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MacGowan RJ, Chavez PR, Dana R, Hannah M, Raiford JL, Caldwell JA, Wall KM, Johnson JA, Sharma A, Hightow-Weidman L, Stephenson R, Sanchez T, Smith AJ, Sullivan S, Jones J, Sullivan PS. Efficacy of Internet Recruitment and HIV Self-Testing for Diagnosing HIV Infections Among Black and Hispanic/Latino MSM and Transgender Women in 11 US States, 2020-2021. J Acquir Immune Defic Syndr 2024; 97:133-141. [PMID: 39250647 PMCID: PMC11386906 DOI: 10.1097/qai.0000000000003476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION We evaluated internet platforms for distributing HIV self-tests (HIVSTs) to Black or African American (Black) and Hispanic or Latino men who have sex with men (MSM) and transgender women (TGW). METHODS We recruited MSM and TGW from general interest, dating, and lesbian, gay, bisexual, and transgender platforms. Two HIVSTs were mailed to all MSM and TGW. Surveys (screening, baseline, 4-month, and results reporting) were completed online. After 4 months, participants were mailed another HIVST and a dried blood spot card. All HIVST interpretations and images of HIVST devices were reported online. RESULTS Of 2093 MSM and 102 TGW, most were recruited through general interest and dating platforms. Over 50% were 18-29 years old, most identified as gay or bisexual. Overall, 45% had not tested for HIV in the past 12 months, and 9.1% of MSM reported a positive (reactive for HIV antibodies) HIVST result, with the highest percentage among Black MSM (11.5%). Dating platforms recruited higher percentages of MSM who recorded positive results compared with MSM from general interest platforms during the intervention period (11.9% vs 5.5% (P < 0.0001)), and MSM who had never tested for HIV reported a greater percentage of positive HIVST results compared with MSM who had been tested for HIV before enrollment (16.1% vs. 7.1%; P < 0.0001). MSM were able to correctly interpret and report HIVST results. Of TGW, 7% reported a positive HIVST result. CONCLUSIONS Internet dating and general interest platforms can be key to increasing awareness of infection among BMSM, HMSM, and TGW persons, including those who do not use existing HIV services. TRIAL REGISTRATION www.clinicaltrials.gov Identifier: NCT04219878.
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Affiliation(s)
- Robin J MacGowan
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Pollyanna R Chavez
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Ruth Dana
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Marissa Hannah
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Jerris L Raiford
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Joanna A Caldwell
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Kristin M Wall
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Jeffrey A Johnson
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Akshay Sharma
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Lisa Hightow-Weidman
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
- Currently, Florida State University College of Nursing, Institute on Digital Health and Innovation, Tallahassee, FL; and
| | - Rob Stephenson
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Amanda J Smith
- Division of HIV Prevention, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA
| | | | - Jeb Jones
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA
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Beecroft A, Vaikla O, Pant Pai N. Digital HIV self-testing as an exemplar: a perspective on benefits, challenges, and opportunities. Expert Rev Mol Diagn 2024:1-13. [PMID: 39323182 DOI: 10.1080/14737159.2024.2406974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/17/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Digital human immunodeficiency virus self-testing (HIVST) leverages digital supports, enhancing accessibility, privacy, and early detection of HIV, empowering individuals to manage their HIV status and facilitating timely linkage to care. These advancements contribute to reduced HIV transmission and thereby lead to improved health outcomes. AREAS COVERED This perspective examines the current landscape of digital HIVST strategies, highlighting challenges that must be addressed and opportunities that are presented as the field evolves. EXPERT OPINION Implementing advances in digital HIVST requires a unified digital network architecture that integrates proven tools (digital supports) within the World Health Organization's One Health Agenda. This includes strategies effective in diverse settings, supported by evolving governance and ethics frameworks that ensure data safety and privacy. Although data on linkages to care are strong, digital HIVST strategies may need further field validation, especially in low-income countries. Key challenges include systems integration, data privacy safeguards, and implementation of proven digital supports. Embracing digital readers, machine learning solutions, chatbots, and wearable solutions can improve outcomes that translate to significant public health benefits in the context of HIV elimination. Investing in digital technologies and integrating digital HIVST into HIV prevention and care programs can enable progress toward UNAIDS elimination targets.
