Pant Pai Nitika, Smallwood Megan, Desjardins Laurence, Goyette Alexandre, Birkas Krisztian G, Vassal Anne-Fanny, Joseph Lawrence, Thomas Réjean
Department of Medicine, McGill University, Montreal, QC, Canada.
Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, QC, Canada.
J Med Internet Res. 2018 Nov 27;20(11):e10258. doi: 10.2196/10258.
BACKGROUND: Although HIV self-testing strategies have been recommended by the World Health Organization, HIV self-tests are not yet approved in Canada. Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing. We developed an innovative, multilingual software app called HIVSmart! to plug these gaps. OBJECTIVE: This study aimed to test our app-optimized oral HIV self-testing strategy for feasibility in men who have sex with men (MSM) who presented to test at a large sexual health clinic (Clinique Médicale L'Actuel) in Montreal. METHODS: Between July 2016 and February 2017, we offered a strategy consisting of the OraQuick In-Home HIV Test (an investigational device) and a tablet installed with the HIVSmart! app to study participants, who presented at a private office in the clinic, mimicking an unsupervised home environment. We evaluated the strategy for its feasibility, acceptability, and preference. Using the HIVSmart! app, participants were guided through the self-testing process. We determined feasibility with a metric defined as the completion rate, which consisted of the following 3 steps: (1) self-test conduct; (2) self-test interpretation; and (3) linkages to care. Participants independently performed, interpreted, recorded their self-test and result, engaged in pre- and posttest counseling, and sought linkages to care. Laboratory tests (p24, Western Blot, and RNA), as per country algorithms, were expedited, and linkages based on the rapid test status were arranged. RESULTS: Mean age of the 451 participants enrolled was 34 (range, 18-73) years. Of all participants, 97.1% (438/451) completed and submitted the survey through the HIVSmart! app. In total, 84.7% (371/438) of the participants were well educated (beyond high school) and 52.5% (230/438) had been tested within the past 6 months. Of the 451, 11.5% (52/451) were on pre-exposure prophylaxis. Feasibility (completion rate), an average proportion of the 3 steps, was computed to be 96.6% (419/451). The acceptability of the strategy was high at 98.5% (451/458). A majority of the participants (448/451, 99.3%) were found to be self-tested and lab-confirmed negative and were counseled after self- and rapid tests. In total, 0.7% (3/451) of the participants who self-tested positive and were lab-confirmed positive were linked to a physician within the same day. Furthermore, 98.8% (417/422) of the participants found the app to be useful and 94.0% (424/451) were willing to recommend it to a friend or partner. CONCLUSIONS: The HIVSmart! app-optimized strategy was feasible, accepted, and preferred by an educated, urban MSM population of Montreal. With the app, participants were able to perform, interpret, store results, and get rapidly linked to care. The HIVSmart!-optimized, self-testing strategy could be adapted and contextualized to many at-risk populations within Canada and worldwide, thereby maximizing its public health impact.
背景:尽管世界卫生组织已推荐HIV自我检测策略,但HIV自我检测在加拿大尚未获批。目前获批的HIV自我检测提供的免费热线不足以实现快速转介至咨询与护理、准确解读检测结果以及在HIV自我检测期间提供支持。我们开发了一款名为HIVSmart!的创新型多语言软件应用程序来填补这些空白。 目的:本研究旨在测试我们的应用程序优化的口服HIV自我检测策略在蒙特利尔一家大型性健康诊所(Clinique Médicale L'Actuel)进行检测的男男性行为者(MSM)中的可行性。 方法:在2016年7月至2017年2月期间,我们为前来诊所一间私人办公室的研究参与者提供了一种策略,该策略包括OraQuick居家HIV检测(一种研究用设备)和一台安装了HIVSmart!应用程序的平板电脑,模拟无人监督的家庭环境。我们评估了该策略的可行性、可接受性和偏好性。使用HIVSmart!应用程序,指导参与者完成自我检测过程。我们用一个定义为完成率的指标来确定可行性,该指标包括以下3个步骤:(1)自我检测操作;(2)自我检测解读;(3)转介至护理。根据国家算法加快实验室检测(p24、蛋白印迹法和RNA),并根据快速检测结果安排转介。 结果:纳入的451名参与者的平均年龄为34岁(范围18 - 73岁)。在所有参与者中,97.1%(438/451)通过HIVSmart!应用程序完成并提交了调查。总共有84.7%(371/438)的参与者受过良好教育(高中以上学历),52.5%(230/438)在过去6个月内接受过检测。在451名参与者中,11.5%(52/451)正在接受暴露前预防。可行性(完成率),即这3个步骤的平均比例,经计算为96.6%(419/451)。该策略的可接受性很高,为98.5%(451/458)。大多数参与者(448/451,99.3%)自我检测且实验室确认结果为阴性,并在自我检测和快速检测后接受了咨询。总共有0.7%(3/451)自我检测呈阳性且实验室确认结果为阳性的参与者在同一天被转介给了医生。此外,98.8%(417/422)的参与者认为该应用程序有用,94.0%(424/451)愿意将其推荐给朋友或伴侣。 结论:HIVSmart!应用程序优化的策略在蒙特利尔受过良好教育的城市男男性行为人群中是可行的、可接受的且受欢迎的。借助该应用程序,参与者能够进行检测、解读结果、存储结果并迅速转介至护理。HIVSmart!优化的自我检测策略可以根据加拿大和全球许多高危人群的情况进行调整和因地制宜,从而最大化其对公共卫生的影响。
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