Exploring use of a real-time remote monitoring and follow-up system for home-based, HIV self-testing among high-risk men who have sex with men

Brown University, Providence RI

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Abstract

? DESCRIPTION (provided by applicant): Rates of new HIV infections continue to increase among men who have sex with men (MSM), despite stability or decline among other risk groups. While a large proportion of these new HIV transmissions originate from among MSM who are aware of their infection but not engaged in care, up to 50% of infections may be transmitted by individuals who are unaware of their status. Home-based self-HIV testing (HBST) offers considerable promise for increasing the number of MSM who are aware of their status by overcoming many prominent obstacles to clinic-based testing, such as concerns about confidentiality and inconvenience. Studies suggest that many MSM who have never tested would prefer to do so at home and feel they would test more often with HBST. HBST may also be uniquely well-suited for connecting particularly high-risk, hard to reach segments of MSM with testing. MSM who meet partners online and via mobile apps are among these, and an extensive body of research has shown clear relationships between meeting partners online and higher HIV-risk behavior. Despite the promise of HBST for expanding access to testing among these high-risk and difficult to reach MSM, prominent concerns prevent their widespread integration into prevention programs. Among the most vital of these are concerns that HBST users may not be adequately linked with post-testing resources, such as counseling, confirmatory HIV testing, testing for other sexually-transmitted diseases (STIs), and other prevention resources (e.g., pre-exposure prophylaxis). As a result, many HBST users may delay seeking care. OraSure's(r) OraQuick, the only FDA-approved HBST available, offers a free, 24-hour helpline that provides these services to users who seek it, but few users do and this passive approach may miss critical opportunities to engage with hard to reach populations. Coupling existing and ubiquitous technologies with the delivery of HBSTs can enable a more active system for engaging with HBST users after testing to offer timely follow-up and post-test counseling remotely. Monitoring HBST use in real-time and providing prompt follow-up could be an intervention-in-itself that increases the likelihood of future testing and the number of users who are successfully linked with care and other prevention services. Given this gap in HBST service delivery, the goals of this exploratory research are to: (1) refine technology that enables real-time, remote monitoring of HBST kits, allowing timely delivery of post-test counseling and referrals to HBST users over the phone (Enhanced HBST), and (2) test whether this enhanced HBST increases the likelihood of any testing, repeat testing, and successful linkage to other prevention services compared to standard HBST in a sample of high-risk MSM who meet partners online. Findings can inform whether proactively following-up with HBST users is feasible, acceptable, and useful, and can encourage future research exploring optimal methods for providing follow-up.