Web-Based HIV Testing in Abruzzo, Italy: Analysis of 15-Month Activity Results
Publication: AIDS Patient Care and STDs
Volume 30, Issue Number 10
Abstract
Undiagnosed cases of HIV infection in developed countries are estimated at 20–30% of individuals living with HIV. Web-based strategies may represent a new approach to easier, wider, and unrestricted access to early testing. The Abruzzo Region, Italy, developed a Web-based tool to recruit persons at high risk of HIV and other sexually transmitted infections (STIs). At the Website www.failtestanchetu.it, browsers found information on STIs (HIV, hepatitis B and C, and syphilis), a structured questionnaire called “risk calculator” to assess one's own risk behaviors and direct booking of their test at one of six sites throughout the region. The Website was advertised on local media and in pharmacies, high schools, sports facilities, and factories. Between February 1, 2014, and May 31, 2015, about 6000 users visited the Website; 3046 people attended a visit for counseling on risk behaviors, signs, or symptoms of STIs and accepted blood drawing for HIV, hepatitis B Virus (HBV), hepatitis C Virus (HCV), and syphilis tests. Fifty-eight (1.90%) subjects were positive for HCV, 56 (1.84%) for HBsAg, 90 (2.95%) for Treponema pallidum antibodies, and 28 (0.92%) for HIV. Ninety-two percent of HIV-positive patients were successfully linked to care. Late presenters were less frequent in this sample than in the population diagnosed with HIV in Italy in 2014. An overall 7% proportion of HIV, HBV, HCV, and syphilis-unaware cases were all transferred to care, with the exception of three people. HIV seropositivity among testers was higher than 2/1000, the cost-effectiveness threshold suggested for effective testing. Therefore, our Web-based unrestricted and free access methodology appears worth further and wider evaluation.
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References
1.
European Centre for Disease Prevention and Control. HIV/AIDS Surveillance in Europe. Stockholm: ECDC. Available at: http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=729 (Last accessed October 5, 2016).
2.
van Sighem A, Nakagawa F, De Angelis D, et al. Estimating HIV incidence, time to diagnosis, and the undiagnosed HIV epidemic using routine surveillance data. Epidemiology 2015;26:653–660.
3.
Hall HI, Frazier EL, Rhodes P, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med 2013;173:1337–1344.
4.
Campsmith ML, Rhodes PH, Hall HI, Green TA. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. J Acquir Immune Defic Syndr 2010;53:619–624.
5.
Supervie V, Ndawinz JD, Lodi S, Costagliola D. The undiagnosed HIV epidemic in France and its implications for HIV screening strategies. AIDS 2014;28:1797–1804.
6.
van Veen MG, Presanis AM, Conti S, et al. National estimate of HIV prevalence in the Netherlands: Comparison and applicability of different estimation tools. AIDS 2011;25:229–237.
7.
Yang Q, Boulos D, Yan P, et al. Estimates of the number of prevalent and incident human immunodeficiency virus (HIV) infections in Canada, 2008. Can J Public Health 2010;101:486–490.
8.
Wand H, Yan P, Wilson D, et al. Increasing HIV transmission through male homosexual and heterosexual contact in Australia: Results from an extended back-projection approach. HIV Med 2010;11:395–403.
9.
Mammone AN, Navarra A, Regine V, et al. Prevalence of Undiagnosed HIV in Italy at the End of 2012: An Estimate Based on Surveillance Data and Disease Stage. VI Italian Conference on AIDS and Retroviruses, Roma, 25–27 Maggio, 2014.
10.
Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS 2012;26:893–896.
11.
Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 2006;20:1447–1450.
12.
Mocroft A, Lundgren JD, Sabin ML, et al. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE). PLoS Med 2013;10:e1001510.
13.
Holt M, Rawstorne P, Wilkinson J, Worth H, Bittman M, Kippax S. HIV testing, gay community involvement and internet use: Social and behavioural correlates of HIV testing among Australian men who have sex with men. AIDS Behav 2012;16:13–22.
14.
Han L, Bien CH, Wei C, et al. HIV self-testing among online MSM in China: Implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr 2014;67:216–221.
15.
Tuck MK, Chan DW, Chia D, et al. Standard operating procedures for serum and plasma collection: Early detection research network consensus statement standard operating procedure integration working group. J Proteome Res 2009;8:113–117.
16.
Rayment M, Thornton A, Mandalia S, et al. HIV testing in non-traditional settings—the HINTS study: A multi-centre observational study of feasibility and acceptability. PLoS One 2012;7:e39530.
17.
Paltiel AD, Walensky RP, Schackman BR, et al. Expanded HIV screening in the United States: Effect on clinical outcomes, HIV transmission, and costs. Ann Intern Med 2006;145:797–806.
18.
Suthar AB, Ford N, Bachanas PJ, et al. Towards universal voluntary HIV testing and counselling: A systematic review and meta-analysis of community-based approaches. PLoS Med 2013;10:e1001496.
19.
Wallace LA, Li J, McDaid LM. HIV prevalence and undiagnosed infection among a community sample of gay and bisexual men in Scotland, 2005–2011: Implications for HIV testing policy and prevention. PLoS One 2014;9:e90805.
20.
