During 2019, approximately 34,800 new HIV infections occurred in the United States (1), and it is estimated that approximately 80% of HIV transmission occurs from persons who either do not know they have HIV infection or are not receiving regular care (2). Since 2006, CDC has recommended that persons who are disproportionately affected by HIV (including men who have sex with men [MSM]) should test for HIV at least annually (3,4). However, data from multiple sources indicate that these recommendations are not being fully implemented (5,6). TakeMeHome, a novel public-private partnership to deliver HIV self-testing kits to persons seeking HIV testing in the United States, was launched during March 2020 as home care options for testing became increasingly important during the COVID-19 pandemic. The initiation of the program coincided with the national COVID-19 Public Health Emergency declaration, issuance of stay-at-home orders, and other restrictions that led to disruption of traditional HIV testing services. During March 31, 2020–March 30, 2021, 17 state and local health departments participating in the program allowed residents of their jurisdictions to order test kits. Marketing for TakeMeHome focused on reaching gay, bisexual, and MSM through messages and embedded links in gay dating applications. Most participants in the program reported that they had either never tested for HIV (36%) or that they had last tested >1 year before receiving their self-test kit (56%). After receiving the self-test kit, >10% of respondents reported accessing additional prevention services. Health departments can increase options for HIV testing by distributing publicly funded self-test kits to persons without proximate access to clinic-based testing or who prefer to test at home. Increased and regular HIV testing among MSM will help meet annual testing goals.

Self-testing is an effective HIV screening method for MSM (7) that can facilitate access to antiretroviral treatment, preexposure prophylaxis (PrEP), and other prevention services (8). The COVID-19 pandemic disrupted HIV testing services, persons reported not being able to access HIV testing services (9), and hundreds of thousands of HIV screening tests were either delayed or skipped (10). CDC sent a “Dear Colleague” letter on April 28, 2020* recommending that grantees consider HIV self-testing as an option to fill the gap in prevention services. This report describes the use and results of TakeMeHome,^† a centralized system established during March 2020 to distribute HIV self-test kits.

TakeMeHome offers rapid HIV self-tests (OraQuick In-Home HIV Test), paid for by state and local health departments or other partners at no cost to persons in participating jurisdictions. The program was developed by Building Healthy Online Communities (BHOC)^§ in partnership with the National Alliance of State and Territorial AIDS Directors (NASTAD)^¶ and Emory University.** From its inception on March 31, 2020, TakeMeHome established eligibility criteria included residence in a participating zip code, age ≥18 years, and report of no HIV test in the past 12 months. Eligibility was later expanded to persons reporting more recent HIV tests in some participating locations, per jurisdiction request. Several jurisdictions also chose to allow up to two kits per order. All participants were offered a nonincentivized follow-up survey 10 days after their HIV test kit was mailed. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. CDC’s role was to provide technical assistance.^†† Results of the evaluation were analyzed using SPSS software (version 26; IBM).

Characteristics of persons who ordered kits are summarized for all participants. For the subset of persons who ordered kits and responded to the BHOC follow-up survey, reasons for ordering a self-test kit and the proportion of persons who reported accessing other HIV and sexually transmitted infection (STI) prevention services were calculated. To date, two participating health departments established matches between persons who ordered kits and HIV case surveillance to document new diagnoses in persons who had participated in HIV self-testing.

Seventeen health jurisdictions supported self-test kit distribution for their residents during the first year of the program (14 for 6–12 months and three for <6 months). During this time, 5,325 kits were mailed to 4,904 persons. Sixty-seven percent of participants were cisgender men; 6% were transgender, nonbinary, or genderqueer (Table 1). Overall, 1,764 participants (36%) reported never having tested for HIV before ordering an HIV self-test. Among 855 respondents to the follow-up survey (17% of persons who received kits), 73% reported male-to-male sexual contact (Table 2). Most survey respondents reported hearing about the program through marketing by BHOC within gay dating applications (71%), believing that the program addressed issues of convenience (63%) and privacy (46%), and being willing to recommend the program to a friend (90%). After receiving the self-test kit, 10% of respondents reported accessing additional STI testing, and 8% reported accessing PrEP. Among persons who had never previously tested for HIV, 8% reported additional STI testing, and 6% reported accessing PrEP after participating in the program (Figure). The two health departments that matched kit orders to HIV case surveillance estimated that 0.6%–0.8% of those who received a kit were subsequently reported to have newly diagnosed HIV.