What would you choose: Online or Offline or Mixed services? Feasibility of online HIV counselling and testing among Thai men who have sex with men and transgender women and factors associated with service uptake

Abstract

Introduction HIV testing coverage remains low among men who have sex with men (MSM) and transgender women (TGW). We studied characteristics of Thai MSM and TGW who chose online and/or offline platforms for HIV counselling and testing and the feasibility of integrating online technologies and HIV self‐testing to create service options.MethodsFrom December 2015 to June 2017, MSM and TGW enrolled from Bangkok Metropolitan Region and Pattaya could choose between: 1 offline HIV counselling and testing (Offline group), 2 online pre‐test counselling and offline HIV testing (Mixed group), and 3 online counselling and online, supervised, HIV self‐testing (Online group). Sociodemographic data, risk behaviour and social network use characteristics were collected by self‐administered questionnaires. Logistic regression models identified covariates for service preferences.ResultsOf 472 MSM and 99 TGW enrolled, 202 self‐selected the Offline group, 158 preferred the Mixed group, and 211 chose the Online group. The Online group had the highest proportion of first‐time testers (47.3% vs. 42.4% vs. 18.1%, p < 0.001) and reported highest HIV prevalence (15.9% vs. 13.0% vs. 3.4%, p = 0.001) as compared to Offline and Mixed groups, respectively. Having tested for HIV twice or more (OR 2.57, 95% CI 1.03 to 6.41, p = 0.04) increased the likelihood to choose online pre‐test counselling. Being TGW (OR 6.66, 95% CI 2.91 to 15.25, p < 0.001) and using social media from four to eight hours (OR 2.82, 95% CI 1.48 to 5.37, p = 0.002) or >8 hours (OR 2.33, 95% CI 1.05 to 5.16, p = 0.04) increased selection of online, supervised, HIV self‐testing. Providers primarily used smartphones (79.2%) and laptops (37.5%) to deliver online services. Self‐testing strip image sharpness and colour quality were rated “good” to “excellent” by all providers. Most participants (95.1%) agreed that online supervision and HIV self‐testing guidance offered were satisfactory and well delivered.ConclusionsOnline HIV services among MSM and TGW are feasible in Thailand and have the potential to engage high proportions of first‐time testers and those with high HIV prevalence. When designing public health interventions, integrating varied levels of online HIV services are vital to engage specific sections of MSM and TGW populations in HIV services.Clinical Trial NumberNCT03203265

Linkages to HIV confirmatory testing and antiretroviral therapy after online, supervised, HIV self‐testing among Thai men who have sex with men and transgender women

“…The study was supported by amfAR GMT Initiative grant. Factors associated with preferences for online or offline HIV services at study entry were previously reported . Here we reported findings on seroconversion, retention and linkages to HIV confirmatory testing and ART initiation during the 12‐month study period.…”

“…We previously reported that the use of online, supervised, HIV self‐testing is feasible in Thailand and has potential to engage a high proportion of MSM and TGW who are first‐time testers and those with high HIV prevalence . In this paper, we demonstrated that MSM and TGW who chose to have online, supervised, HIV self‐testing had a high HIV incidence at 5.2 per 100 person‐years.…”

“…Many ongoing studies are exploring the online self‐management concept for HIV testing, PrEP and ART use among MSM and TGW . Use of online social networks was reported as always by 95% of our participants, with Facebook (92%) and LINE application (91%) being the two most common networks, and 89% accessed these social networks through mobile phone . Integrating health self‐management tools into freely available and widely‐used online platforms, although vary by countries and region, would seem to be more feasible and sustainable than investing in new standalone applications which could risk limited access by potential users .…”

“…Among 70 recruited offline, 56 (80%) selected the Offline group and 14 (20%) the Online group. We enrolled 571 participants and seven were subsequently excluded (3 without risk in the past six months, 2 aged <18 years old, 1 lived outside of study area and 1 known HIV‐positive case) . Of 564 participants (465 MSM and 99 TGW) who contributed data to the current analysis, 200 selected the Offline group, 156 chose the Mixed group and 208 preferred the Online group (Figure ).…”

Building the evidence base to optimize the impact of key population programming across the HIV cascade

“…A study from Thailand also demonstrates the promise of leveraging technology and self‐testing to improve reach and testing uptake among MSM and transgender women . In this study, Phanuphak et al .…”