Abstract
Self-testing for HIV is an accessible, effective testing method for clinical and research contexts. From 2017 to 2022, we conducted annual, mail-in HIV testing with participants in our U.S. national longitudinal cohort of 6253 sexual and gender minority (SGM) individuals. Using multivariable logistic regression, we examined factors associated with failure to deliver HIV-positive results by phone despite extensive outreach. Of 16,000 samples tested, 315 were reactive (98% cisgender sexual minority men). We successfully delivered two-thirds of reactive results (n = 209). Unsuccessful result delivery was associated with frequent (once/week or more) methamphetamine use (OR = 2.195, p = .004), one or more recent HIV-positive sexual partner(s) (OR = 2.764, p < .001), and at least one indicator of socioeconomic vulnerability (OR = 2.413, p < .001). In the adjusted model, only socioeconomic vulnerability (AOR = 1.864, p = .034) and recent HIV-positive partner(s) (AOR = 2.220, p = .005) remained significant. Finally, we performed an exploratory cross-sectional mediation analysis, which suggested the impact of frequent methamphetamine use on failure to deliver HIV results was mediated by socioeconomic vulnerability, with significant indirect effect (ab = - 0.056, p = .002) and total effect (c = - 0.184, p = .008). Although remote self-testing can help SGM access HIV testing, difficulties remain in successfully delivering stigmatizing and stressful information like HIV results-particularly to those using methamphetamine or experiencing socioeconomic vulnerabilities, and those with HIV-positive sex partner(s) who may suspect a positive result. Tailored strategies are needed to better connect these populations into the status-neutral HIV care continuum.