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Martínez-Riveros H, Díaz Y, Montoro-Fernandez M, Moreno-Fornés S, González V, Muntada E, Romano-deGea P, Muñoz R, Hoyos J, Casabona J, Agustí C. An Online HIV Self-Sampling Strategy for Gay, Bisexual and Other Men Who Have Sex with Men and Trans Women in Spain. J Community Health 2024; 49:535-548. [PMID: 38141149 PMCID: PMC10981614 DOI: 10.1007/s10900-023-01311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/24/2023]
Abstract
We aimed to evaluate the feasibility of an online self-sampling pilot intervention for HIV testing addressed to gay, bisexual, and other men who have sex with men (GBMSM) and trans women (TW) users of dating apps in Spain. The website https://www.testate.org/ was designed to offer self-sampling kits for HIV testing and online consultation of the results. It was advertised on gay dating apps. Participants requested the delivery of a saliva self-sampling kit by mail and a postage-paid envelope to send the sample to the reference laboratory. An anonymous acceptability survey was conducted. The cascade of care was estimated. From November 2018 to December 2021, 4623 individual users ordered self-sampling kits, 3097 returned an oral fluid sample to the reference laboratory (67.5% return rate). 87 reactive results were detected. 76 were confirmed to be HIV-positive, we estimated an HIV prevalence of 2.45% (95% CI 1.9-3.0%). 100% of those referred to specialized care are in treatment. 45.8% of participants took more than one test. 23 incident cases were detected among repeat testers, of which 20 were confirmed. The estimated incidence was 1.00 confirmed case per 100 individual-years of follow-up. 98.01% of participants would recommend it to a friend. The most identified advantages were convenience and privacy. We demonstrated that the online offer of oral self-sampling kits for HIV detection and reporting results online among GBMSM and TW users of dating apps is feasible. The intervention counted with a high acceptability and high efficacy (in terms of reactivity, confirmation and linkage to care rates).
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Affiliation(s)
- Héctor Martínez-Riveros
- Doctorate Program in Methodology of Biomedical Research and Public Health, Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Badalona, Spain.
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain.
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain.
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Edifici Muntanya, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Spain.
| | - Yesika Díaz
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marcos Montoro-Fernandez
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
| | - Sergio Moreno-Fornés
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria González
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Service, Clinical Laboratory Metropolitana Nord, Badalona, Barcelona, Spain
| | - Esteve Muntada
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
| | - Pol Romano-deGea
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
| | - Rafael Muñoz
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain
| | - Cristina Agustí
- Centre for Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Ministry of Health of the Government of Catalonia, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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McGuire M, de Waal A, Karellis A, Janssen R, Engel N, Sampath R, Carmona S, Zwerling AA, Suarez MF, Pai NP. HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010-2021). EClinicalMedicine 2021; 39:101059. [PMID: 34430835 PMCID: PMC8367787 DOI: 10.1016/j.eclinm.2021.101059] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. METHODS We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. FINDINGS 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77-97%), preferred over in-person and hybrid options by more first-time testers (47-48%), highly feasible (93-95%), and were overall effective in supporting linkage to care (53-100%). Social media and app-based innovations also had high acceptability (87-95%) and linkage to care proportions (80-100%). SMS innovations increased kit return rates (54-94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54-93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. INTERPRETATION HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally.
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Affiliation(s)
- Madison McGuire
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Anna de Waal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC H3A 1A2, Canada
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
| | - Angela Karellis
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
| | - Ricky Janssen
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Nora Engel
- Department of Health, Ethics and Society, Maastricht University, Postbus 616 6200 MD, Maastricht, the Netherland
| | - Rangarajan Sampath
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Sergio Carmona
- Foundation for Innovative New Diagnostics, Chemin des Mines 9, Geneva 1202, Switzerland
| | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z, Canada
| | | | - Nitika Pant Pai
- The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada
- Department of Medicine, McGill University, 3605 rue de la Montagne, Montréal, QC H3G 2M1, Canada
- Corresponding author at: The Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, 5252 blvd de Maisonneuve W., Montreal, QC H4A 3J1, Canada.
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HIV testing in Spain: Are we doing our job? Enferm Infecc Microbiol Clin 2021; 39:1-2. [DOI: 10.1016/j.eimc.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022]
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Maté T, Hoyos J, Guerras JM, Agustí C, Chanos S, Kuske M, Fuertes R, Stefanescu R, Pulido J, Sordo L, de la Fuente L, Belza MJ. Potential of HIV Self-Sampling to Increase Testing Frequency Among Gay, Bisexual, and Other Men Who Have Sex With Men, and the Role of Online Result Communication: Online Cross-Sectional Study. J Med Internet Res 2020; 22:e21268. [PMID: 33252346 PMCID: PMC7735895 DOI: 10.2196/21268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background Late HIV diagnosis remains frequent among the gay, bisexual, and other men who have sex with men (GBMSM) population across Europe. HIV self-sampling could help remove barriers and facilitate access to testing for this high-risk population. Objective We assessed the capacity of HIV self-sampling to increase the testing frequency among GBMSM living in Denmark, Germany, Greece, Portugal, Romania, and Spain, and evaluated the role of new technologies in the result communication phase. Methods We analyzed a convenience sample of 5019 GBMSM with prior HIV testing experience who were recruited during 2016 through gay dating websites. We estimated the proportion of GBMSM who reported that the availability of self-sampling would result in an increase of their current testing frequency. We constructed a Poisson regression model for each country to calculate prevalence ratios and 95% CIs of factors associated with an increase of testing frequency as a result of self-sampling availability. Results Overall, 59% (between country range 54.2%-77.2%) of the participants considered that they would test more frequently for HIV if self-sampling was available in their country. In the multivariate analysis, the increase of testing frequency as a result of self-sampling availability was independently associated with reporting a higher number of unprotected anal intercourse events in all countries except for Greece. Independent associations were also observed among GBMSM who were not open about their sex life in Germany, Greece, Portugal, and Spain; those with a lower number of previous HIV tests in Denmark, Greece, Portugal, and Spain; and for those that took their last test more than 3 months previously in Germany, Portugal, Romania, and Spain. In addition, 58.4% (range 40.5%-73.6%) of the participants indicated a preference for learning their result through one-way interaction methods, mainly via email (25.6%, range 16.8%-35.2%) and through a secure website (20.3%, range 7.3%-23.7%). Almost two thirds (65%) of GBMSM indicated preferring one of these methods even if the result was reactive. Conclusions Availability of HIV self-sampling kits as an additional testing methodology would lead to a much-needed increase of testing frequency, especially for the hidden, high-risk, and undertested GBMSM population. Online-based technologies without any personal interaction were preferred for the communication of the results, even for reactive results.
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Affiliation(s)
- Tomás Maté
- Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Juan Hoyos
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Salut, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Generalitat de Catalunya, Badalona, Spain
| | | | | | | | | | - Jose Pulido
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Sordo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
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