Implementation of an online HIV prevention and treatment cascade in Thai men who have sex with men and transgender women using Adam's Love Electronic Health Record system

Implementation Strategies for Digital HIV Prevention and Care Interventions for Youth: A Scoping Review

PURPOSE OF REVIEW

Despite the proliferation of evidence-based digital HIV prevention and care interventions for youth globally, their implementation remains suboptimal. This scoping review aimed to identify implementation strategies used to deliver digital HIV interventions to youth.

RECENT FINDINGS

We reviewed studies published in PubMed between 2018-2024 that described the development or use of implementation strategies for digital HIV interventions for youth. We identified eight studies that reported on implementation strategies and an additional 37 studies that reported on implementation outcomes. The predominant strategy used was identifying and preparing champions, such as peer leaders. Most studies assessed implementation outcomes of acceptability and feasibility, while few evaluated long-term outcomes like cost or sustainability. This review highlights the emerging, under-researched state of implementation science around digital HIV interventions in both the United States and low- and middle-income countries. Further research is needed to develop and test implementation strategies aligned to digital interventions; otherwise, evidence-based digital HIV interventions will remain underused by broader youth populations.

A Differentiated HIV Pre-Exposure Prophylaxis Delivery Model for High-Risk Groups in Nanning City, South China: Findings from a Pilot Program

In China, pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) and HIV-serodiscordant couples is low. We offered differentiated PrEP options tailored to MSM in a community-based organization (CBO) setting, and to HIV-serodiscordant couples attempting conception in a specialized HIV care clinic. The CBO facilitated PrEP by linkage with a telemedicine platform for virtual consultation; additional online follow-up on social media was conducted by peers. PrEP was taken properly in 88.7% of visits. Retention was 82.4% at Month 6. MSM having HIV-infected partners over the past 6 months were more likely to adhere to PrEP; ≥ 50 years old and daily oral PrEP were significant predictors for failing in retention. Five pregnancies were reported in the clinic. A peer-led and social media, telemedicine-assisted PrEP model within a CBO is a feasible approach to roll out PrEP among MSM. Integrated PrEP in specialized HIV clinics is appropriate for serodiscordant couples attempting conception.

Outreach strategies to promote HIV testing and linkage-to-care focusing on a young sexual and gender-diverse population in Bangkok, Thailand

INTRODUCTION

Human Immunodeficiency Virus (HIV) prevalence among young gender-diverse (a wide range of gender identities for people whose gender identity is different from the sex that they were assigned at birth) individuals is high but testing coverage among this key population remains low. We aim to evaluate strategies for outreach, HIV testing, and linkage to proper management in young men-who-have-had-sex-with-men (MSM, homosexual male) and transgender women (TGW) in Bangkok, Thailand.

METHODS

The "YM2M outreach program" consisted of two strategies: 1) online platforms (OP) and 2) physical outreach activities (POA). Participant questionnaires were completed on a voluntary basis during outreach activities during 2018-2021. Demographic and behavioral characteristics were assessed for association with HIV positivity.

RESULTS

A total of 3,972 homosexual male and TGW participated in the YM2M program: 2,973 by OP and 999 by POA. Of 2,230 participants who reported gender identity, 603/1,392 (43.3%) of OP and 252/985 (25.6%) of POA were gender diverse. Of 631 (21.2%) participants in OP and 970 (97.1%) in POA who underwent testing, 286 (45.3%) in OP and 41 (4.2%) in POA were HIV-positive. The venue reporting highest HIV yield was the Mor-Lam (11.5%). Among those with an HIV-positive test, 175 (61.2%) from OP and 23 (51.1%) from POA were successfully linked to HIV care. The independent factors associated with HIV positive in OP were being youth (adjusted odd ratio (aOR), 0.37; 95%CI 0.16-0.81; P = 0.01) and suspected or confirmed STI (aOR 15.39; 95%CI 7.17-33.03, P<0.01); while those in in POA at Mor-Lam were being gender diverse (aOR, 8.43; 95%CI 1.94-36.62; P<0.01) and reactive syphilis test (aOR, 5.40;95%CI 2.45-11.88; P<0.01). Linkage to pre-exposure prophylaxis (PrEP) among HIV-negative participants was low, 4.9% and 2.6% in OP and POA participants, respectively.

CONCLUSIONS

While uptake of HIV testing was higher in POA while OP was more effective in identifying undiagnosed people living with HIV/AIDS and linking them to care. Neither strategy was considered effective in linkage to PrEP.

Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review

BACKGROUND

Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects.

METHODS

We followed Arksey and O'Malley's framework for scoping reviews (2005) integrating adaptations by Levac et al (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and grey literature comparing uptake of digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between 2010 and 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socioeconomic status (SES), Social capital and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics.

RESULTS

We included 27 articles from 7914 titles and abstracts. Among these, 20 of 27 (74.1%) were observational studies, 23 of 27 (85.2%) described web-based interventions and 18 of 27 (66.7%) involved postal-based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by PROGRESS-Plus factors. While most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata, uptake was higher among women, white people with higher SES, urban residents and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors contributing to health equity in these interventions.

CONCLUSION

Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasising the need to prioritise health equity in their design and evaluation.

HIV self-testing for men who have sex with men in Sweden. A cross-sectional study concerning interest to use HIV self-tests

Background

HIV self-testing (HIVST) has been found to have high acceptability among men who have sex with men (MSM) internationally and might contribute to increase testing frequencies, but many countries, including Sweden, lack policies for using HIVST.

Objective

To examine interest to use and willingness to pay for HIVST, and associated factors, among MSM attending HIV testing venues in Sweden.

Method

This cross-sectional study analyzed data from a self-administered survey, consisting of 33 questions, collected at six HIV testing venues in Sweden in 2018. The sample consisted of sexually active men who have sex with men, aged ≥ 18 years, and not diagnosed with HIV. Data were analyzed descriptively and by univariable and multivariable logistic regression.

Result

Among 663 participants (median age 33 years), 436 respondents (65.8%) expressed interest to use HIVST. Among those interested, less than half, 205 (47.0%), were willing to pay for HIVST. Being interested in HIVST was found to be negatively associated with being in the 55 years or older age group (AOR 0.31, CI 0.14–0.71), and having had syphilis, rectal chlamydia, or rectal gonorrhea in the preceding 12 months (AOR 0.56, CI 0.32–0.99). In the sample of MSM interested in HIVST, willingness to pay was positively associated with being in the age groups 35–44 years (AOR 2.94, CI 1.40–6.21), 45–54 years (AOR 2.82, CI 1.16–6.90), and 55 years or above (AOR 3.90, CI 1.19–12.81), and negatively associated with being single (AOR 0.56, CI 0.36–0.88).

Conclusion

This study found high interest for HIVST in a sample of MSM in Sweden. However, HIVST offered at a cost is likely to negatively affect uptake among MSM broadly, compared with free availability.

Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review

BACKGROUND

eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes.

OBJECTIVE

We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use.

METHODS

We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired.

RESULTS

Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed.

CONCLUSIONS

The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required.

TRIAL REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.

Participatory Action Research to Co-Design Internet-Based HIV Prevention with Young Men Who Have Sex with Men in HIV Prevention in Bali, Indonesia

There is increasing awareness of the need to develop innovative and relevant methodologies to best capture the voices of Young Men Who Have Sex with Men (YMSM), which will inform HIV prevention. This article discusses the process of researching with YMSM in Bali, the solution to methodological gaps in research for Internet-based HIV prevention. This research endorsed the Habermas Communicative Action Theory which was then translated to Participatory Action Research (PAR) methodology. Nine YMSM aged 18-24 years old participated in this research through multiple research activities for four months. Data collection included structured group meetings, group workshops, informal participant observations, and after-hour conversations over afternoon tea and shared meals. Participants used a range of visual and digital media to share their collective ideas and different trial strategies. We argue for the opportunity for participatory action research to strengthen the roles of YMSM in HIV prevention.

A qualitative study of the impact of coronavirus disease (COVID-19) on psychological and financial wellbeing and engagement in care among men who have sex with men living with HIV in Thailand

Objectives

The coronavirus disease (COVID‐19) pandemic is an unprecedented event with massive global health and socio‐economic impacts on vulnerable populations, especially people living with HIV. The epidemic has severely affected Thailand’s economy and potentially impacted the financial and psychological wellbeing of Thai HIV‐positive men who have sex with men (MSM).

Methods

Between 15 June and 10 December 2020, we conducted qualitative interviews with 26 MSM living with HIV in Thailand who participate in an Adam’s Love We Care Study. We intentionally recruited individuals who may have experienced a greater impact of COVID‐19. Interviews explored worry, stigma and stress surrounding COVID‐19, and multiple domains of potential COVID‐19 impact: financial/employment, HIV service delivery and antiretroviral (ART) adherence during the first 10 months of the COVID‐19 pandemic.

