Mixed-Methods Evaluation of the Incorporation of Home Specimen Self-Collection Kits for Laboratory Testing in a Telehealth Program for HIV Pre-exposure Prophylaxis

Abstract

Home specimen self-collection kits with central laboratory testing may improve persistence with PrEP and enhance telehealth programs. We offered Iowa TelePrEP clients the choice of using a home kit or visiting a laboratory site for routine monitoring. Mixed-methods evaluation determined the proportion of clients who chose a kit, factors influencing choice, associations between kit use and completion of indicated laboratory monitoring, and user experience. About 46% (35/77) chose to use a kit. Compared to laboratory site use, kit use was associated with higher completion of extra-genital swabs (OR 6.33, 95% CI 1.20–33.51, for anorectal swabs), but lower completion of blood tests (OR 0.21, 95% CI 0.06–0.73 for creatinine). Factors influencing choice included self-efficacy to use kits, time/convenience, and privacy/confidentiality. Clients reported kit use was straight-forward but described challenges with finger prick blood collection. Telehealth PrEP programs should offer clients home kits and support clients with blood collection and kit completion.

Delivering HIV pre-exposure prophylaxis (PrEP) care online: A scoping review

“…PrEP-related elements of care were mainly delivered via websites (n=41), followed by video call (n=10), smartphone apps (n=10), email (n=6), and YouTube videos (n=2), with some studies implementing more than one modality. Sixteen studies delivered PrEP-related elements of care in the context of PrEP, [24,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] 38 delivered an aspect of HIV testing online without being explicitly related to PrEP, [25][26][27] one study provided renal test results online outside a PrEP context, [78] and four studies reviewed existing online content. [79][80][81][82] We have grouped our findings depending on whether or not PrEP is explicitly incorporated into each service given the possible higher relevance of the studies that delivered care in a PrEP context.…”

“…Aspects of HIV testing were delivered online in ten studies, specifically: ordering HIV self-tests (HIVSTs) or selfsampling kits (n=4), online booking for a face-to-face appointment (n=2), providers sending results to patients (n=2), patients sending results to providers (n=1), online HIV counselling (n=1), and an online instructional video for completing HIVSTs (n=1). Two studies provided services relating to renal monitoring; specifically, one allowed participants to order a self-sampling kit for creatinine analysis, [29] and the other offered online booking for in-person renal function tests. [34] One service, documented in two papers, allowed participants to order 90 days' worth of PrEP online following satisfactory test results and assessment.…”

“…Seven studies described somewhat complete PrEP pathways. [29,[34][35][36][39][40][41] Online modalities were employed in conjunction with face-to-face and telephone-based care and studies tended to rely on clinic or lab-based testing for HIV, renal function, and STIs.…”

“…[28,30,43,54,59,67,77] Moreover, one study was able to demonstrate the feasibility of having patients self-sample for creatinine, with 81% of the self-samples being adequate for analysis. [29] Barriers to, and facilitators of, online PrEP-related care Nineteen studies identified barriers, facilitators and other factors that influenced engagement with their specific service. Herein, we focus solely on the facilitators and factors linked to the PrEP-related elements of care that were delivered online.…”

“…Convenience was identified as a facilitator in eight studies; [26,29,35,36,56,60,63,65] in particular, the ability of online services to help overcome geographic barriers and scheduling issues. [26,29,56,60,63] Participants cited the need to attend a specific physical location for testing as a barrier. [36] However, blood-based self-sampling was also reported as a barrier for people who had not performed the procedure before.…”