Dating apps and websites as tools to reach anonymous sexual contacts during an outbreak of hepatitis A among men who have sex with men, Berlin, 2017

Abstract

Background In an outbreak of hepatitis A among men who have sex with men (MSM) in Berlin (2016 and 2017), patients frequently reported anonymous sex and use of dating applications to meet sexual contacts, hampering tracing and vaccination of contacts. Aim Our objective was to evaluate dating apps and websites as a means of spreading prevention messages among MSM during the ongoing outbreak. Methods Advertisements in different formats were placed on three MSM dating apps and eight websites for anonymous dating during three weeks in March and April 2017. We calculated frequency of ads shown and click-through rates (CTR) and investigated the independent effect of format and platform on the number of clicks using a negative binomial regression model. We evaluated the campaign’s impact using a survey among visitors of a large gay-lesbian street-festival in Berlin. Results Overall, 1,920,180 ads were shown and clicked on 8,831 times (CTR = 0.46%). The multivariable model showed significantly more clicks on one dating app (incidence rate ratio (IRR) = 9.5; 95% confidence interval (CI): 7.7–12.2) than on websites and on full-screen ads (IRR = 3.1; 95% CI: 2.5–3.8) than on banner ads. Of 266 MSM who participated in the survey, 190 (71%) knew about the outbreak and 39 (15%) declared to have been vaccinated recently because of the campaign. Conclusions Dating apps provided a means to rapidly reach and influence a substantial number of MSM in Berlin and should complement case-based contact tracing among MSM in outbreak settings. Clicking on ads depended on platform and format used.

A description of a hepatitis A outbreak in men who have sex with men and public health measures implemented in Seine-Maritime department, Normandy, France, 2017

“…While most of them declared homosexual intercourses, other did not report homosexual intercourses during the exposition period, and other were female. These findings highlighted the risk of secondary dissemination by oro-fecal transmission routes [ 39 ] and the mandatory report form should allow the identification of any transmission routes.…”

“…MSM using gay-dating apps and having sex-on premises (sauna) were specifically targeted as frequently reported by cases [ 37 ]. The use of pop-up messages broadcasted on gay-dating apps were of great benefit, as attested by vaccinees that reported being commonly informed through this channel [ 39 ]. The high numbers of clicks on each new message certified that information on the campaign was widely diffused, though it is not possible to assess the proportions of vaccinees among viewers of these messages.…”

Hepatitis A outbreak among MSM in Berlin due to low vaccination coverage: Epidemiology, management, and successful interventions

“…As shown by the case interviews, MSM had limited awareness of the vaccination recommendation. Doctors however seem to play a crucial role in engaging their patients: MSM who were informed by their physician about the HAV outbreak were more likely to be vaccinated as compared to those informed by other sources (Ruscher et al 2019). Doctors' advice was the strongest motivation for vaccination in another study (Horstkötter et al 2019).…”

“…Specific aspects of this outbreak in several countries have already been published (Freidl et al 2017; European Centre for Disease Prevention and Control (ECDC) 2016; European Centre for Disease Prevention and Control 2017a; Ndumbi et al 2018;Charre et al 2017). Publications referring to the German outbreak focus on i) an early description in a rapid communication (Werber et al 2017), ii) results of a cross sectional study among hepatitis A cases and a case cohort study comparing a subgroup of these cases to a reference cohort of MSM to characterize the affected population and investigate risk factors (Thoulass et al 2018), and iii) a social media campaign using dating apps to raise awareness among the MSM community (Ruscher et al 2019).…”

Hepatitis A: At-Risk Populations

“…As a matter of fact, in this at-risk group, the widespread availability and use of mobile-accessible, especially geosocial networking apps for MSM facilitate anonymous sexual activities being potential drivers of recent outbreaks of HAV [13][14][15][16]. On the other hand, dating apps and websites can be an important and effective tool to promote HAV infection prevention campaigns in outbreaks, with the advantage of a range of hard-to-reach MSM seeking anonymous sex [17].…”