Announcing a New Method of Hiv Testing: the Planning of Robust Home Testing for Hiv Combined with Internet Counselling

Background Recent estimates indicate that 40% of the HIV infections in the Netherlands are undiagnosed. Earlier diagnosis of HIV will improve individual health outcomes and reduce further spread. Self tests for HIV have become available, which allow individuals to test at home without involvement of health care professionals. Although self tests may help to increase HIV test uptake, there are concerns about test quality, counseling and medical follow up. Objective The Public Health Service of Amsterdam has initiated the HivTest@Home project to develop and evaluate a service that provides reliable HIV self-tests using oral fluid in combination with an Internet counseling strategy for individuals at high risk for HIV: migrants from HIV-endemic countries and men who have sex with men (MSM). Methods A website and logistic infrastructure will be developed that will inform individuals about HIV self-testing, enable individuals to purchase an HIV self-test online, and offer user-friendly instructions, pre- and post-test counseling and low-threshold contact options with health care professionals. For the development of the self-test service we use the ceHRes Roadmap: a framework that provides a comprehensive set of methods and instruments for the development of sustainable eHealth technologies based on human-centered design and business modelling strategies. For example, persona (i.e., “fictional user archetypes based on user research”) will be used to stimulate user-centered thinking when designing the service, and community and professional experts and public stakeholders will be closely involved in the development of the service. The website will contain an intake questionnaire that will assess eligibility for using the service. Those who do not originate from an HIV-endemic country, and those who are not MSM will be advised to consult their general practitioner (GP) or clinic for sexually transmitted infections (STI) for an individual risk assessment for HIV and other STI, and will be discouraged from using the self testing service. Migrants from HIV endemic countries and MSM will be encouraged to test for HIV. The STI clinic and GP will be referred to as the preferred locations for testing considering their inclusive testing for multiple STIs. Those who do not opt for the regular testing facilities will be offered the possibility to purchase an HIV self-test. With the test, they will receive a code to access an elaborated pre-test trajectory including step-by-step instructions and counseling. Movies and information modules will be used, and low-threshold contact options with health care professionals will be offered (e.g., using Skype, telephone, or web cam). After testing, a post-test counseling procedure will be offered online for both positives and negatives. For individuals who test positive, a follow-up procedure will be set up in order to motivate them to access regular health care as soon as possible for confirmation testing and referral to an HIV outpatient clinic. Results The service will be launched in 2013, accompanied by a media campaign targeting migrants and MSM. We aim to distribute 2,000 tests within a 12-month period, assuming an HIV prevalence of newly diagnosed individuals of 2.5-5.0%. Using data collected online from participants, web statistics, interviews with participants, and clinical follow-up data, we will evaluate the feasibility and acceptability of the service and its effectiveness in identifying undiagnosed HIV infections. Conclusions If feasible and effective this new method can create another reliable low-threshold testing option for various risk populations -an option needed to break the cycle of low-testing numbers. []