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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to: Jeffrey A. Participants were recruited using flyers, announcements through social media, and direct referral from staff members of the community-based organizations serving the TW communities. Results: Nearly half of the participants Overall, our findings underscore the need for additional research on how to most effectively implement HIVST for key populations, including TW, such that uptake and retention in regular HIV screening is sustained. Globally, transgender women TW are at significantly higher risk for HIV than people in the general adult population, with an estimated Worldwide, being TW is almost universally stigmatized, resulting in increased discrimination, gender-based violence and abuse, marginalization, and social exclusion that can limit TW's access to vital health services and placing them at greater risk for HIV. HIV testing is the gateway to a range of HIV prevention and treatment options, such as pre-exposure prophylaxis PrEP for those testing negative and antiretroviral therapy ART for those who test positive. In addition to reaching individuals who have never tested for HIV or those who test infrequently, HIVST empowers users to test on their own, which normalizes screening and can facilitate partner testing. While global research on the implementation of HIVST has increased exponentially, few studies have explored self-testing in TW 23—26 and none in the Malaysian context. Therefore, we sought to directly assess willingness to use HIVST among this highly stigmatized and difficult-to-reach group. The data reported in this study are derived from a cross-sectional study of TW in Malaysia conducted in Inclusion criteria were: 1 age of 18 years or older; 2 male sex assigned at birth and reporting gender identity as female or identified as a TW; 3 living in Malaysia; and 4 self-reported HIV-negative or HIV status unknown. Before conducting this survey, formative interviews were conducted with leaders from the Malaysian TW community to help identify regions around Malaysia with established communities of TW. Based on their feedback, we recruited TW in three out of nine states across peninsular Malaysia, including Selangor inclusive of the Greater Kuala Lumpur region , Penang, and Seremban. A total of individuals were screened for study eligibility. After screening, 7 were identified as ineligible and 13 declined to participate, yielding a final analytic sample of Participants were recruited using convenience sampling procedures, including posting of flyers in venues frequented by TW, announcements through social media, and by direct referral from staff members at community-based organizations serving the TW community. Participants were recruited and interviewed in three states of Malaysia, including Selangor inclusive of the Greater Kuala Lumpur region , Penang, and Seremban. Screening was conducted in a private room by a trained research assistant who was also a member of the TW community. Individuals who met inclusion criteria and expressed an interest in participating were then guided through the informed consent procedures. After providing consent, participants completed a self-administered, anonymous survey using a tablet or laptop computer. All study materials were translated from English to Bahasa Malaya by trained translators. Back translation was conducted to ensure accuracy of all study materials. Independent variables from the survey included participant characteristics, sexual risk behaviors, drug and alcohol use, health measures, criminal justice involvement, and physical and sexual victimization items. Variables were selected based on a review of the relevant literature and knowledge of the Malaysian context. Participant characteristics included age, ethnicity Malay vs. Prior injection of illicit drugs was also measured for the lifetime. General and sexual health measures were also included. Prior HIV testing was measured for lifetime and last 12 months. Prior sexually transmitted infection STI testing i. Recent doctor visit was defined as having been examined by a medical doctor for any reason in the last 12 months. Recent use of HT was defined as any use of feminizing hormones in the last 90 days, including oral and injectable formulations. Experience of childhood physical and sexual violence and adulthood physical violence was measured using questions from the U. We computed descriptive statistics, including frequencies and percentages for categorical variables and means, standard deviations, and ranges for continuous variables. Bivariate logistic regression analyses were conducted between each of the independent variables and the primary outcome, willingness to use HIVST. Childhood physical assault was excluded from the final model due to its high correlation with childhood sexual assault. The goodness of fit of the final model was assessed using the Hosmer—Lemeshow test. Most participants were Malay Regarding sexual risk behaviors, Almost half Almost four-fifth Furthermore, Regarding violence and victimization, over one-third reported having experienced physical assault Nearly half of participants Table 2 shows the independent correlates associated with willingness to use HIVST in the multivariable regression. Given that participants in the current study were recruited from venues where HIV testing is routinely provided to TW e. Nonetheless, a HIVST strategy that is patient centered and responsive to the needs of key populations is likely to be well received by patients in the Malaysian context. Ultimately, our results support that the need for Malaysia to rapidly develop national guidelines on HIVST to ensure key populations at high risk for HIV can access this alternative modality for testing, ultimately expanding and improving the uptake and frequency of HIV testing among groups with the greatest gaps in testing coverage. This result contrasts with prior research which found HIVST acceptability to be positively correlated with number of sexual partners. Findings further revealed that mobile phone or apps are popular means for meeting sexual partners among Malaysian TW This finding is consistent with previous studies with other risk groups, which investigated the role of geosocial networking GSN apps for meeting potential sex