Results

Participants perceived themselves as immunocompromised and susceptible, and feared contracting COVID‐19. Participants worried that contracting COVID‐19 would lead to HIV status disclosure and stigmatization. Participants had considerable worry about job loss as a result of the economic downturn, and some shared challenges associated with relocation and re‐engaging with HIV care. Financial stress and lack of basic necessities caused by job losses were commonly reported. Participants reported optimal ART adherence as a consequence of local HIV service delivery responses, convenient ART refills and Adam’s Love online support interventions.

Conclusions

Our study highlights that the COVID‐19 pandemic produced high levels of anxiety and concerns about additional stigma among MSM living with HIV. It had a significant negative effect on the daily lives of our participants. These findings indicate a need for the provision of confidential COVID‐19 diagnosis and care, relief programmes, vaccination roll‐out equity, and addressing employment needs of vulnerable populations.

HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010-2021)

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.

Developing HIV prevention online using a habermasian 'lifeworld' approach with young men who have sex with men from Bali

The Internet is a promising medium to strengthen participation in Human Immunodeficiency Virus (HIV) prevention among young men who have sex with men (YMSM). This study engaged YMSM from Bali in codesigning online HIV prevention using a series of participatory action research focus groups. Further, this research utilized Habermasian critical theory of communicative action to interpret the findings. This was framed around the current mismatch between HIV prevention, the "systemworld", and the lived reality, or "lifeworld", of YMSM in Bali. Using a model of intervention called "So Us", YMSM aspired to HIV prevention which reflects their identity, language, and interaction style.

Elimination of hepatitis C among HIV-positive population in Asia: old and new challenges

Hepatitis C virus (HCV) prevalence is high among people living with HIV co-infected with HCV, people who inject drugs, men who have sex with men and inmates in correctional settings. The barriers to eliminate HCV among these key populations include diagnosis challenges, lack of awareness, discrimination and stigmatization. In addition, scaling up of HCV treatment has been a challenge in Asia–Pacific with the lack of national policies, targets and unavailability of appropriate direct-acting antivirals regimens. In order to achieve HCV micro elimination within these high-risk populations, novel strategies to improve the cascade of care from diagnosis to treatment with direct-acting antivirals, complemented by behavioral change interventions, harm reduction services for people who inject drugs, civil society led advocacy and policies from the government, will be necessary.

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

INTRODUCTION

HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC.

METHODS

We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner.

RESULTS AND DISCUSSION

Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability.

CONCLUSIONS

Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study

Background

Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach.

Objective

The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia.

Methods

A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations.

Results

From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly.

Conclusions

This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV.

Strategies to improve access for MSM in low-income and middle-income countries

PURPOSE OF REVIEW

HIV prevention and treatment interventions for MSM are not well studied or reported from low-income and middle-income countries (LMIC) in comparison to those targeting gender-conforming populations. Some evidence-based strategies to engage MSM in appropriate healthcare have recently reported on their experiences and impact. Novel recruitment strategies have been developed for treatment and preexposure prophylaxis (PrEP) for MSM, leveraging new community engagement strategies and social media technologies.

RECENT FINDINGS

Despite publication of several new guidelines, there is little recent evidence available to guide MSM health programs in LMIC, highlighting the need for ongoing research and publication. Some important PrEP pilot study results have recently been published, such as the PrEP Brazil and Princess PrEP programmes, which could guide the scale-up of MSM PrEP. The novel use of technology and online platforms to strengthen MSM health delivery and support is particularly important.

SUMMARY

Providing healthcare to MSM requires consideration of context, broad stakeholder engagement, implementation of best practice guidelines and ongoing situational assessment and integration of novel community engagement methods that are evidence-based. Implementation of improved antiretroviral programmes and the access to PrEP for MSM are vital.

What would you choose: Online or Offline or Mixed services? Feasibility of online HIV counselling and testing among Thai men who have sex with men and transgender women and factors associated with service uptake

Introduction

HIV testing coverage remains low among men who have sex with men (MSM) and transgender women (TGW). We studied characteristics of Thai MSM and TGW who chose online and/or offline platforms for HIV counselling and testing and the feasibility of integrating online technologies and HIV self‐testing to create service options.

Methods

From December 2015 to June 2017, MSM and TGW enrolled from Bangkok Metropolitan Region and Pattaya could choose between: 1 offline HIV counselling and testing (Offline group), 2 online pre‐test counselling and offline HIV testing (Mixed group), and 3 online counselling and online, supervised, HIV self‐testing (Online group). Sociodemographic data, risk behaviour and social network use characteristics were collected by self‐administered questionnaires. Logistic regression models identified covariates for service preferences.

