RESUMO
The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.
Assuntos
Poliomielite , Poliovirus , Criança , Humanos , Paralisia , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Vacina Antipólio Oral/efeitos adversos , Vigilância da População , Saúde Pública , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Sexually transmitted infections (STIs) are recognized as one of the conditions in which HIV testing is most clearly indicated. We analyse whether people diagnosed with an STI are being tested for HIV according to the experience of participants in an outreach rapid testing programme in Spain. Between 2008 and 2010, 6293 individuals underwent rapid testing and completed a self-administered questionnaire. We calculated the percentage of individuals that were diagnosed with an STI in the last 5 years and identified the setting where the last episode occurred. We then determined the percentage not receiving an HIV test after the last STI diagnosis and estimated the associated factors. Overall, 17.3% (N = 959) of participants reported an STI diagnosis in the last 5 years, of which 81.5% occurred in general medical settings. Sixty-one percent reported not undergoing HIV testing after their last STI diagnosis, 2.2% of whom reported they had refused the test. Not receiving an HIV test after the last STI diagnosis was independently associated with not being a man who has sex with men (MSM), having had fewer sexual partners, being diagnosed in general medical settings and having received a diagnosis other than syphilis. An unacceptably large percentage of people diagnosed with STI are not being tested for HIV because healthcare providers frequently fail to offer the test. Offering routine HIV testing at general medical settings, regardless of the type of STI diagnosed and population group, should be a high priority and is probably a more efficient strategy than universal screening in general healthcare settings.
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Sorodiagnóstico da AIDS/estatística & dados numéricos , Diagnóstico Tardio/estatística & dados numéricos , Epidemias , Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Atenção à Saúde , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e Questionários , Sífilis/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Shortly after the approval of an over-the-counter HIV self-test in the US, we conducted a study to estimate the proportion of men who have sex with men (MSM) in Spain who knew that unauthorized HIV self-tests could be purchased online, and the proportion that had already used these tests, as well as their socio-demographic and behavioural correlates. METHODS: Between September 2012 and February 2013, MSM users of gay dating websites were invited to complete an online questionnaire. We calculated estimates of the knowledge and use of unauthorized HIV self-testing and assessed the associated factors by rare event logit regression models. RESULTS: Among 8620 participants, 4.2 % (95 % CI:3.8-4.6) knew they could buy an unauthorized HIV self-test kit online, and 12.7 % (95 % CI:12.0-13.4) thought that such a test might exist, although they had never seen one. Only 0.7 % (95 % CI:0.5-0.9) had ever self-tested. In the multivariable analysis, knowledge of online availability of self-tests was associated with being a non-Latin American foreigner, having at least two previous HIV tests, intending to test for HIV in the next year, and knowing about U.S. approval of self-testing. Ever-use of HIV self-testing was associated with being over 34 years of age, living outside Spain during the last 12 months, and knowing about U.S. approval of self-testing. CONCLUSIONS: Both knowledge and use of unauthorized HIV self-testing among MSM in Spain was very low among HIV negative or untested MSM in Spain. The recent approval in the United Kingdom and France might increase the number of MSM seeking such testing and possibly using unauthorized test kits not meeting quality standards.
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Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Infecções por HIV/diagnóstico , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
HIV self-testing, not yet available in Spain, is a strategy thought to be able to increase the number of people tested and testing frequency. 3,373 attenders of a street-based HIV rapid-testing program gave their opinion on authorizing over-the-counter self-tests and a potentially shorter lead time if self-tests were available. 88.0 % of participants were in favor of authorization, 9.2 % had no clear opinion and 2.8 % were against. 54.6 % of men who have sex with men (MSM), 38.4 % of men who have sex with women and 36.3 % of women acknowledged a potential for lead time reduction. Potential lead time was associated with being ≥35 years, having a university degree, never injected drugs, previous HIV tests and being concerned about an HIV positive result, and in MSM, also having ≥5 partners. Self-testing seems a promising strategy for Spain: its authorization is supported by nearly all potential users and almost three quarters of MSM would have opted to advance their current testing if self-tests were available.
Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Sorodiagnóstico da AIDS/métodos , Adulto , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Prioridades em Saúde , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Opinião Pública , Comportamento Sexual , Parceiros Sexuais , Estigma Social , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Given the shortage of community-based HIV testing initiatives in resource-rich countries not targeting most-at-risk populations, we aimed to evaluate whether a highly visible mobile programme promoting and offering rapid HIV testing in the street can attract persons at risk for infection who have never been tested. METHODS: Between 2008 and 2011, the programme served 7552 persons in various Spanish cities who answered a brief questionnaire while awaiting their results. The factors associated with being tested for the first time were analysed using two logistic regression models, one for men who have sex with men (MSM) and the other for only heterosexual men (MSW) and women. RESULTS: 3517 participants (47%) were first-time testers (24% of MSM, 56% of MSW and 60% of women). Among them, 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM. Undergoing a first HIV test was independently associated with age <30, being from Spain or another developed country, lack of university education, having fewer partners, having had unprotected sex with casual partners and not having been diagnosed with a sexually transmitted infection. In heterosexuals, also with never injected drugs, and in MSM, with not being involved in the gay community. Among those tested for the first time, 22% had never thought of being tested and 62% decided to be tested when they passed by and noticed the programme, regardless of their previous intentions. CONCLUSIONS: This community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community. Programme visibility was a decisive factor for almost two of every three persons who had never been tested.
Assuntos
Infecções por HIV/diagnóstico , Heterossexualidade , Homossexualidade Masculina , Programas de Rastreamento , Unidades Móveis de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Prioridades em Saúde , Heterossexualidade/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Parceiros Sexuais , Estigma Social , Espanha/epidemiologia , Inquéritos e Questionários , Sexo sem ProteçãoRESUMO
INTRODUCTION: We estimate the proportion of participants willing to pay the US price (30) or 20 for an HIV self-test and analyse their associated factors. METHODS: In a street-based testing program, 497 participants in a feasibility self-test study answered the question, "What would be the maximum price you would be willing to pay for a similar test to this one so you can use it at your convenience?" RESULTS: Only 17.9% would pay ≥30, while 40.0%, ≥20. In the logistic regression, paying more was associated with being tested outside the campuses and having paid or been paid for sex. CONCLUSION: In Spain, self-testing would not have an impact unless it became more affordable to potential users.
Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Kit de Reagentes para Diagnóstico/economia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Espanha , Adulto JovemRESUMO
INTRODUCTION: The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. METHODS: We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008. RESULTS: The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. CONCLUSION: Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.
Assuntos
Sorodiagnóstico da AIDS , Aconselhamento/estatística & dados numéricos , Soropositividade para HIV/psicologia , Unidades Móveis de Saúde , Adulto , Diagnóstico Tardio/prevenção & controle , Escolaridade , Emigrantes e Imigrantes/estatística & dados numéricos , Emprego , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Soropositividade para HIV/diagnóstico , Humanos , Consentimento Livre e Esclarecido , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Trabalho Sexual/estatística & dados numéricos , Comportamento Sexual , Espanha , Inquéritos e Questionários , Fatores de TempoRESUMO
BACKGROUND: In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient's views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don't know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing. METHODS: We analyzed data from 3120 persons attending a mobile HIV testing programme located on a central street in the gay district of Madrid. RESULTS: 64% were men (of which, 55% had had sex with other men), 59.5% were <30 years, 35.4% foreigners, 50.6% had a university degree,71.7% a regular employment, 59.3% reported multiple partners and inconsistent condom use and 56.5% had been tested for HIV. Non Governmental Organizations and specific HIV/STI centres received the maximum rating from over 60% of participants, followed by self-testing (38.9%). Pharmacies (20.8%) and hospital emergency departments (14.2%) were the worst valued testing sites. Over 80% gave the highest rating to having immediate test results, not needing a previous appointment, and free testing, while less than 50% gave the maximum rating to privacy and anonymity. CONCLUSIONS: HIV testing services that don't require an appointment, based on free tests with rapid results are most valued by a young, not socially marginalized but high risk sexual exposure population. On the contrary, issues traditionally highly valued by health care providers or AIDS social organizations (privacy and anonymity) are much less valued.
