HIV

Technology-Assisted HIV Testing Interventions

Various initiatives around the world, including the US Department of Health and Human Services’ “Ending the HIV Epidemic: A Plan for America,” have been introduced with a goal of ending the HIV epidemic by 2030.1 Key components of the initiative include diagnosing, treating, and preventing HIV, as well as responding quickly to potential HIV outbreaks.1

The findings of a study published in Current HIV/AIDS Reports indicate that technology-assisted HIV testing interventions could serve as a key strategy in reaching national and global targets for HIV status awareness among at-risk groups, as well as the general population.2

Consultant360 discussed the implications of these findings further with Keith Horvath, PhD, associate professor in the Department of Psychology at San Diego State University in California.

C360: Could you discuss some of the most promising technology-assisted HIV testing interventions and how they may aid in reaching national and global targets for HIV status awareness among at-risk patients, as well as the general population?

Dr Horvath: First, it’s important to recognize that this field is relatively new. We found only 6 definitive trials that provided results on the efficacy of technology-assisted interventions. Those larger trials primarily focus on using existing social media platforms and text messaging for intervention delivery. There are a number of interventions that have completed the pilot phase and are being tested in larger trials as our systematic review was published. Those pilot trials used a wider variety of delivery platforms, such as web-based and native mobile app interventions. At this point, we are still trying to understand what platforms are most impactful for what communities, as technology access and adoption varies by community. We note this only because identifying the most promising technology-assisted HIV testing interventions may change as this field matures.

That said, there are 2 interventions worth highlighting. The first is that of Tang et al (2018)3, in which Tang and colleagues crowdsourced relevant content and then distributed community-tailored content through WeChat–the most popular social media platform in China. They also made HIV self-testing kits available. This resulted in both overall higher rates of HIV testing in intervention communities and higher rates of HIV self-testing compared with control communities. This study demonstrates the power of using platforms that can distribute tailored information and messages to a large number of individuals and the effect it can have at the community level.

The second intervention approach that may be important as we move forward is reflected by the HealthMindr mobile app by Sullivan et al (2017).4 Although reported as a pilot study, the app provided a range of prevention tools from HIV information and HIV self-testing kit ordering capabilities, to updated information on pre-exposure prophylaxis. The potential for this approach is that future interventions could provide a menu of prevention options, enabling users to take advantage of the resources that they are most likely to use. The future of technology-assisted HIV testing interventions is that these resources may be embedded into larger prevention interventions.

C360: Are there any barriers in technology-assisted HIV testing interventions, such as lack of access? How can these barriers be addressed?

Dr Horvath: As with any approach, there are barriers that are important to recognize. As noted earlier, one of the greatest barriers is the relatively few definitive trials demonstrating the efficacy of this approach. However, more trials are currently underway.

That aside, there certainly are differences in technology access and adoption depending on where people live in the United States and within other countries. Urban-rural divides persist in the sense that technologies that may be leveraged in larger urban areas, such as smartphone internet browsing, are not available in rural areas, where simple text messaging may be the only option. Efforts to expand technology capabilities in rural or remote regions from this lens is as much about health equity as it is about economic opportunity.

Another major barrier is the lack of understanding for how technology-assisted interventions should be scaled up. More information is needed for how technology-assisted interventions should be integrated into HIV clinics, physicians’ and other health care providers’ practices, and public health departments. For more than a decade, proponents of these approaches have noted the ability to scale up these interventions broadly to reach a large swath of the population we are trying to reach. Until we are able to understand how to integrate these interventions into existing health care systems and then incorporate this understanding, that potential will not be realized. That is a challenge that needs to be addressed in future research efforts.

C360: What is the next step in terms of future research in this area?

Dr Horvath: There are a few important future research priorities in this area. First, it will be critical for the results of ongoing technology-assisted interventions to be published so the evidence base can be further built in this emerging area. For those interventions found to be efficacious, learning how best to integrate technology-assisted interventions into current practices and clinics is needed to broadly disseminate these interventions. For example, it may be important for medical providers to prescribe technology-assisted interventions for their patients in order to optimize adoption and use.

Finally, there is a critical need to develop and test technology-assisted interventions for monolinguistic speakers, especially in the United States, for populations such as those who speak Spanish. This will not simply involve translating content from English to Spanish, but rather investing time and resources into working with communities to culturally adapt technology-assisted interventions. 

C360: What key takeaways do you hope to leave with infectious disease specialists on this topic?

Dr Horvath: I have 3 key takeaways on this topic. First, this field is still young, so more information about how effective these approaches are, and with which communities, is forthcoming.

There may be simple technology-assisted interventions that could be incorporated into current practices, such as text message reminders. However, text messages are likely most impactful if they occur regularly and if they not only to remind patients that it may be time to be tested, but also provide reasons or motivations for why they should be tested.

Lastly, HIV self-testing components were incorporated into many of the reviewed interventions. It may be worthwhile to consider how HIV self-testing may be incorporated into clinical practice. HIV self-tests are utilized as long as they are offered for free or reduced costs. Patients who wish to pick up an HIV self-test at a clinic to take at home may be good candidates for follow-up services, including other prevention services or linkage to HIV care.

—Christina Vogt

References:

  1. Ending the HIV epidemic: a plan for America. Centers for Disease Control and Prevention. Page last reviewed on March 17, 2020. Accessed June 17, 2020. https://www.cdc.gov/endhiv/index.html
  2. Horvath KJ, Walker T, Mireles L, Bauermeister JA, Hightow-Weidman L, Stephenson R. A systematic review of technology-assisted HIV testing interventions. Curr HIV/AIDS Rep. Published online June 8, 2020. doi:10.1007/s11904-020-00506-1
  3. Tang W, Wei C, Cao B, et al. Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial. PLoS Med. Published online August 28, 2018. doi:10.1371/journal.pmed.1002645
  4. Sullivan PS, Driggers R, Stekler JD, et al. Usability and acceptability of a mobile comprehensive HIV prevention app for men who have sex with men: a pilot study. JMIR Mhealth Uhealth. 2017;5(3). doi:10.2196/mhealth.7199