Results

Of 472 MSM and 99 TGW enrolled, 202 self‐selected the Offline group, 158 preferred the Mixed group, and 211 chose the Online group. The Online group had the highest proportion of first‐time testers (47.3% vs. 42.4% vs. 18.1%, p < 0.001) and reported highest HIV prevalence (15.9% vs. 13.0% vs. 3.4%, p = 0.001) as compared to Offline and Mixed groups, respectively. Having tested for HIV twice or more (OR 2.57, 95% CI 1.03 to 6.41, p = 0.04) increased the likelihood to choose online pre‐test counselling. Being TGW (OR 6.66, 95% CI 2.91 to 15.25, p < 0.001) and using social media from four to eight hours (OR 2.82, 95% CI 1.48 to 5.37, p = 0.002) or >8 hours (OR 2.33, 95% CI 1.05 to 5.16, p = 0.04) increased selection of online, supervised, HIV self‐testing. Providers primarily used smartphones (79.2%) and laptops (37.5%) to deliver online services. Self‐testing strip image sharpness and colour quality were rated “good” to “excellent” by all providers. Most participants (95.1%) agreed that online supervision and HIV self‐testing guidance offered were satisfactory and well delivered.

Conclusions

Online HIV services among MSM and TGW are feasible in Thailand and have the potential to engage high proportions of first‐time testers and those with high HIV prevalence. When designing public health interventions, integrating varied levels of online HIV services are vital to engage specific sections of MSM and TGW populations in HIV services.

Clinical Trial Number

NCT03203265

Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using "Vialogues": a randomized controlled trial

We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24-32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p = 0.029) and higher median percentage of condom use for anal intercourse (p = 0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p = 0.001), popper usage (p = 0.002), median number of sexual partners (p = 0.003), and increased median condom use percentage (p = 0.006). Our study highlights that "Vialogues" intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.

A Systematic Review of Interventions that Promote Frequent HIV Testing

As of 2017, the Centers for Disease Control and Prevention (CDC) HIV testing guidelines recommend that those at increased risk for HIV are tested two to four times per year. Evidence-based interventions that promote frequent and repeated testing remain sparse. We conducted a systematic review to: (1) identify frequent testing interventions; and (2) determine which were successful in increasing frequent testing rates. We searched PubMed, PsycINFO, Web of Science, Embase, and CINAHL for peer-reviewed articles published between January 1, 2010 and September 30, 2017. Ten studies met inclusion criteria. Operationalization of frequent HIV testing varied widely across studies. Four interventions involved text message reminders for HIV testing, three involved community-based testing, two self-testing, and one rapid testing. Text message reminder interventions were most successful in increasing rates of frequent HIV testing. Future research should standardize frequent testing measurement to allow for more robust comparisons of intervention efficacy.

A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments

It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.

Mate Yako Afya Yako: Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men

The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men's attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for young men in Tanzania. Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam, Tanzania who socialize in networks locally referred to as "camps". Men reported privacy, confidentiality, and saving time as the primary reasons for their self-testing interest. Most participants had high perceived control and self-efficacy to self-test and seek confirmatory HIV testing. Nevertheless, men reported concerns related to their ability to perform the test and the potential lack of post-test counseling. Specific recommendations for the intervention included providing HIVST education and pre-test counseling, and using mobile health (mHealth) strategies for participants to reach a healthcare professional for further assistance. The findings suggest that while HIVST is highly acceptable among men in Tanzania, future interventions will need to address the challenges that men may face with HIVST before promoting it as an alternative or supplement to facility-based HIV testing.

Using eHealth to engage and retain priority populations in the HIV treatment and care cascade in the Asia-Pacific region: a systematic review of literature

BACKGROUND

The exponential growth in the reach and development of new technologies over the past decade means that mobile technologies and social media play an increasingly important role in service delivery models to maximise HIV testing and access to treatment and care. This systematic review examines the impact of electronic and mobile technologies in medical care (eHealth) in the linkage to and retention of priority populations in the HIV treatment and care cascade, focussing on the Asia-Pacific region.

METHODS

The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane Collaboration guidelines. Both grey and published scientific literature from five different databases were searched for all original articles in English published from 2010 to 2017. Studies conducted outside the Asia-Pacific region or not including HIV priority populations were excluded. The methodological quality of studies included in the review was assessed using the Quality Assessment Tool for Quantitative Studies.

