HIV self-testing (HST) could be an effective strategy for helping those at high risk test more regularly. However, concerns about HST's lack of follow-up care and referral have so far limited its use. In a pilot, randomized controlled trial, high-risk HIV-negative, or status unknown men who have sex with men (MSM; N = 65) were recruited from January 2016 to February 2017 and received (1) HST kits by mail, equipped with devices that detected when kits were opened and prompted a follow-up call from a counselor (eTEST); (2) standard HST kits with no follow-up (standard); or (3) informational letters about HIV testing locations (control) at baseline, 3 months, and 6 months. Monthly surveys over 7 months assessed HIV testing, sexually transmitted infection (STI) testing, access to prevention services, and behavioral risk reduction. All participants (100%) in the eTEST and standard HST groups reported HIV testing at least once during the 7-month period compared with 72% of controls. Repeat testing was higher among those in the HST groups versus controls (79% vs. 41%). Participants in the eTEST group were significantly more likely to receive risk reduction counseling, prevention supplies (e.g., condoms and lube), and PrEP referrals during the study period compared with standard HST and controls. No effects on STI testing or PrEP initiation emerged. Delivering HST kits to high-risk MSM at regular intervals could increase HIV testing rates and encourage more regular testing. Providing active post-test referrals alongside HST might also connect high-risk men with some other important services that encourage prevention behaviors.
Alcohol use is a key risk factor for HIV infection among men who have sex with men (MSM). Past studies show that brief motivational interventions (BMI) can increase the use of prevention methods (e.g., condoms), reduce alcohol use, and can be adapted for web-based delivery. However, few studies have explored these interventions' effects in MSM. Forty high-risk, heavy drinking MSM who sought rapid HIV testing were randomly assigned to receive either (1) standard post-test counseling (SPC) alone, or (2) SPC plus Game Plan (GP), a tablet tablet-based BMI for alcohol use and HIV risk. Over three months of follow-up, GP participants reported 24% fewer heavy drinking days, 17% fewer alcohol problems, and 50% fewer new anal sex partners than controls. GP participants also reported fewer high-risk condomless anal sex (CAS) events than controls, but these differences were not significant. These initial results suggest that webbased BMIs may be promising tools to help MSM reduce health risk behaviors.
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.
Timeline is valid for assessing overall engagement in alcohol use, drug use, and sexual behavior over a 30-day window. However, researchers interested in the specific timing of behaviors within assessment intervals should use smaller follow-up intervals (e.g., 7 days, 14 days) or more intensive reporting methods (e.g., daily diary).
Background: Pre-exposure prophylaxis (PrEP) is highly efficacious, but some groups of men who have sex with men (MSM) may have difficulty adhering to daily dosing. Prevention-effective adherence suggests that PrEP's efficacy depends on adherence at the time of HIV exposure, yet few studies have examined how exposures (i.e., high-risk sex) overlap with periods of consecutive missed PrEP doses. Substance use may also play a role in these vulnerable periods. Methods: We used digital pill bottles to monitor the daily adherence of 40 PrEP-experienced patients recruited from an outpatient clinic in the Northeastern US over a six-month period. Participants also completed detailed online diaries every two weeks during this time that surveyed their sexual behavior and substance use each day. Results: Daily adherence was high overall (M = 83.9%, SD = 18.0%), but 53% (N = 21) had a lapse of > 3 consecutive daily PrEP doses over six months. Participants' rate of engaging in highrisk condomless anal sex (CAS) did not differ across lapse days versus continuously-adherent days. Alcohol use was not associated with engaging in CAS during a PrEP lapse. However, participants reported engaging in CAS significantly more often during a PrEP adherence lapse on days when they also used stimulant drugs.
BackgroundComputers have tremendous potential for helping people change behaviors that put their health at risk. This potential has led to the development of a variety of health behavior intervention technologies (BITs) in recent years. While many of these BITs have been informed by scientific theories on behavior change, poor design can fail to engage intended users. User-centered, interaction design (IxD) research can help BIT developers create tools that are intuitive and enjoyable and that align with intended users' goals. In this manuscript, we describe an IxD research process we used to inform the development of a tablet-optimized web application designed to help heavy drinking gay and bisexual men reduce their risk for HIV when they seek HIV testing.MethodsWe conducted focus groups with subject matter experts (SMEs, N = 10) and intended users (N = 25). In the SME group, HIV test counselors were recruited to provide an understanding of the priorities and challenges of post-test counseling. In focus groups with intended users, participants created detailed, personalized models of two “typical” users of the proposed app (“personas”) that could be used to guide design decisions.ResultsSMEs emphasized the importance of putting patients at ease, and suggested that interventions should prioritize identifying personal risks and provide options for change. Personas created by intended users provided important details about users' attitudinal and emotional contexts, and their possible motivations and goals for using the app. These suggested that users might be most motivated to use the app in order to understand their personal risks, compare their behavior with others like them, help them decide whether they want to change to reduce their risk, and see all their options for doing so. Personas also provided insights about the aesthetic experience that might be most appealing to users.ConclusionsInteraction design research can provide BIT development teams with personal models of likely users to help guide decisions about the allocation of design resources and the overall form and spirit of the software. These insights can help teams build BITs that are more engaging and interesting to intended users.
We observed that the ionic current through a gold/silicon nitride (Si3N4) nanopore could be modulated and gated by electrically biasing the gold layer. Rather than employing chemical modification to alter device behavior, we achieved control of conductance directly by electrically biasing the gold portion of the nanopore. By stepping through a range of bias potentials under a constant trans-pore electric field, we observed a gating phenomenon in the trans-pore current response in a variety of solutions including potassium chloride (KCl), sodium chloride (NaCl), and potassium iodide (KI). A computational model with a conical nanopore was developed to examine the effect of the Gouy-Chapman-Stern electrical double layer along with nanopore geometry, work function potentials, and applied electrical bias on the ionic current. The numerical results indicated that the observed modulation and gating behavior was due to dynamic reorganization of the electrical double layer in response to changes in the electrical bias. Specifically, in the conducting state, the nanopore conductance (both numerical and experimental) is linearly proportional to the applied bias due to accumulation of charge in the diffuse layer. The gating effect occurs due to the asymmetric charge distribution in the fluid induced by the distribution of potentials at the nanopore surface. Time dependent changes in current due to restructuring of the electrical double layer occur when the electrostatic bias is instantaneously changed. The nanopore device demonstrates direct external control over nanopore behavior via modulation of the electrical double layer by electrostatic biasing.
Background: HIV disproportionately affects men who have sex with men (MSM) in the USA, and new infections continue to increase, particularly among African American (AA) and Hispanic/Latino (H/L) MSM. 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. HIV self-testing (HST) may be an important tool for increasing rates and frequency of testing. HST may 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 HST 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. Methods: We developed a mobile health platform (eTest) that monitors when HST users open their tests in real time, allowing us to provide timely, "active" follow-up counseling and referral over the phone. In this study, 900 high-risk MSM (with targets of 40% AA, 35% H/L) who have not tested in the last year will be recruited from social media and other gay-oriented websites in several major cities. Over 12 months, participants will be randomly assigned to receive (1) HST with post-test phone counseling and referral (eTest condition), (2) HST without active follow-up (standard condition), or (3) reminders to get tested for HIV at a local clinic (control) every 3 months. Primary outcomes include rates of HIV testing, receipt of additional HIV prevention services, and PrEP initiation verified by clinical medical records.
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