterize the HIV prevention continuum following self-testing, and identify correlates associated with obtaining post-test care and discussing PrEP. We prospectively recruited individuals who obtained an HIVST through a municipal program in Philadelphia, a metropolitan area with high burden of HIV. We examined factors associated with seeing a provider after self-testing, and among those who saw a provider, factors associated with discussing PrEP. Between October 2022 and March 2024, 282 people met inclusion criteria. Men who have sex with men (MSM) comprised 28% of the study sample, 22% identified as Black cis-gender women, and 22% reported no prior HIV test. At one-month follow-up, 53% of respondents with HIV-negative/unknown status saw a provider, but less than a quarter of those discussed PrEP. Black individuals were more than twice as likely to see a provider compared with White individuals. Among those who saw a provider, MSM and Latinx/e individuals were more likely to discuss PrEP, while those assigned female at birth were less likely to discuss PrEP. Implementation of a municipal HIVST program can advance health equity by reaching priority populations, including previously untested persons. Although over half of participants saw a provider after self-testing, very few discussed or initiated PrEP. Interventions to promote linkage to care and PrEP uptake are needed to maximize the impact of HIVST.