Abstract
BackgroundMen who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV.ObjectiveThe aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone.MethodsIn phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST.ResultsPhase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful.ConclusionsUsing BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time.
Highlights
Trends in HIV diagnoses over the past decade show promising signs of progress—though progress has been uneven and certain groups, gay and bisexual men and African Americans, continue to be the most affected
Over the full decade examined (2005-2014), the annual number of HIV diagnoses in the United States declined by 19 percent
African American women continue to be disproportionately affected by HIV, accounting for six in 10 diagnoses among women in 2014
Summary
African Americans, more than any other racial or ethnic population, continue to be disproportionately affected by HIV in the United States. While African Americans represent approximately 12 percent of the total U.S population, they accounted for almost half (44 percent) of all HIV diagnoses in 2014. Southern states account for an estimated 44 percent of all people living with an HIV diagnosis, despite making up roughly one-third (37 percent) of the national population. One goal of the National HIV/AIDS Strategy for the United States is for all states to reduce the death rate among persons living with a diagnosed HIV infection to 21.7 per 1,000 individuals by 2015. While only five states reached the national 2015 goal of 90 percent awareness, almost 70 percent of the worst performing states were in the South
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