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ETEST: A “SMART” HOME HIV TESTING SYSTEM ENABLING REAL-TIME FOLLOW-UP AFTER TESTING
Tyler B. Wray1, Philip A. Chan2, Don Operario1, Erik Simpanen1
1Brown Univ, Providence, RI, USA,2The Miriam Hosp, Providence, RI, USA
Men who have sex with men (MSM) are at high risk for HIV, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV could encourage more regular testing and potentially detect some new infections earlier, but providing sufficient follow-up after testing is a challenge. A more active approach to post-test follow-up with HBST may be needed, so that those who receive reactive (preliminary positive) results can be efficiently linked with care, and those who test negative can be connected with other key prevention services (e.g., safe sex supplies, sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP] consultation).
We developed the 'eTEST' system, which uses Bluetooth low energy beacons (BLE) and a smartphone app to remotely monitor when HBST kits have been opened (see Fig. 1), allowing Qualified HIV Test Counselors (QHTCs) to actively follow up with users over the phone after testing. In this 7 month study, we recruited 60 high-risk MSM who had not tested in the last year from MSM-oriented 'hookup' apps and randomly assigned them to receive one of the following in the mail at baseline, 3-months, and 6-months: either (1) 'eTEST' HBST kits, (2) standard HBST kits, or (3) reminders to seek clinic-based testing. Those in the 'smart' HBST condition received follow-up calls from QHTCs within 24 hours, while those in the 'standard' group had no follow-up.
Between-groups comparisons suggested that more participants in the HBST conditions reported having tested for HIV (98% vs. 40%, t=0.93, p<.05) and other STIs compared with the control condition (45% vs. 10%, t=1.98, p<.05), but these rates did not differ between the 'smart' and standard HBST groups. However, compared with control and standard HBST conditions, more in the 'smart' HBST group received HIV risk reduction counseling (65% vs. 25%, t=2.98, p<.05), safe sex supplies (55% vs. 17%, t=2.45, p<.05), and were referred for PrEP consultation (55% vs. 0%, t=3.61, p<.05). More 'smart' HBST participants also began PrEP (15% vs. 0%), but this difference was not significant.
Initial results suggest that HBST may encourage more regular HIV and STI testing among high-risk MSM, and that the eTEST system in particular may be useful for engaging individuals with other critical services. Further research is needed to determine whether eTEST facilitates earlier detection of new infections and linkage to care.