A novel Online‐to‐Offline (O2O) model for pre‐exposure prophylaxis and HIV testing scale up

Abstract

Introduction: PrEP awareness and uptake among men who have sex with men (MSM) and transgender women (TG) in Thailand remains low. Finding ways to increase HIV testing and PrEP uptake among high-risk groups is a critical priority. This study evaluates the effect of a novel Adam’s Love Online-to-Offline (O2O) model on PrEP and HIV testing uptake among Thai MSM and TG and identifies factors associated with PrEP uptake. Methods: The O2O model was piloted by Adam’s Love (www.adamslove.org) HIV educational and counselling website. MSM and TG reached online by PrEP promotions and interested in free PrEP and/or HIV testing services contacted Adam’s Love online staff, received real-time PrEP eCounseling, and completed online bookings for receiving services at one of the four sites in Bangkok based on their preference. Auto-generated site- and service-specific e-tickets and Quick Response (QR) codes were sent to their mobile devices enabling monitoring and check-in by offline site staff. Service uptake and participant’s socio-demographic and risk behaviour characteristics were analyzed. Factors associated with PrEP uptake were assessed using multiple logistic regression. Results: Between January 10th and April 11th, 2016, Adam’s Love reached 272,568 people online via the PrEP O2O promotions. 425 MSM and TG received eCounseling and e-tickets. There were 325 (76.5%) MSM and TG who checked-in at clinics and received HIV testing. Nine (2.8%) were diagnosed with HIV infection. Median (IQR) time between receiving the e-ticket and checking-in was 3 (0–7) days. Of 316 HIV-negative MSM and TG, 168 (53.2%) started PrEP. In a multivariate model, higher education (OR 2.30, 95%CI 1.14–4.66; p = 0.02), seeking sex partners online (OR 2.05, 95%CI 1.19–3.54; p = 0.009), being aware of sexual partners’ HIV status (OR 2.37, 95%CI 1.29–4.35; p = 0.008), ever previously using post-exposure prophylaxis (PEP) (OR 2.46, 95%CI 1.19–5.09; p = 0.01), and enrolment at Adam’s Love clinic compared to the other three sites (OR 3.79, 95%CI 2.06–6.95; p < 0.001) were independently associated with PrEP uptake. Conclusions: Adam’s Love O2O model is highly effective in linking online at-risk MSM and TG to PrEP and HIV testing services, and has high potential to be replicated and scaled up in other settings with high Internet penetration among key populations.

Online-to-offline models in HIV service delivery

“…Use of QR codes and a free application with real-time monitoring features helped track, validate participants and identify participants’ choice of service. The median (IQR) time between receiving e-ticket and check-in was only 3 (0–7) days [28*]. Interestingly, these results are consistent with an O2O model in Canada comprising of a comprehensive web-based testing service integrated with six sexual health sites integrated with existing sexual health services for scaling STI testing among MSM.…”

“…Of 72 unique publications identified in our original search, 14 studies [18–19, 20*, 21*, 22*, 23*, 24*, 25*, 26*, 27*, 28*, 29, 30**, 31**,32*] met the inclusion criteria and were published between April 2015 and March 2017 (Table 1). Inclusion criteria included articles in English that reported data on impact of online interventions in increasing access to HIV and sexually transmitted infections (STIs) related information, reaching and engaging online key populations in HIV/STIs awareness and/or demonstrating testing and prevention services uptake.…”

“…Inclusion criteria included articles in English that reported data on impact of online interventions in increasing access to HIV and sexually transmitted infections (STIs) related information, reaching and engaging online key populations in HIV/STIs awareness and/or demonstrating testing and prevention services uptake. Authors carefully examined the study design, methods, technology platforms, study location and population, key themes, aims and guiding theories, and outcomes, and placed them in a framework of four major types of O2O models based on previous literature [28, 33–37]. We base our O2O models mainly on the information seeking models of Choo and Marchionini [33–35], Platt’s social media “engagement spectrum” framework [36] and novel PrEP scale-up model proposed by Anand and colleagues [28, 37], that provided us with novel insights into four approaches that could facilitate online to offline linkages, including one-way information provision and information-seeking and use behavior, promotions and advertisements for engagement, bi-directional communication and support to stimulate participation through fostering interactions (multi-way engagement), and lastly an integrated approach incorporating previous approaches together with direct online bookings to receive services at collaborated offline sites.…”

“…Majority 73% of those who printed the lab forms actually submitted specimens [29, 30**]. The requirement to print a laboratory requisition was noted as a major barrier to service uptake and the study recommended barcode scanning from client’s smartphone as future alternative, similar to the strategy used in Thailand [28*]. Impressively, in Italy, implementation of an Integrated O2O model comprising of web-based tool with region wide deployment, ‘risk calculator’ and online booking system for direct booking of test at one of six linked Infectious Diseases Units, resulted in nearly 3,500 users completing online bookings, and 3,046 individuals (87%) presented for offline testing (HIV/STI, hepatitis B virus (HBV) and hepatitis C virus (HCV) testing) in over 15 months [31**].…”

“…To address the scale-up challenges [79, 80] O2O models are being implemented. A novel O2O model piloted by Anand and colleagues, has demonstrated remarkable potential in reducing barriers and scaling PrEP among high-risk, closeted MSM and TG individuals [28*]. Of 316 HIV-negative participants linked to sites, the majority (53.2%) started PrEP as compared to HIV testing alone.…”