Tyler B. Wray, Philip A. Chan, Erik M. Simpanen, Don Operario
BACKGROUND: Men 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. OBJECTIVE: The 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. METHODS: In 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. RESULTS: Phase 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. CONCLUSIONS: Using 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.
Serge‐Paul Eholié, François Eba Aoussi, Ismael Songda Ouattara, E. Bissagnené · 5 authors
Many successes have been achieved in HIV care in low- and middle-income countries (LMIC): increased number of HIV-infected individuals receiving antiretroviral treatment (ART), wide decentralization, reduction in morbidity and mortality and accessibility to cheapest drugs. However, these successes should not hide existing failures and difficulties. In this paper, we underline several key challenges. First, ensure long-term financing, increase available resources, in order to meet the increasing needs, and redistribute the overall budget in a concerted way amongst donors. Second, increase ART coverage and treat the many eligible patients who have not yet started ART. Competition amongst countries is expected to become a strong driving force in encouraging the least efficient to join better performing countries. Third, decrease early mortality on ART, by improving access to prevention, case-finding and treatment of tuberculosis and invasive bacterial diseases and by getting people to start ART much earlier. Fourth, move on from WHO 2006 to WHO 2010 guidelines. Raising the cut-off point for starting ART to 350 CD4/mm(3) needs changing paradigm, adopting opt-out approach, facilitating pro-active testing, facilitating task shifting and increasing staff recruitments. Phasing out stavudine needs acting for a drastic reduction in the costs of other drugs. Scaling up routine viral load needs a mobilization for lower prices of reagents and equipments, as well as efforts in relation to point-of-care automation and to maintenance. The latter is a key step to boost the utilization of second-line regimens, which are currently dramatically under prescribed. Finally, other challenges are to reduce lost-to-follow-up rates; manage lifelong treatment and care for long-term morbidity, including drug toxicity, residual AIDS and HIV-non-AIDS morbidity and aging-related morbidity; and be able to face unforeseen events such as socio-political and military crisis. An old African proverb states that the growth of a deep-rooted tree cannot be stopped. Our tree is well rooted in existing field experience and is, therefore, expected to grow. In order for us to let it grow, long-term cost-effectiveness approach and life-saving evidence-based programming should replace short-term budgeting approach.