Use of a Rapid HIV Home Test Prevents HIV Exposure in a High Risk Sample of Men Who Have Sex With Men

Alex Carballo-Diéguez; Timothy Frasca; Ivan Balan; Mobolaji Ibitoye; Curtis Dolezal

Disclosures

AIDS and Behavior. 2012;16(7):1753-1760. 

In This Article

Methods

Our study was conducted in New York City, USA, with approval from the New York State Psychiatric Institute Institutional Review Board. Recruitment took place in person and online at sites frequented by gay men with advertisement indicating that researchers were studying possible uses of a rapid HIV home test. Study candidates called the research office and responded to a few pre-screening questions. Those who qualified were invited to an in-person screening interview (Visit 1). After consent procedures, men were given a comprehensive description of rapid HIV HT, how it worked, and its window-period-related limitations. Subsequently, they took the first half of a 2-part, computer-assisted self-interview (CASI) that collected, inter alia, demographic information, HIV knowledge,[26] sexual risk behavior in the prior 3 months, alcohol and substance use history, and prior history of STIs. Next, participants tested themselves with OraQuick following written instructions while monitored by a researcher. While waiting 20 min for the result of the test, participants completed the second part of the CASI. It included, among other sections, questions on whether the participant intended to use HT with partners when it became available OTC; his perceived capacity to discuss the use of HT with a partner and handle potentially positive results; his perceived ability to judge whether a partner could become violent and avoid or handle violent situations (adapted from),[27] and an 18-item questionnaire (true/false) specifically developed for this study on rapid HIV tests and their limitations, specifically the window period. Any incorrect responses to the last questionnaire generated feedback to the participant with the correct answer and its rationale; furthermore, the research assistant provided added clarification if necessary.

Negative HIV test results obtained with OraQuick at this visit and interpreted unaided by the participant were confirmed using a second rapid test (Clearview® Complete HIV 1/2) that is blood-based. The data collected during this screening process allowed us to determine participant eligibility.

Eligibility criteria included: man; 18 years of age or older; fluent in English or Spanish; HIV-negative; not in a monogamous relationship; engages in anal intercourse at least three times per month; never or seldom uses condoms (no condom use in last 10 occasions for those with 4 or less partners or in less than 80 % of occasions for those with more than 4 partners in the past year); aware that unprotected receptive anal intercourse (RAI) may lead to HIV transmission; understands the window period of OraQuick; reports likelihood of using HT to screen potential sexual partners; and feels he can avoid or handle potential violence resulting from proposing to use the test.

Study candidates who fulfilled eligibility criteria returned to the research offices on a subsequent day (Visit 2). After a new consent process, they enrolled in the 3-month study. They received a bag containing condoms, 16 HT kits, written instructions on HT kit use, a card with HIV- and violence-related resources available in the community, the study Website address, and a 24-h hotline number they could use for assistance from two senior clinical psychologists supervising the study. Participants were also trained on how to use an interactive voice response system (IVRS) to call at least once per week to report their sexual behavior and HT use. If no call was placed in a week, participants received an automatic reminder generated by the system. If they did not respond to the reminder, a staff member called them personally. Staff also called in response to any IVRS report of an HIV-positive result.

Visit 3 took place 3 months after Visit 2. Participants underwent an in-depth interview conducted by a clinical psychologist following an interview guide. The guide explored the constructs of the IMB model with specific attention to motivational factors that led participants to use (or not use) the test with different partners and the skills they employed to propose and use HT, interpret results, and handle partners' reactions. Furthermore, in the course of this interview, a summary of the data collected through the IVRS was discussed and ambiguous issues clarified.

Participants received between 30 and 70 as compensation for their time at the different visits, plus a modest monetary incentive per call and a bonus if calls were received at least once a week, for a possible total of $190.

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