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

基本信息

批准号：
10292977
负责人：
Philip Andrew Chan
金额：
$ 64.85万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-12-01 至 2023-10-31
项目状态：
已结题

项目摘要

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.

项目概要/摘要在美国，艾滋病毒对男男性行为者 (MSM) 的影响尤为严重，而且新增感染病例也较多继续增加，特别是在非裔美国人 (AA) 和西班牙裔/拉丁裔 (H/L) MSM 中。据估计，这些新感染中高达 50% 源自约 20% 的 MSM 如果不了解自己的状况，扩大艾滋病毒检测可以降低发病率。通过促进早期诊断和治疗，艾滋病毒检测率在 AA 中特别低。和 H/L MSM，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。家庭艾滋病毒自我检测 (HBST) 为增加 MSM 人数提供了巨大希望通过克服临床检测的主要障碍（例如不便和考虑到保密问题，HBST 也可能特别适合 AA 和 H/L MSM。对医疗保健的不信任导致检测率低，尽管它有希望，但许多人担心。 HBST 没有充分地将用户与关键的测试后资源联系起来，例如验证性测试和对测试呈阳性的人进行护理，这些限制可能会导致与现有护理的联系延迟。 FDA 批准的 HBST 套件提供免费的 24 小时帮助热线，为寻求帮助的人提供这些服务，但是很少有用户这样做，这种“被动”方法可能会错过与 MSM 进一步接触的关键机会为了应对这些挑战，我们开发了一个使用移动健康平台（“eTEST”）。物联网 (IoT) 技术可实时监控 HBST 用户何时打开测试，使我们能够在一项试点研究中，我们在他们这样做后通过电话提供及时、“主动”的后续咨询和转介。研究表明，定期通过邮寄提供 HBST 可以提高高危人群中任何/重复 HIV 检测的比率 MSM 与基于诊所的检测提醒进行比较此外，那些接受后续电话咨询的人。 HBST 后更有可能接受降低风险咨询，向医疗服务提供者咨询有关鉴于这些有希望的结果，拟议的研究将进行全面的预防性预防。在 AA 和 H/L MSM 人口较多且 HIV 发病率较高的地区对该方法进行了有效性试验：密西西比州杰克逊、加利福尼亚州洛杉矶和马萨诸塞州波士顿去年未进行 HIV 检测的高危 MSM。将从面向 MSM 的“挂钩”移动应用程序中招募，并分配接受 (1) HBST 测试电话咨询/转介（“eTEST”条件），(2) “标准”HBST，无需主动跟进，或 (3) 提醒您在治疗过程中每隔三个月在当地诊所进行艾滋病毒检测（“对照”条件） 12 个月后，我们将探讨 eTEST 系统对关键结果的影响，包括 HIV 检测率、与标准 HBST 或诊所相比，接受额外的 HIV 预防服务和 PrEP 启动我们还将探讨eTEST系统在各种情况下的成本效益。与仅依赖传统的基于临床的测试相比。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Longitudinal effects of home-based HIV self-testing on well-being and health empowerment among men who have sex with men (MSM) in the United States.

家庭艾滋病毒自我检测对美国男男性行为者 (MSM) 的福祉和健康赋权的纵向影响。

DOI：
发表时间：
2020
期刊：
影响因子：
1.7
作者：
Wray, Tyler B;Chan, Philip A;Simpanen, Erik M
通讯作者：
Simpanen, Erik M

eTest: a limited-interaction, longitudinal randomized controlled trial of a mobile health platform that enables real-time phone counseling after HIV self-testing among high-risk men who have sex with men.

eTest：一项针对移动健康平台的有限互动、纵向随机对照试验，可在男男性行为的高危男性中进行艾滋病毒自我检测后提供实时电话咨询。

DOI：
发表时间：
2020-07-16
期刊：
影响因子：
2.5
作者：
Wray, Tyler B;Chan, Philip A;Klausner, Jeffrey D;Mena, Leandro A;Brock, James B;Simpanen, Erik M;Ward, Lori M;Chrysovalantis, Stafylis
通讯作者：
Chrysovalantis, Stafylis