This document summarizes a study that used online and mobile technologies to longitudinally enroll and follow white, black, and Hispanic men who have sex with men to assess HIV incidence and linkage to care. The study found that black and Hispanic men were more willing to take home HIV tests than white men. Of those who received test kits, 82% returned results, with some differences by race/ethnicity. The study identified 25 HIV-positive individuals, and was able to link 86% of them to care. This study demonstrated the ability to engage and assess minority populations online and through mobile technologies.

1. Christine Khosropour, MPH
Rollins School of Public Health
Emory University
August 15, 2011
2011 National HIV Prevention Conference
Atlanta, GA

3.  Underrepresentation of black and Hispanic
study participants
 Lack of biological outcomes on study
participants
 Inability to retain participants for a period
sufficient to assess outcome measures
 High attrition of black and Hispanic MSM

4.  Underrepresentation of black and Hispanic
study participants
 Lack of biological outcomes on study
participants
 Inability to retain participants for a period
sufficient to assess outcome measures
 High attrition of black and Hispanic MSM

7. Sharma et al, JIAPAC, 2011

9.  Enrolled white, black, and Hispanic MSM in an
online 12-month longitudinal study
 > 18 years old
 Had a male sex partner in past 12 months
 Willing to complete an at-home HIV test
 Had an SMS-enabled mobile phone

10.  Enrolled white, black, and Hispanic MSM in an
online 12-month longitudinal study
 > 18 years old
 Had a male sex partner in past 12 months
 Willing to complete an at-home HIV test
 Had an SMS-enabled mobile phone

11. Bi-monthly FU
Online FU
Baseline Month 12
Black Online Online
Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Click-through
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Bi-monthly FU
Online FU
Baseline Month 12
Screening Consent White Online Online
Questions Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Bi-monthly FU
Online FU
Baseline Month 12
Hispanic Online Online
Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test

13. Bi-monthly FU
Online FU
Baseline Month 12
Black Online Online
Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Click-through
banner ad
Bi-monthly FU
Online FU
Baseline Month 12
Screening Consent White Online Online
Questions Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Bi-monthly FU
Online FU
Baseline Month 12
Hispanic Online Online
Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test

15. Willing to take Not willing to take
home HIV test home HIV test
Crude Odds Ratio
n (%) n (%)
Race/Ethnicity (95% CI)
White, non-Hispanic 3,126 (48) 3,442 (52) Referent
Black, non-Hispanic 2,977 (60) 1,963 (40) 1.67 (1.55 – 1.80)
Hispanic 1,445 (59) 1,023 (41) 1.56 (1.42 – 1.71)
Total 7,548 (54) 6,428 (46)

17. Bi-monthly FU
Online FU
Baseline Month 12
Black Online Online
Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Click-through
banner ad
Bi-monthly FU
Online FU
Baseline Month 12
Screening Consent White Online Online
Questions Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test
Self-report:
• HIV negative Online FU
Bi-monthly FU
• Unknown Hispanic
Baseline Month 12
Online Online
• Never tested Survey Survey
Bi-monthly FU
Baseline SMS FU Month 12
HIV Test HIV Test

18.  Secure data transfer
 Results over the phone
 HIV+ automatically linked to a
counselor
 FDA approved call center
 Access to local resources
 Only FDA-approved
telemedicine HIV counseling and
testing service in US

19. 896
HIV test kits sent
17.5%
157 62.9% 564 19.5%
175
Black White Hispanic

20.  Choice of reminder modality
 Phone call
 Text message
 Email
 Personal outreach
 Phone call to participant

21. 896 82% 735
Test kits sent Test kits returned
564 85% 481
White White
157 73% 115
Black Black
175 79% 139
Hispanic Hispanic

22. 735 3.4% 25
Test kits returned HIV +
481 2.3% 11
White White
115 7.8% 9
Black Black
139 3.6% 5
Hispanic Hispanic

23. 25 HIV+
• 11 White
• 9 Black
• 5 Hispanic
11
Did not continue study
14 Active FU
• 7 White
• 5 Black
• 2 Hispanic
2 Not Linked
12 Linked to Care 12 Received
• 7 White
• 3 Black Counseling
• 2 Hispanic

24.  Willingness to take home HIV test
 82% HIV at-home test kit return
 Biological outcome = estimated HIV incidence
 Difference in kit return by race/ethnicity
 Personal outreach to increase kit return
 3.4% HIV+ among self-reported non-positive
 Known linkage to care = 86% among respondents

25.  Research participants
 Patrick Sullivan, DVM, PhD
 Alexandra Ricca, MPH
 Sullivan Research Team
 Cyclogram
 Emory Center for AIDS Research (CFAR)
 P30 AI050409
 NIH, National Center on Minority Health and
Health Disparities
 Grant # RC1MD004370