Mobolaji Ibitoye

AWARENESS OF POST-EXPOSURE PROPHYLAXIS (PEP) AND PRE-EXPOSURE PROPHYLAXIS (PrEP) IS LOW BUT INTEREST IS HIGH AMONG MEN ENGAGING IN CONDOMLESS ANAL SEX WITH MEN IN BOSTON, PITTSBURGH, AND SAN JUAN

This study examines awareness of and experiences with post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) among 228 men recruited in Boston, Pittsburgh, and San Juan between 12/2010 and 6/2012. All of them reported having condomless anal sex with a man in the prior year. Overall, 41% had heard of PEP, ranging from 16% in San Juan to 64% in Boston. Only 21% had heard of PrEP, ranging from 8% in San Juan to 36% in Boston. Three had used PEP, and none had used PrEP. After the methods were described to participants, interest in both was high, with intentions to use PEP and PrEP respectively at 9.1 and 7.7 (10-point scale). Increased public education is needed to raise awareness of these HIV prevention methods, especially among MSM who acknowledge potential risk behavior. It also seems likely that many such men would use these methods once they become aware of them.

Home Testing Past, Present and Future: Lessons Learned and Implications for HIV Home Tests

The recent approval in the United States of the first rapid home test to diagnose HIV raises questions about its potential use and impact. We reviewed the existing literature on the unassisted use of home tests involving self-collection and testing of biological samples by untrained users—including existing HIV self-testing studies—to shed some light on what can be expected from the availability of the HIV home test. The studies reviewed showed that most participants could properly perform home tests, obtain accurate results, and interpret them—yielding high correlations with laboratory and health-professional performed tests. Users often had trouble performing blood-based tests. Participants generally understood the need to confirm positive test results. Materials accompanying HIV home tests should emphasize symptoms of acute infection and the need for additional testing when recent infection is suspected. Different home-test-based screening modalities, personalized HIV-counseling resources and HIV home test impact evaluation methods should be studied.ResumenLa aprobación reciente en los Estados Unidos del primer examen de uso casero para diagnosticar el VIH plantea una serie de interrogantes sobre su eventual uso y el impacto potencial. Revisamos la literatura existente sobre el uso sin ayuda professional de una variedad de exámenes caseros que requieren la auto-colección y testeo de muestras biológicas por parte de usuarios sin capacitación—incluyendo los estudios existentes sobre el auto-examen por VIH—para destacar lo que se podría anticipar ahora que el examen casero por VIH está disponible. Los estudios revisados demostraron que la mayoría de los participantes sí podrían llevar a cabo los exámenes caseros correctamente, obtener resultados fidedignos e interpreterlos, así produciendo correlaciones altas con los resultados de exámenes practicados por profesionales de la salud. Los usuarios con frecuencia tenían dificultades administrándose exámenes basados en muestras de sangre. Los participantes generalmente comprendían la necesidad de exámenes de confirmación. Los materiales que acompañan los exámenes caseros por VIH deberían poner énfasis en los síntomas de infecciones agudas y en la necesidad de obtener exámenes adicionales cuando se sospecha de una infección reciente. Futuros estudios sobre exámenes caseros para el VIH deberían explorar diferentes modalidades para su uso, cómo personalizar los recursos de consejería y cómo evaluar su impacto.

Attitude and Behavior Changes Among Gay and Bisexual Men After Use of Rapid Home HIV Tests to Screen Sexual Partners

Abstract HIV testing can now be self-administered outside clinical settings through the purchase of home testing (HT) kits. Individuals also can use the kits to perform a test on a potential sexual partner prior to intercourse. We provided a 3-month supply of HT kits to men who reported multiple male partners and little or no condom use for anal intercourse. Participants used the test kits with partners in over 100 occasions. At the end of the study, approximately half of the participants described shifts in their attitudes and/or behaviors related to sexual risk. Reported changes included increased awareness of risk, increased discussion of STI/HIV safety measures, changes in partner choice and heightened consciousness of partner thinking. Easy access to HT kits may be a risk-reduction strategy for men with a high risk profile because their regular use could have an impact beyond the specific sexual encounter.ResumenActualmente, las personas pueden comprar libremente la prueba para el VIH y auto-administrársela fuera del ámbito clínico. Asimismo, pueden ofrecer la prueba a una pareja potencial antes de tener relaciones sexuales. En un estudio, hombres que declararon tener múltiples parejas masculinas y escaso uso de condones para el coito anal, recibieron una cantidad de kits durante tres meses. Los kits fueron utilizados con parejas en más de 100 ocasiones. Al final del estudio, aproximadamente la mitad de los participantes describieron cambios en sus actitudes y/o conductas relacionadas al riesgo sexual. Los cambios relatados incluyeron: mayor conciencia del riesgo, discusiones más frecuentes de medidas de seguridad para evitar infecciones, alteraciones en el tipo de pareja buscada y mayor conciencia de los pensamientos de las parejas. Facilitar el acceso a las pruebas para el VIH puede ser una estrategia preventiva prometedora para hombres con un perfil de riesgo alto, ya que su uso regular puede tener un impacto más allá del encuentro sexual específico.