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Affiliation(s)
- Ashlyn Beecroft
- Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Olivia Vaikla
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, QC, Canada
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Rana SK, Perkins RB, Carr D, Feldman S, Welch K, Duffey-Lind E, Villa A. Evaluation of Human Papillomavirus Vaccination and Cancer Prevention Behaviors among LGBTQI + Individuals: A Cross-Sectional Study. J Community Health 2024:10.1007/s10900-024-01401-1. [PMID: 39235543 DOI: 10.1007/s10900-024-01401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 09/06/2024]
Abstract
Human Papillomavirus (HPV) vaccination and cervical cancer screening rates are suboptimal in the US, particularly among historically underserved groups like Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+)-identifying women and transgender men. Therefore, our cross-sectional study assessed factors associated with these rates among LGBTQI+-identifying women and transgender men.HPV-related cancer knowledge, HPV vaccination and cervical cancer screening status, and the acceptability of self-collection for screening of 1983 LGBTQI+-identifying women and transgender men was assessed via an online survey available to members of the HER mobile app from March to May 2022. Associations between sociodemographic factors, vaccination, and screening were assessed using multivariable logistic regressions from November 2022 to December 2023.Most participants aged 18-26 (77.0%) and 6.3% of participants aged ≥46 (P < 0.001) had received at least one dose of the HPV vaccine. Cervical cancer screening rates were positively associated with age: 70.5% of those aged 21-26 and 96.1% aged ≥46 (P < 0.001). Screening was negatively associated with male gender identity (OR, 0.13; 95% CI, 0.04-0.42; P < 0.001), being uninsured (OR, 0.40; 95% CI, 0.24-0.67; P < 0.001), and being unvaccinated against HPV (OR, 0.28; 95% CI, 0.18-0.43; P < 0.001). 29.6% of those unscreened believed screening was not needed, and 22.1% were uncomfortable with pelvic exams. 40.4% of all participants would prefer self-collection for screening. Our findings indicate opportunities to increase screening and vaccination. Among under-screened individuals, lack of knowledge about screening necessity and discomfort with pelvic exams were important barriers. Targeted interventions addressing patient knowledge, practitioner communication, and exploring self-screening strategies are warranted.
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Affiliation(s)
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avdesian School of Medicine and Boston Medical Center Cancer Center, Boston, MA, USA
| | - Devan Carr
- Community Benefits Office, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Eileen Duffey-Lind
- Team Maureen, North Falmouth, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alessandro Villa
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute, Baptist Health South Florida, 8900 North Kendall Drive, Miami, FL, 33176, USA.
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Tapia Y, Saleska J, Gonzalez-Valentino O, Liashenko J, Stafylis C, Brown B, Brooks R, Klausner JD. Proyecto Facil: Using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) as a Diagnostic Tool to Improve Access to Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) via Telemedicine. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:16-32. [PMID: 38349353 DOI: 10.1521/aeap.2024.36.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Following the underutilization of pre-exposure prophylaxis (PrEP) among Latinx men who have sex with men (MSM) and transgender women in Southern California and the growing use of the delivery of PrEP through telemedicine, the California Department of Public Health implemented a telemedicine component to their already existing assistance program. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to identify and characterize factors inhibiting the successful implementation of the telemedicine program through in-depth, online stakeholder interviews and online community focus groups with Latinx MSM and trans women in southern California. Obstacles reported by stakeholders were complicated enrollment process, preference for in-person care, more appealing private sector models of PrEP, while community members reported low awareness of the program, fear of complications due to immigration status, challenges to fulfill enrollment requirements. Findings can used for the future improvement of the ongoing program, as well as other similar PrEP telemedicine programs.
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Affiliation(s)
- Yara Tapia
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Jessica Saleska
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | | | - Joshua Liashenko
- University of California, Riverside School of Medicine, Riverside, California
| | - Chrysovalantis Stafylis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California
| | - Ronald Brooks
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
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Shrestha RK, Hecht J, Chesson HW. Analyzing the Costs and Impact of the TakeMeHome Program, a Public-Private Partnership to Deliver HIV Self-Test Kits in the United States. J Acquir Immune Defic Syndr 2024; 95:144-150. [PMID: 37831623 PMCID: PMC10841436 DOI: 10.1097/qai.0000000000003323] [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] [Received: 03/24/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND HIV testing is an entry point to access HIV care and prevention services. Building Healthy Online Communities developed a website ( TakeMeHome.org ) where participants can order HIV home test kits. The purpose of this study was to analyze the costs and impact of the TakeMeHome program. METHODS We estimated the costs of TakeMeHome across all participating jurisdictions for the first year of the program. We estimated program costs using purchase orders and invoices, contracts, and allocation of staff time, and the costs included website design, participant recruitment, administration and overhead, HIV self-test kits, and shipping and handling. Primary outcomes of the analysis were total program cost, cost per HIV test, and cost per new HIV diagnosis. RESULTS The TakeMeHome program distributed 5323 HIV self-tests to 4859 participants over a 12-month period. The total program cost over this period was $314,870. The cost per HIV test delivered was estimated at $59, and the cost per person tested was $65. The program identified 18 confirmed new HIV diagnoses (0.6% positivity) verified with surveillance data in 7 health jurisdictions at $169,890. The cost per confirmed new HIV diagnosis was estimated at $9440. CONCLUSIONS The TakeMeHome program delivered HIV self-testing at a reasonable cost, and the program may be a cost-effective use of HIV prevention resources. The public-private partnership can be an effective mechanism to validate HIV diagnoses identified with self-testing and provide HIV prevention and linkage to care services.
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Affiliation(s)
- Ram K Shrestha
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA; and
| | - Jennifer Hecht
- Building Healthy Online Communities and Springboard HealthLab, Richmond, CA
| | - Harrell W Chesson
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, GA; and
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