An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization which increases access to and uptake of testing among key populations who are at high risk for HIV infection. Objective: To describe the development and feasibility of a free, anonymous, Internet-based HIV self-testing (HIVST) strategy designed for men who have sex with men (MSM) in Curitiba, Brazil (E-testing). Methods: The project was developed under the scope of the “A Hora é Agora” (Time is now) program. Individuals aiming to request an HIVST package (2 tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, packages distribution, and return of test results were monitored via a platform-integrated system. Results: Between February 2015 and January 2016, the website documented 17,786 unique visitors with 3,218 provided complete answers to the online questionnaires. Most individuals self-reported being white (77%), young (median age was 25 years, interquartile range 22-31), educated (87.3% complete secondary education or more), and had previously tested for HIV (62.5%). Overall, 2,526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals reporting to have used E-testing visited the pre-specified health facility for confirmatory testing (30 positive; 7 negative). Conclusions: E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional MSM population centers in Brazil.