partners. It is possible that individuals who solicit clients online are making a rational judgment about their own risk levels and are willing to use HIVST. This may indicate not only a concern about risk of HIV infection but also a self-management response to their HIV risk behaviors, 50 allowing them to conveniently learn their HIV status and link to appropriate care early in the process. We found that willingness to use HIVST was negatively associated with TW participants reporting living in Kuala Lumpur, and those exhibiting depressive symptoms, which was highly prevalent Prior research has suggested that one of the reasons for nonutilization of HIVST is the psychological distress that might arise from receiving a positive HIVST result without immediate personal or professional support present. It is further documented that the decision to seek HIV testing is influenced by numerous psychological factors e. Providing individuals with access to resources for counseling and support services pre- and post-HIVST, for example through h hotlines, contact information for local mental health providers or access to virtual counseling services, could mitigate some of the potential psychological distress associated with HIVST within this population. Alternatively, HIVST programs for key populations could be designed to include online counseling and support through video chat programs, such as WhatsApp or Zoom, which may alleviate some of the psychological fears testers may have. Furthermore, having experienced sexual assault in childhood was associated with greater willingness to use HIVST in our sample. Many studies have established a strong association between experiences of childhood sexual violence and later engagement in sexual risk-taking behaviors, such as having multiple sexual partners, inconsistent condom use, and participation in transactional sex. Additional research is needed to further elucidate this relationship to characterize and guide appropriate intervention development tailored specifically to this at-risk group. The results of this study must be considered in the context of certain limitations. First, participants were recruited at venues where HIV testing services were being provided community-based organizations , which may explain the higher rate of recent HIV testing in our sample. Furthermore, participants were recruited using direct referrals from staff members of the local community-based organizations, which may have biased our sample toward TW who are already connected to clinical resources and services. TW in regions without such community-based organizations may have less access to outreach and support and, in turn, may be more willing to adopt HIVST. The findings reported in this study are therefore constrained by the lack of contextual information related to HIVST and its potential influence on actual uptake and prompt for future research. Third, all data were collected through self-report, introducing the potential for social desirability bias i. Fourth, the use of a cross-sectional study design limited our ability to make causal inferences. Nonetheless, our findings represent important data about TW's self-perceived willingness to use HIVST in Malaysia—a topic and population warranting further study given the significantly lower rate of linkage to HIV prevention and treatment services in the Malaysian context. The findings in this study contribute to a growing evidence base that suggests HIVST has the potential to greatly enhance uptake and retention to HIV testing in TW while also providing novel posttest pathways for linking individuals to prevention and treatment services. Since WHO's release of the guidelines on HIVST in , 77 countries have adopted formal policies on self-testing, while many others are currently developing them. As a discreet and convenient approach, HIVST might be most useful in reaching TW who are reluctant or unable to access traditional venue-based HIV testing services because of concerns about privacy, stigma, and discrimination, and, in some instances, criminalization. The findings from this study could be relevant as the market for HIV self-tests takes shape in the country, with the MoH in the process of developing necessary strategic plans, regulations, implementation guidance, and standard operating procedures needed for scale-up. Important considerations must be given while selecting service delivery models and support tools. For example, it is important to empower and effectively engage stakeholders and key population members in developing and adapting an HIVST service delivery model. The remote services that will complement the convenience and privacy of HIVST, such as new digital, social media, video or messaging platforms, toll-free hotlines, can be key for the scaling up and implementation of HIVST. Furthermore, it is important to raise community awareness about the benefits of HIV testing—including self-testing—and subsequent linkage to prevention or treatment services. Especially important here is the increased interest among those who are at increased risk for HIV infection. These results underscore the need to examine how best to implement safe and effective HIVST service delivery models to ensure utility of HIVST as an additional alternative to increase HIV testing rates among this marginalized and hard-to-reach group. As the MoH plans to scale-up HIVST among stigmatized and hard-to-reach groups, further research needs to be done to identify approaches to deliver HIVST in a safe and effective model to meet the diverse needs and preferences of those wishing to use this technology. Additional studies to determine optimal subsidy levels for self-tests as well as support options to link to appropriate services after HIVST is also needed. As a library, NLM provides access to scientific literature. Transgend Health. Find articles by Roman Shrestha. Find articles by Jonathan M Galka. Find articles by Iskandar Azwa. Find articles by Sin How Lim. Find articles by Thomas E Guadamuz. Find articles by Frederick L Altice. Find articles by Jeffrey A Wickersham. Collection date Sep. Copyright , Mary Ann Liebert, Inc. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Number of sex work clients per day last month. Used mobile phone or mobile apps to find clients.

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