The Centers for Disease Control and Prevention (CDC) awarded an Emory University-led project $8.3 million to construct a new HIV self-testing program, TogetherTakeMeHome (TTMH). The project’s goal is to ship 1 million tests across the country, making it the largest nationwide mailed HIV self-test program to date.
The project was first developed in 2020 with the organization Building Healthy Communities Online (BHOC).
After BHOC Co-Founder and Director Jen Hecht and her team developed TTMH, she turned to Emory, viewing the University as the best choice for collaboration since Emory had already completed numerous research studies indicating the possibility of mailing self-testing kits.
“When … the funding notification came out, we were very interested in applying and it was natural for us to reach out to Emory as a group that had so much expertise in this area that we would work together,” Hecht said.
Associate Professor of Surgery Patrick Sullivan, who is one of the leaders of this project, said that the tests Emory mailed are over 99% accurate in both test sensitivity and specificity.
The tests are also free of charge to those who request them, making testing more accessible, Sullivan added.
HIV has been a historically stigmatized virus that disproportionately impacts the LGBTQ community, Sullivan said. With the ease and discreteness of the test, Sullivan emphasized that mailed self-tests will eliminate obstacles to getting tested, such as having to go into a doctor’s office.
Emory is working with Amazon, the “experts in delivery on time,” to ship the tests, Sullivan noted. He called the collaboration “seamless.”
“People do not want something that says, ‘Your HIV Test is Here’ on their doorstep,” Sullivan said. “No one thinks twice when they see an Amazon package on their doorstep.”
An ad campaign that increases knowledge of the free HIV self-testing program will cater to the gay community, Sullivan said.
Facebook, Instagram and other social media platforms will feature ads and influencers to promote the program, Sullivan said. Ads will also populate primarily gay dating apps, such as Grindr.
Gay and bisexual men, who should test annually, are two times more likely to test once a year and three times more likely to test more than once a year if they get mailed tests for free, based on a smaller sample size study in preparation for this program, Sullivan explained.
TTMH confirms results via oral swab, rather than drawing blood in a hospital like most HIV-testers might experience. Hecht noted the process is very similar to instructions listed in an OraQuick self-testing video, another in-home oral HIV test.
“The video kind of walks them through that process: they would swab their mouth, it would be put in a test tube and they wait 20 minutes,” Hecht said. "Alongside the package includes very, very detailed instructions, a link to the video, as well as some other resources for folks. There's also actually a 24/7 hotline phone number that can be really useful if folks have questions.”
These tests are available for everyone, and Sullivan stated that he recommends that all people get tested at least once in their lifetime. The most important outcome is that people are far more likely to go to a doctor and receive treatment if they test positive and are ultimately less likely to spread HIV, Sullivan said.
Hecht said that anonymous data from the program will be collected and assessed through as comparing order information, surveys and qualitative interviews and surveys, after five years. The anonymity discourages social desirability — or the tendency to answer based on assumptions of what people want to hear — from skewing the data analysis. Hecht added that TTMH is committed to protecting the privacy of patients.
The anonymous data collection will allow Emory researchers to see how effective the Emory testing program will be in helping detect cases of HIV and preventing unnecessary spread, Sullivan explained.
“That allows for other types of data collection where folks don't have to answer; and if they do choose to answer they can … share as openly as they want,” Hecht said. “One really important point of it is that we enter it with a very nonjudgmental kind of attitude and … let folks know and be at ease that they can share any experience, positive or negative, with us.”
TTMH is meant to “complement” in-person testing service and encourage further testing for other sexually transmitted diseases as the public health care system works toward better accessible health care, Hecht explained.
“This is just one piece of a large puzzle,” Hecht said. “But it is absolutely a major concern across the board about how fractured our system is and how hard it is to access care.”
