High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil

Hoagland, Brenda; Torres, Thiago Silva; Bezerra, Daniel C.; Benedetti, Marcos; Pimenta, Cristina; Veloso, Valdiléa G.; Grinsztejn, Beatriz

doi:10.1016/j.bjid.2020.11.002

Cited by 38 publications

(38 citation statements)

References 11 publications

(9 reference statements)

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“…Half of all studies (54%, 25/46) deployed website-based interventions. Results were largely in favor of digital strategies including e-testing websites [15] , [16] , [17] , [18] , [19] , study websites [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , online counselling [33] , [34] , [35] , [36] , [37] , [38] , and chatbots [39] .…”

Section: Resultsmentioning

confidence: 99%

“…Eight (32%, 8/25) studies assessing web-based interventions reported acceptability outcomes [ 18 , 21 , [26] , [27] , [28] , [29] , 37 ]. Willingness to use web-based HIVST interventions (61%−79%) [ 18 , 21 , 26 , 27 , 29 , 37 , 38 ] and ease of use (97%) [28] was high across studies, and among high-risk groups such as MSM, transgender women, men with multiple sexual partners, and men who were less likely to have previously sought out HIV testing [ 28 , 29 , 37 ]. An RCT conducted among MSM in China found the intervention group receiving HIVST with promotion of online real-time instructions and counseling expressed greater willingness to take up HIV testing than a control group receiving promotion only for conventional HIV testing (69.0 vs 43.9%, p <0.001) [37] .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…One article evaluated the willingness of patients in Brazil to use telemedicine for PrEP. 13 The study assessed 680 PrEP users where 23% consented to use telemedicine for PrEP care with HIV self-testing kits and 89% felt satisfied with their care when asked in a survey. This study also reported 79% of PrEP users expressed willingness to use HIV self-testing kits as part of their care.…”

Section: Resultsmentioning

confidence: 99%

Telemedicine for HIV Care: Current Status and Future Prospects

Smith¹,

Badowski²

2021

HIV

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Due to the COVID-19 pandemic, the use of telemedicine has been highlighted, especially in specialties, such as the management of HIV. Recent data were reviewed between January 1, 2019 and March 20, 2021 by searching English language manuscripts for studies documenting clinical outcomes in HIV care and the patient experience. A PubMed, Google Scholar, and bibliography review based on the search terms “HIV,” “telemedicine,” and “telehealth” was conducted. Studies included in this analysis were comprised of adult patients living with HIV, receiving care for HIV via telemedicine with reported clinical outcomes or perceptions of using telemedicine in the management of their HIV care. Of the 179 studies identified, 12 met inclusion for this analysis. Only two studies provided data on clinical outcomes of HIV (virologic outcomes), one pre-pandemic and one during COVID-19. The study evaluating viral suppression during COVID-19 demonstrated lower rates of virologic suppression and lower rates of missed appointments when shelter-in-place orders were issued compared to before the start of the pandemic. The remaining studies focused on patient-related outcomes as they related to the usability and adoption of telehealth models. Many practices documented the benefits and limitations of telemedicine based on the rapid switch from traditional in-person clinics. Benefits included retention in care for patients who lived a far distance from clinic, privacy for patients not wanting to be seen attending an HIV clinic, and more flexibility in scheduling appointments. Some limitations included patients’ access to technology, ability and willingness to use technology, and privacy of patients who are homeless and reside in a shelter where homelessness is 3 times greater in people living with HIV compared to the general population. Healthcare should be tailored to the individual patient by assessing their needs and limitations, particularly with patients who may be at risk for discontinuation of care, particularly in the homeless population. In addition, there are mixed data on factors such as age, sex, and race being limiting factors in willingness to use technology. From the studies reviewed, willingness to engage with technology did not differ by age, sex, or race but did differ by access and willingness to use technology. Greater limitations were access to appropriate devices for telemedicine and digital literacy. Although there have been difficulties with the switch to telemedicine in clinics during the COVID-19 pandemic, many patients have reported being satisfied with care and would be interested in continuing once the shelter-in-place order is lifted. Future studies should focus on the provision of HIV care using telemedicine beyond the pandemic and focus on ways to improve the telemedicine experience for the patient.

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“…For example, in Brazil, among a large sample of MSM and transgender/non-binary individuals, most participants reported preferring at-home HIV testing to in-clinic, and 79% of individuals who had never completed an at-home test reported willingness to self-test. 30 …”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study

Moitra

Tao

Olsen³

et al. 2022

The Lancet Regional Health - Americas

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Background Non-emergent clinical services were limited or suspended during the early stages of the coronavirus disease 2019 (COVID-19) pandemic in the United States (U.S.). This could adversely impact epidemics of public health importance, such as HIV, and access to testing, which is a cornerstone of prevention efforts. Methods In this observational study, we collected HIV testing and positivity rate clinical data from four geographically diverse U.S. healthcare systems in New Orleans, Louisiana; Minneapolis, Minnesota; Providence, Rhode Island; and, Seattle, Washington. Data from 2019 to 2020 were examined to assess changes in HIV testing in community-based, emergency department, and outpatient settings. Poisson regression was used to explore trends in HIV testing through phases of the COVID-19 pandemic. Findings In outpatient settings, there was a 68-97% reduction in the number of HIV tests per week during each state's stay-at-home order period, compared to during the pre-stay-at-home order period in early 2020. HIV testing remained reduced 11-54% after states transitioned to advisory phases. The HIV positivity rate increased slightly at outpatient settings, except in New Orleans where it fell. Interpretation We found a concerning trend of substantially decreased HIV testing across four geographically diverse sites. These findings suggest that new HIV infections within the U.S. may be undiagnosed and not yet linked to clinical care and services, as a consequence of the COVID-19 pandemic. Thus, augmented efforts to identify patients and link them to HIV services will be needed as healthcare settings return to full operation. Funding U.S. National Institute of Mental Health.

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High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil

Cited by 38 publications

References 11 publications

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

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

Telemedicine for HIV Care: Current Status and Future Prospects

Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study

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