Parisi MR, Soldini L, Vidoni G, et al. Cross-sectional study of community serostatus to highlight undiagnosed HIV infections with oral fluid HIV-1/2 rapid test in non-conventional settings. New Microbiol 2013;36:121–132.
21.
Fernandez-Lopez L, Rifa B, Pujol F, et al. Impact of the introduction of rapid HIV testing in the voluntary counselling and testing sites network of Catalonia, Spain. Int J STD AIDS 2010;21:388–391.
22.
Thornton AC, Delpech V, Kall MM, Nardone A. HIV testing in community settings in resource-rich countries: A systematic review of the evidence. HIV Med 2012;13:416–426.
23.
Scognamiglio P, Chiaradia G, Oldrini, et al. Outreach Program of HIV Rapid Testing Among People at Higher Risk of HIV Living in Italy: Preliminary Results VII Italian Conference on AIDS and Retroviruses, Riccione, 17–19 Maggio, 2015.
24.
Ruutel K, Lohmus L, Janes J. Internet-based recruitment system for HIV and STI screening for men who have sex with men in Estonia, 2013: Analysis of preliminary outcomes. Euro Surveill 2015;20:pii:.
25.
Camoni L, Federico B, Capelli G, et al. Few Italian drug users undergo HIV testing. AIDS Behav 2011;15:711–717.
26.
Valdiserri RO, Holtgrave DR, West GR. Promoting early HIV diagnosis and entry into care. AIDS 1999;13:2317–2330.
27.
Kurth AE, Lally MA, Choko AT, Inwani IW, Fortenberry JD. HIV testing and linkage to services for youth. J Int AIDS Soc 2015;18(2 Suppl 1):19433.
28.
Burke RC, Sepkowitz KA, Bernstein KT, et al. Why don't physicians test for HIV? A review of the US literature. AIDS 2007;21:1617–1624.
29.
Klein PW, Martin IB, Quinlivan EB, Gay CL, Leone PA. Missed opportunities for concurrent HIV-STD testing in an academic emergency department. Public Health Rep 2014;129(Suppl 1):12–20.
30.
Centro Studi Investimenti Sociali (CENSIS). Biomedical Monitor 2014. Available at: www.censis.it/7?shadow_comunicato_stampa=120983 (Last accessed April 3, 2016).
31.
Cheng W, Cai Y, Tang W, et al. Providing HIV-related services in China for men who have sex with men. Bull World Health Organ 2016;94:222–227.
32.
Hottes TS, Farrell J, Bondyra M, Haag D, Shoveller J, Gilbert M. Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: Opinions and expectations of prospective clients. J Med Internet Res 2012;14:e41.
33.
Rhodes SD, Vissman AT, Stowers J, et al. A CBPR partnership increases HIV testing among men who have sex with men (MSM): Outcome findings from a pilot test of the CyBER/testing internet intervention. Health Educ Behav 2011;38:311–320.
34.
Swendeman D, Rotheram-Borus MJ. Innovation in sexually transmitted disease and HIV prevention: Internet and mobile phone delivery vehicles for global diffusion. Curr Opin Psychiatry 2010;23:139–144.
35.
Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep 2015;12:173–190.
36.
Gaydos CA, Barnes M, Aumakhan B, et al. Can e-technology through the Internet be used as a new tool to address the Chlamydia trachomatis epidemic by home sampling and vaginal swabs? Sex Transm Dis 2009;36:577–580.
37.
Kahn RH, Moseley KE, Thilges JN, Johnson G, Farley TA. Community-based screening and treatment for STDs: Results from a mobile clinic initiative. Sex Transm Dis 2003;30:654–658.
38.
Lambert NL, Fisher M, Imrie J, et al. Community based syphilis screening: Feasibility, acceptability, and effectiveness in case finding. Sex Transm Infect 2005;81:213–216.
39.
Lynn WA, Lightman S. Syphilis and HIV: A dangerous combination. Lancet Infect Dis 2004;4:456–466.
40.
Price H, Gilson R, Mercey D, et al. Hepatitis C in men who have sex with men in London—a community survey. HIV Med 2013;14:578–580.
41.
Schmidt AJ, Falcato L, Zahno B, et al. Prevalence of hepatitis C in a Swiss sample of men who have sex with men: Whom to screen for HCV infection? BMC Public Health 2014;14:3.
42.
Polilli E, Tontodonati M, Flacco ME, et al. High seroprevalence of HCV in the Abruzzo Region, Italy: Results on a large sample from opt-out pre-surgical screening. Infection 2016;44:85–91.
Information & Authors
Information
Published In
AIDS Patient Care and STDs
Volume 30 • Issue Number 10 • October 2016
Pages: 471 - 475
PubMed: 27749107
Copyright
Copyright 2016, Mary Ann Liebert, Inc.
History
Published in print: October 2016
Published online: 1 October 2016
Authors
Authors Contributions
E.P., G.P., C.D., V.C., A.G., D.D.G., M.P.S., J.V., and M.P. conceived and designed the program. P.D.S., A.S., P.F., T.U., F.S., and L.P. contributed to the development of the project. E.P., G.P., and E.R. analyzed the data. E.P., G.P., and E.R. wrote the article draft.
Author Disclosure Statement
No competing financial interest exist.
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