Anticipated and Actual Reactions to Receiving HIV Positive Results Through Self-Testing Among Gay and Bisexual Men

We explored anticipated and actual reactions to receiving HIV positive results through self-testing with a diverse group of 84 gay and bisexual men in New York City. Grounded Theory was used to investigate these reactions in a two-phase study, one hypothetical, followed by a practical phase in which self-tests were distributed and used. Three major themes emerged when participants were asked about their anticipated reactions to an HIV positive self-test result: managing emotional distress, obtaining HIV medical care, and postponing sexual activity. When participants were asked about their anticipated reactions to a partner’s HIV positive self-test result, five themes emerged: provide emotional support; refrain from engaging in sex with casual partner; avoid high-risk sexual activity with both main and casual partners; seek medical services; and obtain a confirmatory test result. Although none of the participants tested positive, seven of their partners did. Participants provided emotional support and linked their partners to support services. The availability of HIV self-testing kits offers potential opportunities to tackle HIV infection among individuals with high-risk practices.ResumenExploramos las reacciones anticipadas y que ocurrieron al recibir un resultado de VIH positivo con el uso de la prueba de auto test de VIH en un grupo diverso de 84 hombres gay y bisexuales en la ciudad de Nueva York. Usamos la Teoría Fundamental para investigar estas reacciones en un estudio de dos fases, una fase hipotética, y la otra práctica en la cual las pruebas de auto test de VIH fueron distribuidas y usadas. Tres temas generales surgieron cuando le preguntamos a los participantes acerca de cómo ellos reaccionarían a un resultado positivo como resultado del uso de la prueba de auto test de VIH: brindar apoyo emocional, buscar atención médica para el VIH, y evitar la actividad sexual. En cuanto a sus reacciones en caso de que su pareja recibiera un resultado positivo, hubo cinco temas: brindar apoyo emocional; evitar la actividad sexual riesgosa con la pareja casual; participar en actividades sexuales no riesgosas con la pareja principal y casual; conectar a la pareja con servicios médicos; y el deseo de obtener una prueba confirmatoria para el VIH. Aunque ninguno de los participantes resultó ser positivo, siete de sus parejas sí recibieron resultados positivos. Los participantes que se encontraron en esta situación hablaron de cómo brindar apoyo emocional y conectar a la pareja con servicios de apoyo. La disponibilidad de la prueba casera ofrece oportunidades para abordar la infección del HIV en individuos con prácticas de alto riesgo.

Cartographic Analysis of Antennas and Towers: A Novel Approach to Improving the Implementation and Data Transmission of mHealth Tools on Mobile Networks

Background Most mHealth tools such as short message service (SMS), mobile apps, wireless pill counters, and ingestible wireless monitors use mobile antennas to communicate. Limited signal availability, often due to poor antenna infrastructure, negatively impacts the implementation of mHealth tools and remote data collection. Assessing the antenna infrastructure prior to starting a study can help mitigate this problem. Currently, there are no studies that detail whether and how the antenna infrastructure of a study site or area is assessed. Objective To address this literature gap, we analyze and discuss the use of a cartographic analysis of antennas and towers (CAAT) for mobile communications for geographically assessing mobile antenna and tower infrastructure and identifying signal availability for mobile devices prior to the implementation of an SMS-based mHealth pilot study. Methods An alpha test of the SMS system was performed using 11 site staff. A CAAT for the study area’s mobile network was performed after the alpha test and pre-implementation of the pilot study. The pilot study used a convenience sample of 11 high-risk men who have sex with men who were given human immunodeficiency virus test kits for testing nonmonogamous sexual partners before intercourse. Product use and sexual behavior were tracked through SMS. Message frequency analyses were performed on the SMS text messages, and SMS sent/received frequencies of 11 staff and 11 pilot study participants were compared. Results The CAAT helped us to successfully identify strengths and weaknesses in mobile service capacity within a 3-mile radius from the epicenters of four New York City boroughs. During the alpha test, before CAAT, 1176/1202 (97.84%) text messages were sent to staff, of which 26/1176 (2.21%) failed. After the CAAT, 2934 messages were sent to pilot study participants and none failed. Conclusions The CAAT effectively illustrated the research area’s mobile infrastructure and signal availability, which allowed us to improve study setup and sent message success rates. The SMS messages were sent and received with a lower fail rate than those reported in previous studies.

