Syphilis self-testing to expand test uptake among men who have sex with men (SST)

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Across a wide range of resource-constrained settings, syphilis infection causes substantial morbidity. Syphilis increases the risk of acquiring and transmitting HIV infection, but is frequently asymptomatic. Many men who have sex with men (MSM) with high risk sexual behaviours are unable to receive syphilis testing because of centralized testing sites and stigma associated with testing sites. One way to increase syphilis test uptake among MSM is syphilis self-testing. Syphilis self-testing has a person use a test kit and interpret their own test result. HIV self-testing programs have already introduced the concept of self-testing to MSM and created an infrastructure to distribute and measure uptake of self-testing. Sensitive and specific syphilis self-test kits are available and can be used to detect syphilis infection, similar to treponemal serologies commonly used in clinical practice. Syphilis self-testing could decentralize testing and decrease stigma associated with testing. Our nationwide study found that 174/699 (24.9%) of a Chinese MSM sample already use syphilis self-test kits. We have organized five randomized controlled trials focused on increasing HIV test uptake among MSM.To date, there have been no studies evaluating the efficacy of MSM syphilis self-testing compared to facility-based testing. Our long-term goal is to organize a large two-country study to evaluate if self-testing can improve syphilis diagnosis and treatment. As a first step, we will finalise and pilot an intervention to promote syphilis self-testing and linkage to clinical services. This will establish a strong foundation for a randomized controlled trial if the pilot is deemed effective.The study will take place in Guangzhou (China) and Harare (Zimbabwe), two settings with a high burden of syphilis infection, strong linkages to MSM community organizations and health services, and ongoing HIV self-testing programs. Many research tools and methods developed to measure HIV self-testing can be directly applied in this study. We expect that our China-Africa project would facilitate adoption of the intervention in both other Chinese provinces as well as other less-developed African countries. This project will synergize with and benefit from ongoing China-Africa STI collaboration.