HIV Linkage to Care After Home Testing Improved with HIV App

A smartphone app could be the critical link between at-home HIV testing and rapid access to care for people whose tests come back positive, according to the results of a new study.

At-home rapid HIV testing has been available in the United States since the US Food and Drug Administration (FDA) approved the OraQuick device in 2012; however, other countries, including Canada, have yet to allow at-home testing.

Investigators at McGill University, Montreal, wanted to gauge the potential of home testing for high-risk populations, especially men who have sex with men (MSM). However, they also wanted to combat a potential flaw of at-home testing—patients who test positive for HIV but may be unwilling or unable to seek medical care.

Nikita Pant Pai, MD, MPH, PhD, the study’s lead author, wrote that current tests on the market do not do enough for people who find out they are HIV-positive.

“Currently approved HIV self-tests offer toll-free lines that are insufficient for initiating expedited linkages to counseling and care, accurate interpretation, and support during HIV self-testing,” Dr. Pant Pai and colleagues noted.

To combat that problem, they developed an application—HIVSmart!—that can work on a smartphone or tablet. The app walks patients through the testing process, helps interpret the results, and then links HIV-positive patients with counseling or health care while also providing encouragement.

To test the app, the team recruited 451 MSM with an average age of 35. Since at-home testing is not approved in Canada, the enrollees were asked to come to an office within a medical clinic, where they self-administered the OraQuick at-home test and utilized the HIVSmart! App on a tablet. The goal was to see if such a system was feasible and was accepted by patients.

The investigators found that 96.6% of patients went through all the steps, suggesting the process is feasible. All but 5 patients (98.8%) said the app was useful, and 94% said they would recommend it to a partner. Perhaps most importantly, all 3 of the people who tested positive were connected with a physician the same day. The test results were later confirmed by a laboratory.

“Our study shows that the HIVSmart! App strategy is feasible, accepted, and preferred by an educated, urban MSM population in Montreal,” Dr. Pant Pai said in a statement. “As a strategy, it suits individuals who prefer to test themselves at their convenience in the comfort of a private space such as their home, office, or kiosks.”

Moreover, such a testing regimen will be key in helping to meet the Joint United Nations Programme on HIV/AIDS (UNAIDS)’ so-called 95-95-95 Goals by 2030, according to Réjean Thomas, MD, a study co-author and the founder and CEO of Montreal-based Clinique Médicale L’Actuel. One of those goals is that 95% of people who are HIV-positive are aware that they are HIV-positive.

“By promoting screening, HIVSmart! could help to reduce the number of people living with HIV who do not know their status and allow them to start treatment earlier,” Dr. Thomas said. ‘’An application such as HIVSmart! increases accessibility to testing, especially outside major cities, where it is sometimes harder to get tested because of confidentiality issues.”

An earlier version of this article, “HIV Home App Facilitates Testing, Improves Link to Care,” was published on MD Magazine.com.