Lessons for Rectal Microbicide Development From an Acceptability Trial of a Placebo Gel Applied Prior to Receptive Anal Intercourse

Rectal microbicides, formulated as a gel to be applied before and/or after intercourse, are promising HIV prevention agents and are now in Phase II trials. However, both an optimal formulation and a practical delivery system are needed to ensure that the target population will use the product once efficacy is demonstrated. The precise dynamics of lubricant application by gay and bisexual men who practice anal sex and the qualities they seek in these products are underexplored. As part of a Phase I microbicide acceptability and adherence study conducted in one Puerto Rican and two continental U.S. cities, we recruited 124 young men who have sex with men (YMSM) with a history of unprotected receptive anal intercourse (RAI) and provided them with 40 rectal applicators containing a placebo gel to use prior to RAI during a 12-week period as a proxy for an eventual rectal microbicide. Ninety-five YMSM completed the trial. Their varied preferences as to product viscosity, durability, residue, and mode of application provide important lessons for the design of a product that will be satisfactory to users. Despite many reservations, the participants used the product frequently and found ways to overcome a range of obstacles. A successful rectal microbicide product may need to be presented in a range of viscosities to attract a broad client base.

Fingerprick Versus Oral Swab: Acceptability of Blood-Based Testing Increases If Other STIs Can Be Detected

Self-testing has untapped potential as a strategy to improve access to HIV testing and to increase testing frequency. User acceptability of self-administered oral swab HIV tests is consistently high in both hypothetical and actual-use studies. We explored preferences for oral versus fingerprick HIV self-tests among men who have sex with men with a high risk profile. Participants indicated greater likelihood of using an oral swab over a blood-based test, notwithstanding lower price or quicker results from the latter. However, the likelihood of using an HIV fingerprick test substantially increased if it also offered information on other sexually transmitted infections.ResumenEl uso de las pruebas auto-administradas es una estrategia subutilizada para mejorar el acceso a la prueba para el VIH y para aumentar su frecuencia de uso. La aceptabilidad de las pruebas orales para el VIH es consistentemente alta entre los usuarios en estudios hipotéticos y de práctica. Exploramos las preferencias entre las pruebas orales y de punción digital de hombres que tienen sexo con hombres (HSH), quienes tienen frecuentes conductas de riesgo. Los participantes indicaron una mayor probabilidad de usar la prueba oral sobre la de sangre, a pesar de ventajas de precio o de rapidez en dar resultados. Sin embargo, la probabilidad de usar una prueba de punción digital para el VIH aumentó sustancialmente si ésa les ofrecía además información sobre otras infecciones de transmisión sexual.

Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017)

BACKGROUND We implemented a text message-based Short Message Service computer-assisted self-interviewing (SMS-CASI) system to aid adherence and monitor behavior in MTN-017, a phase 2 safety and acceptability study of rectally-applied reduced-glycerin 1% tenofovir gel compared to oral emtricitabine/tenofovir disoproxil fumarate tablets. We sought to implement SMS-based daily reminders and product use reporting, in four countries and five languages, and centralize data management/automated-backup. METHODS We assessed features of five SMS programs against study criteria. After identifying the optimal program, we systematically implemented it in South Africa, Thailand, Peru, and the United States. The system consisted of four windows-based computers, a GSM dongle and sim card to send SMS. The SMS-CASI was, designed for 160 character SMS. Reminders and reporting sessions were initiated by date/time triggered messages. System, questions, responses, and instructions were triggered by predetermined key words. RESULTS There were 142,177 total messages: sent 86,349 (60.73%), received 55,573 (39.09%), failed 255 (0.18%). 6153 (4.33%) of the message were errors generated from either our SMS-CASI system or by participants. Implementation challenges included: high message costs; poor data access; slow data cleaning and analysis; difficulty reporting information to sites; a need for better participant privacy and data security; and mitigating variability in system performance across sites. We mitigated message costs and poor data access by federating the SMS-CASI system, and used secure email protocols to centralize data backup. We developed programming syntaxes to facilitate daily data cleaning and analysis, and a calendar template for reporting SMS behavior. Lastly, we ambiguated text message language to increase privacy, and standardized hardware and software across sites, minimizing operational variability. CONCLUSION We identified factors that aid international implementation and operation of SMS-CASI for real-time adherence monitoring. The challenges and solutions we present can aid other researchers to develop and manage an international multilingual SMS-based adherence reminder and CASI system.