Assuntos
Infecções por HIV/epidemiologia , Homossexualidade Masculina , Preferência do Paciente , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Adulto , Prestação Integrada de Cuidados de Saúde , Demografia , Infecções por HIV/diagnóstico , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Espanha/epidemiologiaRESUMO
Background: We estimated the association between the level of restriction in nine different fields of activity and SARS-CoV-2 transmissibility in Spain, from 15 September 2020 to 9 May 2021. Methods: A stringency index (0-1) was created for each Spanish province (n = 50) daily. A hierarchical multiplicative model was fitted. The median of coefficients across provinces (95% bootstrap confidence intervals) quantified the effect of increasing one standard deviation in the stringency index over the logarithmic return of the weekly percentage variation of the 7-days SARS-CoV-2 cumulative incidence, lagged 12 days. Results: Overall, increasing restrictions reduced SARS-CoV-2 transmission by 22% (RR = 0.78; one-sided 95%CI: 0, 0.82) in 1 week, with highest effects for culture and leisure 14% (0.86; 0, 0.98), social distancing 13% (0.87; 0, 0.95), indoor restaurants 10% (0.90; 0, 0.95) and indoor sports 6% (0.94; 0, 0.98). In a reduced model with seven fields, culture and leisure no longer had a significant effect while ceremonies decreased transmission by 5% (0.95; 0, 0.96). Models R 2 was around 70%. Conclusion: Increased restrictions decreased COVID-19 transmission. Limitations include remaining collinearity between fields, and somewhat artificial quantification of qualitative restrictions, so the exact attribution of the effect to specific areas must be done with caution.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Espanha/epidemiologiaRESUMO
INTRODUCTION: We assessed poor linkage to HIV care in a sample of HIV positive men who have sex with men (MSM) diagnosed in Spain. METHODS: From 2012 to 2013 we recruited a sample of MSM mainly through gay-dating websites. Poor linkage to care was defined as receiving the first CD4 count >3 months after HIV diagnosis. We performed a logistic regression analysis to estimate factors associated with poor linkage to care and analyzed the underlying reasons. RESULTS: Some 9.4% self-reported poor linkage to care. Those diagnosed in clinical settings other than sexual health clinics or in non-clinical settings presented increased odds of poor linkage to care. The most common reason was being assigned an appointment for first CD4 count >3 months after initial HIV diagnosis. CONCLUSION: Poor linkage to care was very low, but for further improvements fast-track referral pathways should be created, especially in contexts outside sexual health clinics.
Assuntos
Infecções por HIV/diagnóstico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adulto , Contagem de Linfócito CD4 , Infecções por HIV/sangue , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
INTRODUCTION AND AIMS: Amphetamine-type stimulants (ATS) are a putative cause of stroke with high abuse potential. We aim to systematically review the association between use of ATS and stroke. DESIGN AND METHODS: To assure a sensitive search strategy, a broad definition of ATS was used. Cochrane Plus, EMBASE, IBECS/Lilacs, ISI WOK, Medline and Scopus were searched through 2016. Three researchers independently reviewed studies (Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-analyses). Validity and bias were appraised. RESULTS: Of 3998 articles, four cohort studies and eight case-control studies (CCS) were selected; 11 focused on prescribed or over-the-counter ATS. Current ATS users showed a higher ischaemic stroke risk than non-users in two cohort studies {adjusted rate ratio = 1.6 [95% confidence interval (CI) = 1.1, 2.4] and 3.4 [95% CI = 1.1, 10.6]}. One study observed increased risk of haemorrhagic stroke in former users versus non-users [adjusted rate ratio = 2.3 (95% CI = 1.3, 4.1)]. Higher haemorrhagic stroke risk was seen in two CCS among women using ATS [adjusted odds ratio (aOR) = 16.6 (95% CI = 1.5, 182.2) and 3.9 (95% CI = 1.1, 13.1)]. All-stroke was negatively associated with ATS in another CCS [aOR = 0.4 (95% CI = 0.2, 0.8)] and positively associated in the only study on non-medical ATS [aOR = 3.8 (95% CI = 1.2, 12.6)]. Selection bias and uncontrolled confounding were common. DISCUSSION AND CONCLUSIONS: This is the first systematic review on ATS and stroke. Limited epidemiological evidence suggests that ATS use increases stroke risk. Possible disparities in ATS effect across stroke type and higher effect in women deserve further clarification. Studies on non-medical ATS use should be a priority. [Indave BI, Sordo L, Bravo MJ, Sarasa-Renedo A, Fernández-Balbuena S, De la Fuente L, Sonego M, Barrio G. Risk of stroke in prescription and other amphetamine-type stimulants use: A systematic review. Drug Alcohol Rev 2018;37:56-69].
Assuntos
Anfetaminas/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Humanos , Medicamentos sem Prescrição/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamenteRESUMO
BACKGROUND AND OBJECTIVE: Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. METHODS: The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. RESULTS: 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1); 3.4% in MSM (95%CI: 2.8-4.0). The prevalence among Spaniards was 0.8% (0.7-1.0) vs. 2.2 (1.6-2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. CONCLUSIONS: In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.