RESULTS

The database search identified 7309 records. Of the 224 peer-reviewed articles identified for full text review, 16 studies from seven countries met inclusion criteria. Six cross sectional studies found evidence to support the use of eHealth, via text messages, instant messaging, social media and health promotion websites, to increase rates of HIV testing and re-testing among men who have sex with men (MSM). Evidence regarding the efficacy of eHealth interventions to improve antiretroviral treatment (ART) adherence was mixed, where one randomised controlled trial (RCT) showed significant benefit of weekly phone call reminders on improving ART adherence. Three further RCTs found that biofeedback eHealth interventions that provided estimated ART plasma concentration levels, showed promising results for ART adherence.

CONCLUSIONS

This review found encouraging evidence about how eHealth can be used across the HIV treatment and care cascade in the Asia-Pacific region, including increasing HIV testing and re-testing in priority populations as well as ART adherence. eHealth interventions have an important role to play in the movement towards the end of AIDS, particularly to target harder-to-reach HIV priority populations, such as MSM.

Use of expenditure analysis to enhance returns on investments in HIV services

PURPOSE OF REVIEW

Globally, the response to the HIV epidemic is at a crisis point. International investments in the HIV response have been essentially flat for 8 years and domestic budgets in low and middle-income countries - still recovering from the global recession - have not been able to fill the resource gap to drive a full-fledged HIV response. Still, efficiencies and prioritization of evidence-based interventions enable a significant scale-up of treatment, but millions more people remain without treatment. This review looks at recent data and research to evaluate interventions that may help close gaps in service provision that undermine testing and treatment programs.

RECENT FINDINGS

The President's Emergency Plan for AIDS Relief recently began publicly releasing vast programmatic and expenditure data. These data reveal potential efficiency gaps in testing and treatment programs, particularly in the area of linkage and retention. Interventions such as HIV self-testing have been proposed to help, but whether they can deliver better results remains unclear. Same-day initiation on treatment improves initiation, retention, and viral suppression rates.

SUMMARY

Near real-time analysis of data and active response is critical in improving efficiencies in programs. More investment in implementation research is necessary to improve linkage to care and treatment to reach 90-90-90 goals.

Online-to-offline models in HIV service delivery

PURPOSE OF REVIEW

Half the world's population has access to Internet and technologies, and utilization is near-ubiquitous among providers and key populations. Despite being so well connected; identifying, reaching and linking vulnerable populations to HIV clinical services remains a global challenge. This review highlights the emerging online-to-offline (O2O) models, their potential in scaling up services, and evaluating impact, and implications for future research.

RECENT FINDINGS

Globally, four major types of O2O models have been implemented, primarily in the West and Asia, especially among MSM and transgender women. These models have varying levels of impact in terms of reach, engagement, participation, linkage, and ability to track and monitor participants, and assess outcomes. Those integrated with offline sites enable seamless transition, dramatically reduce the O2O linkage time and demonstrate high linkage success (>73%). O2O models are ideal for at-risk, stigmatized, criminalized populations and for scaling-up biomedical prevention interventions such as preexposure and postexposure prophylaxis.

SUMMARY

O2O models represent novel and powerful solutions to reverse the pandemic and could help fill significant programmatic gaps in tracking individuals through HIV cascades. Providers, especially in resource-limited settings, could choose between a variety of current approaches highlighted in this review and employ no-cost or cost-effective technologies to transform their traditional models and leverage O2O models.

Using technology to support HIV self-testing among MSM

PURPOSE OF REVIEW

Technology-based HIV self-testing (HST) interventions have the potential to improve access to HIV testing among gay, bisexual, and other MSM, as well as address concerns about HST use, including challenges with linkage to appropriate follow-up services. This review examines studies that use technology-based platforms to increase or improve the experience of HST among MSM.

RECENT FINDINGS

Seven published studies and eight funded studies were included in this review. Comprehensive prevention interventions with free HST kit distribution and interventions that provide free HST kits and support the HST process address a greater number of barriers (e.g., access, correct use of testing kits, and correct interpretation of results) than studies that only distribute free HST kits through technology-based platforms.

SUMMARY

By addressing HIV-testing barriers and specific HST concerns, these interventions address a critical need to improve first time and repeat testing rates among MSM. Additional research is needed to determine the efficacy of recent formative HST interventions. If proven efficacious, scale-up of these strategies have the potential to increase HIV testing among MSM via expanded HST uptake.