Social network distribution of HIV self-tests among MSM in Australia: a prospective, non-randomised trial.

HIV testing uptake among men who have sex with men (MSM) in Australia remains suboptimal, with lapses and extended testing intervals persisting despite established guidelines. Novel HIV testing strategies address these gaps, particularly among MSM underserved by clinic-based services. We evaluated uptake of HIV self-testing (HIVST) distributed using social network-based strategies among MSM in Australia.In this prospective, non-randomised trial (ACTRN12625000342415), HIV-undiagnosed MSM aged ≥18 years were recruited online on a rolling basis between Jan 30 and April 28, 2025. Participants comprised both test promoters (initially recruited individuals who received HIVST kits for personal use and distribution) and recipients (individuals who received a kit from a promoter). Test promoters each received four HIVST kits-one for personal use and three for distribution. Participants were invited to complete an online survey within three months of kit receipt. Recipients who completed the survey could enrol as second-wave test promoters and receive additional kits. Primary outcome: HIVST use within 7 days of receipt; secondary outcomes: use within 24 h, feasibility and acceptability. Associations with use were estimated using Poisson regression.Ninety-one test promoters received 364 HIVST kits (91 for personal use, 273 for distribution). All promoters used their own kit and completed the follow-up survey (100%). Among the first-wave recipients, 245 kits were survey-verified as used. Eight recipients subsequently enrolled as second-wave test promoters, distributing additional kits and yielding 15 survey-verified secondary recipients. In total, 351 participants completed follow-up surveys. Of respondents, 280 (80%) used the HIVST within 7 days, including 181 (52%) within 24 h. Use within 7 days was more common among participants without government-subsidised healthcare (adjusted rate ratio 1.16, 1.05-1.28; p = 0.004), those not tested in the past 3 months (3-6 months, 1.22 1.02-1.45, p = 0.026; 7-12 months, 1.36 1.16-1.60, p 12 months, 1.30 1.11-1.53, p = 0.001; never tested, 1.31 1.11-1.55, p = 0.002), and those spending little (1.36 1.10-1.68; p = 0.004) or no time (1.33 1.06-1.66; p = 0.015) with LGBTQ+ peers. Most participants found HIVST easy to use (99%) and would reuse it (88%).Social network-based distribution of HIVST is feasible and acceptable, with high HIVST kit usability and rapid uptake among MSM, supporting equitable HIV testing access. Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant and an Australian Government Research Training Program scholarship.