Assuntos
Infecções por HIV/diagnóstico , Adulto , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Farmácias , Prevalência , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: We assess the contribution of a rapid-HIV testing program run by Médicos del Mundo and oriented to vulnerable populations reluctant to attend conventional settings. METHODS: We compare the program outcomes with a network of 20 HIV/STI clinics (EPIVIH) and the Spanish National Surveillance System (SNHSS). RESULTS: 33.3% of the new diagnoses were women (8.6% EPIVIH and 17.7% SNHSS). Transsexuals were 6.9% (1.9% EPIVIH), female sex workers 23.6% (2.0% EPIVIH) and 19.4% Sub-Saharan Africans (3.8% EPIVIH and 7.8% SNHSS). HIV prevalence in men was slightly higher than in the EPIVIH and almost twice among women. CONCLUSIONS: This program is contributing substantially to the promotion of HIV diagnosis in female sex workers, sub-Saharan Africans and transsexuals, which are less present at clinical settings.
Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Profissionais do Sexo/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Feminino , Infecções por HIV/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Espanha/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: Increasing the uptake of HIV testing and decreasing the number of undiagnosed people is a priority for HIV prevention. Understanding the barriers that hinder people from testing is vital, particularly when working with especially vulnerable populations like migrants. Most data available on migrants are based on African migrants in the UK, while barriers to HIV testing in Latin-American migrants living in Europe remain unexplored. Still, they account for a quarter of new diagnosis in Spain and suffer higher rates of delayed diagnosis. METHODS: Between May 2008 and March 2011, a mobile unit offered free rapid HIV tests in different Spanish cities. We compared the prevalence of no previous testing, adjusting for potential confounders by two multivariate logistic models, and described differences in perceived barriers to testing in Latin-American migrants living in Spain versus Spaniards. Participants included men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women. RESULTS: Of the 5920 individuals who got tested and answered a self-administered questionnaire, 36.5% were MSM (20.4% previously untested), 28.9% were MSW (49% previously untested) and 34.6% were women (53% previously untested). Almost one quarter were Latin-American, of whom 30% had never been tested versus 45% of untested Spaniards. After adjusting for potential confounders, Spaniards were more likely to report no previous testing than Latin-Americans among women and MSW all together (Odds Ratio (OR)=2.0; 95% Confidence Interval (CI): 1.7-2.4) and among MSM (OR=1.6; 95% CI: 1.2-2.0). Among the 2455 who had never undergone an HIV test before, main barriers to testing were low perceived risk (54% Spaniards vs. 47% Latin-American) and concerns arising from the loss of anonymity (19.5% vs. 16.9%). Fear of rejection or discrimination and fear of legal problems were a barrier for <2%. CONCLUSIONS: Latin-American migrants living in Spain were more likely to get tested than Spaniards. Regardless of nationality, low perceived risk was the main barrier to testing whereas fear of stigma or discrimination and fear of legal problems were merely incidental. However, new Spanish austerity policies regarding healthcare for migrants in response to the economic crisis may reverse this situation.
Assuntos
Etnicidade , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Migrantes , Adulto , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Jurisprudência , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Comportamento Sexual , Discriminação Social , Estigma Social , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Availability of over-the-counter rapid HIV tests could improve access to testing those reluctant or unable to use current services. We aimed to evaluate the feasibility of HIV self-testing using a finger-stick whole-blood rapid test (Determine™ HIV Combo) to detect both antigen and antibody. METHODS: Before being tested, 313 participants in a street-based testing program were given adapted instructions and a test kit, and performed the self-test without supervision. These participants, together with another 207 who performed supervised self-testing, received additional instructions on how to interpret the test results shown in six colour photos and filled out a questionnaire. Logistic regression and generalized estimating equations (GEE) were used in the statistical analysis. RESULTS: About 8.0% (95%CI:4.8%-11.2%) obtained an invalid self-test. An invalid result was inversely associated with male participants who had sex with men (OR=0.3;95%CI:0.1-1.0). Of the 3111 photos interpreted,4.9% (95%CI:4.1-5.7) were incorrect. Only 1.1% (95%CI:0.3-1.8) of the positive results were interpreted as negative. Age 30 or older (OR=2.1; 95%CI:1.2-3.7), having been born in Latin America (OR=1.6; 95%CI:1.1-2.2),and not having university education (OR=2.1;95%CI:1.2-3.7) were associated with misinterpreting test results in the GEE. Participant's perceptions of both their proficiency when conducting the test and interpretation were related with actual outcomes. Most participants (83.9%) were more motivated than before to use the self-test in the future, and 51.7% would pay >10 Euros for the test if it was sold in pharmacies. CONCLUSIONS: This is the first study showing that blood-based self-testing with current technology is feasible in HIV-negative participants demanding the test and without prior training or supervision. Bearing in mind that it was conducted under difficult weather conditions and using a complex kit, over-the-counter tests could be a feasible option to complement current diagnostic strategies. More studies are needed to accommodate technology, minimise interpretation mistakes and provide on-line support.