HIV Tests by Mail: The First Year of Together TakeMeHome, 2023–2024

HIV self-tests are an effective and cost-effective way to reach people who may be living with undiagnosed HIV, including gay, bisexual and other men who have sex with men (MSM). Self-testing is recommended worldwide and is a key strategy of the Ending the HIV Epidemic in the U.S. (EHE) initiative — and it can open the door to treatment, PrEP (pre-exposure prophylaxis) and other prevention.

In September 2022, CDC funded Emory University and its partners — Building Healthy Online Communities (BHOC), OraSure Technologies, Signal Group and NASTAD — to scale up a national program with a goal of distributing at least 1 million self-tests over five years. It launched on March 14, 2023, as Together TakeMeHome (TTMH).

How it works

• Anyone 17 or older in the United States, including Puerto Rico, can order online — whatever their insurance or immigration status.
• The program mails up to two FDA-approved self-tests, free. People can reorder every 90 days.
• After ordering, people answer a short questionnaire; those who agree get follow-up surveys at 10 and 60 days.
• CDC's Let's Stop HIV Together campaign promoted it to priority audiences — the groups most affected by HIV: MSM, transgender women of any race, and Black cisgender women.

Year one: March 2023–March 2024

Who ordered

Of the 169,623 people (77.3%) who answered at least one question afterward:

• 60.1% were under 35, 71.5% cisgender men, and 54.7% Hispanic or Black; 59.5% lived in large central or fringe metropolitan counties, and half in EHE focus areas.
• About two-thirds (65.3%) of orders came through messages aimed at gay and bisexual men on LGBTQ+ dating apps.
• 54.6% of orders could be traced to a priority audience, plus another 13.3% with missing answers who arrived through a dating-app promotion — 67.9% in all.
• Few were already on PrEP (7.3%) or living with diagnosed HIV (2.4%); the website encouraged them to pass their tests to someone who might benefit more.

Many had never been tested

24.1% had never been tested for HIV, and 24.8% hadn't been tested in the past year.

Among priority audiences, Black cisgender MSM were most likely to have been tested in the past 12 months (58.4%).

What people did with the tests

Among the 14,217 who answered a follow-up survey:

PrEP uptake was highest among cisgender MSM (6.5%).

Positive results

Of 7,893 people who used a test themselves and had no earlier HIV diagnosis, 151 (1.9%) reported a positive result — about twice the rate in all CDC-funded in-person testing. Nearly every demographic group had at least one.

What it shows

Mailed self-tests reached huge numbers quickly, including many people never tested or tested less often than recommended — even in the populations hardest hit by HIV. About a quarter passed tests on, extending the program's reach, and about 12% went on to seek other HIV and STI services soon after ordering. The dating-app partnerships (led by BHOC) and tailored advertising, including place-based promotion in EHE jurisdictions, helped reach MSM — especially Black and Hispanic MSM — Black cisgender women and transgender women, and groups with very high rates of never having been tested, such as young adults, transgender men and other gender-diverse people. For people facing travel time, cost, medical mistrust or stigma, a test in the mail removes some of the barriers.

For clinicians, community groups and health officials: know that these programs exist, ask patients about testing done outside the clinic, and follow up with people who report either a positive or a negative self-test. The national HIV case report form now records self-test use among people newly diagnosed.

Limits

• Only 63.2% of participants gave enough information to tell whether they belonged to a priority audience — though 73.0% of the rest came through LGBTQ+ dating apps, suggesting many did. Belonging to a priority audience also isn't the same as being at risk.
• Self-testing programs can't easily track lab confirmation or later care. Kits and websites point users to services, and research suggests self-testers seek follow-up care about as often as people tested in the community — but few people answered the follow-up surveys, and those who did may have been more likely to test positive or seek services. Other evaluation methods, such as surveys of randomly chosen participants, may be needed.

Sources

Based on Sanchez T, MacGowan RJ, Hecht J, et al., "Findings from the First Year of a Federally Funded, Direct-to-Consumer HIV Self-Test Distribution Program — United States, March 2023–March 2024," MMWR volume 73, number 24, Centers for Disease Control and Prevention, with authors from CDC, Emory University, Building Healthy Online Communities, NASTAD, Signal Group and DLH; a work of the United States government in the public domain. The report gives the number of tests distributed as both 443,813 and 443,183, so its own round figure of about 440,000 is used here.