Mobile health platform for providing real-time follow-up after home-based HIV self-testing for high-risk men who have sex with men

移动健康平台，为男男性接触者的高危男性进行家庭艾滋病自检后提供实时随访

• 批准号: 10058273
• 负责人: Philip Andrew Chan
• 金额: $ 67.49万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10058273
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Affect; African American; Area; Awareness; Behavioral; Boston; Caring; Cellular Phone; Clinic; Clinical; Communities; Consult; Consultations; Continuity of Patient Care; Cost Analysis; Counseling; Data; Diagnosis; Diagnostic Reagent Kits; Early Diagnosis; Early treatment; Emotional; Epidemic; FDA approved; Goals; HIV; HIV Infections; Hispanics; Home; Hour; Human immunodeficiency virus test; Incidence; Infection; Internet of Things; Intervention; Latino; Link; Los Angeles; Medical; Monitor; Outcome; Participant; Personal Satisfaction; Pilot Projects; Population; Prevention; Professional counselor; Provider; Randomized; Research; Resources; Risk Reduction; Safe Sex; Self Administration; Services; Sexually Transmitted Diseases; Study models; System; Technology; Telephone; Testing; Time; Transportation; United States; Wait Time; Work; arm; base; care seeking; care systems; cost effective; cost effectiveness; efficacy testing; efficacy trial; feasibility testing; follow-up; high risk; high risk men; home test; improved; innovation; interest; mHealth; mathematical model; men; men who have sex with men; mobile application; pre-exposure prophylaxis; prevention service; programs; recruit; self testing; smart home; social stigma; stem

Project Summary/Abstract HIV disproportionately affects men who have sex with men (MSM) in the United States, and new infections continue to increase particularly among African American (AA) and Hispanic/Latino (H/L) MSM. Past studies estimate that up to 50% of these new infections originate from the approximately 20% of MSM who are unaware of their status. Expanded HIV testing can produce reductions in incidence when implemented on a broad scale by facilitating earlier diagnosis and treatment. Rates of HIV testing are particularly low among AA and H/L MSM, and innovative approaches to encourage testing may help address high incidence in these men. Home-based, self-testing (HBST) for HIV offers considerable promise for increasing the number of MSM who are aware of their status by overcoming key barriers to clinic-based testing, such as inconvenience and confidentiality concerns. HBST may also be particularly well-suited for AA and H/L MSM, given that stigma and mistrust of medical care contribute to low testing rates. Despite its promise, however, many are concerned that HBST does not sufficiently connect users with critical post-testing resources, such as confirmatory testing and care among those who test positive, and that these limitations may result in delayed linkage to care. Existing, FDA-approved HBST kits provide a free, 24-hour helpline that offers these services to those who seek it, but few users do, and this “passive” approach may miss critical opportunities to engage with MSM for further prevention services. To address these challenges, we developed a mobile health platform (“eTEST”) that uses internet-of-things (IoT) technologies to monitor when HBST users open their tests in real time, allowing us to provide timely, “active” follow-up counseling and referral over the phone after they do so. In a pilot study, we show that providing HBST by mail at regular intervals boosted rates of any/repeat HIV testing among high-risk MSM compared with clinic-based testing reminders. Moreover, those who received follow-up phone counseling after HBST were more likely to receive risk reduction counseling, to consult with a medical provider about PrEP, and to initiate PrEP. Given these promising results, the proposed research will conduct a fully-powered efficacy trial of this approach in areas with large populations of AA and H/L MSM and high HIV incidence: Jackson, MS, Los Angeles, CA, and Boston, MA. High-risk MSM who have not tested for HIV in the last year will be recruited from MSM-oriented “hook-up” mobile apps, and assigned to receive either (1) HBST with post- test phone counseling/referral (“eTEST” condition), (2) “standard” HBST without active follow-up, or (3) reminders to get tested for HIV at a local clinic (“control” condition) at three month intervals over the course of 12 months. We will explore the impact of the eTEST system on key outcomes, including rates of HIV testing, receipt of additional HIV prevention services, and PrEP initiation, compared with standard HBST or clinic- based testing reminders alone. We will also explore the cost effectiveness of the eTEST system under various scenarios compared with relying on traditional, clinic-based testing alone.

项目摘要/摘要 艾滋病毒对美国男男性行为者(MSM)的影响不成比例，以及新的感染 继续增加，特别是在非裔美国人(AA)和西班牙裔/拉丁裔(H/L)男男性接触者中。过去的研究 估计这些新感染中高达50%来自大约20%的MSM，他们是 不知道他们的状态。扩大艾滋病毒检测可以减少发病率 通过促进早期诊断和治疗，扩大范围。在再生障碍性疾病中，艾滋病毒检测率特别低 以及鼓励检测的创新方法可能有助于解决这些男性的高发病率问题。 基于家庭的艾滋病毒自我检测(HBST)为增加MSM人数提供了相当大的希望 通过克服以临床为基础的检测的主要障碍，如不便和 保密问题。HBST也可能特别适合AA和H/L MSM，因为这种耻辱和 对医疗保健的不信任导致了低检测率。然而，尽管它承诺了，但许多人担心 HBST没有将用户与关键的测试后资源充分联系起来，例如验证性测试和 这些限制可能会导致延迟与护理的联系。现有的， FDA批准的HBST试剂盒提供免费的24小时帮助热线，为寻求帮助的人提供这些服务，但 这样做的用户很少，这种“被动”的方式可能会错失与MSM进一步接触的关键机会 预防服务。为了应对这些挑战，我们开发了一个移动健康平台(“eTEST”)，它使用 物联网(IoT)技术可实时监控HBST用户何时打开他们的测试，使我们能够 在他们这样做之后，通过电话提供及时的、“积极的”后续咨询和推荐。在一项初步研究中，我们 显示定期通过邮件提供HBST可提高高危人群中任何/重复艾滋病毒检测的比率 男男性接触者与以诊所为基础的检测提醒。此外，接受后续电话咨询的人 在HBST后，更有可能接受风险降低咨询，咨询医疗提供者关于 准备，并启动PrEP。鉴于这些有希望的结果，拟议的研究将进行全面的 在AA和H/L男男性接触者和艾滋病毒高发地区进行这种方法的疗效试验： 杰克逊、加州洛杉矶和马萨诸塞州波士顿。在过去一年中没有进行艾滋病毒检测的高危男男性行为者 将从面向男男性接触的移动应用程序中招聘，并分配到以下任一项：(1)HBST和POST- 测试电话咨询/转介(“eTEST”条件)，(2)“标准”HBST，没有积极的跟进，或(3) 提醒在以下期间每隔三个月在当地诊所进行艾滋病毒检测(“控制”情况) 12个月。我们将探讨eTEST系统对关键结果的影响，包括艾滋病毒检测率， 与标准的HBST或诊所相比，获得额外的艾滋病毒预防服务和PrEP启动- 仅基于测试提醒。我们亦会探讨电子测试系统在不同环境下的成本效益。 与仅依赖于传统的、基于临床的测试相比。