New Technologies Help MSM Prevent STD Transmission

Technology gives men who have sex with men (MSM) new ways to assess their health status, prevent HIV and other STDs (sexually transmitted diseases), and find care, according to three ongoing pilot studies presented September 21 at the Centers for Disease Control (CDC) 2016 STD Prevention Conference in Atlanta, Georgia.

"New tools should help researchers and clinicians make taking care of your health easy to do while you're on the train or while you have a minute waiting at the airport, and patients should become involved in monitoring, preventing, and seeking care for HIV and other STDs, " Patrick S. Sullivan, DVM, PhD, a member of the US Presidential Advisory Council on HIV/AIDS (PACHA), told Contagion.

Dr. Sullivan, professor in the Department of Epidemiology of the Rollins School of Public Health and co-director of the Prevention Sciences Core at the Center for AIDS Research (CFAR) at Emory University in Atlanta presented data from three ongoing studies that blend technology, services, and medical care to help MSM protect their health and curb the spread of STDs.

"We know that the same behaviors that can lead you to acquire a rectal STI (sexually transmitted infection) can also lead you to acquire HIV," he said in his talk. "[Targeting HIV together with other STDs is] important because we are trying to serve the same population with these programs. We have common interventions, common intervention providers, biological interactions, and important programmatic links between interventions and screening, such as PrEP (pre-exposure prophylaxis) and STI screening."

One such study is the HealthMindr study, which involves a mobile app that MSM use to manage their sexual health. In the study, which has enrolled roughly 120 MSM in Atlanta and Seattle, Washington, participants can enter personal information about their health and sexual activity, receive information about their risk for HIV and other STDs, and plan an appropriate testing schedule. The men can provide sample specimens in a way they choose: through the mail by choosing to receive a test kit at home, where they can provide samples themselves and return them to a lab for testing; or by being tested at a doctor's office. They can choose to receive counseling and treatment and have condoms, PrEP, and PEP (post-exposure prophylaxis) mailed to them at home.

In preliminary results, participants visited the app two or three times a month on average, and at the four-month mark, 99 of them finished their final evaluation. Overall, 78% of the men who at the start of the study reported not liking their current condoms, ordered different condoms through the app, and 87% of those men reported using them; 50% who had not been on a regular testing schedule now had one; and 10% of men who were eligible for PrEP began taking it.

"The men came to the app two or three times a month even though they were not incentivized. Many ordered testing kits and many ordered condoms. I was surprised by the extent of uptake," Dr. Sullivan added. "I think that was a validation of the idea that men want to take care of their health."

HealthMindr has since stopped enrolling participants and the researchers plan to use the app in further studies.

Another technology is the Keep It Up! 2.0 (KIU! 2.0) online self-service STI prevention app, which is designed to encourage young MSM to reduce their unprotected anal sex activity and decrease SDI transmission. The study has enrolled around 900 young MSM between 18 and 24 years of age in Atlanta, New York, New York, and Chicago, Illinois who have recently tested negative for HIV.

KIU! 2.0, developed by Brian Mustanski, PhD, of Northwestern University in Chicago, contains games and videos that cover hooking up online, negotiating safer sex, condom use, HIV facts and myths, and risks for HIV and other STIs.

Participants answer questions about their sexual orientation and experiences, health knowledge and practices, use of drugs, and emotions. Urine and rectal tests for chlamydia and gonorrhea are mailed to them; they collect their own samples and mail them to a lab for testing.

"Young people's follow-through on long-term tasks can be shaky, but in this cohort, 94% young men returned the specimen kit," Dr. Sullivan, a co-investigator, said in his talk.

KIU! 2.0 is has completed enrollment and is now conducting followup.

The final technology discusses, the PrEP@Home study, with around 60 participants in Boston, Massachusetts, San Francisco, California, St. Louis, Missouri, and Atlanta, enables men who are stably on PrEP to be mailed an at-home testing kit every three months so they can monitor themselves without visiting the doctor if they so choose.

"Once men are established on PrEP, their routine and repeat visits to the doctor for ongoing screening creates a burden for healthcare systems and may deter guys who are on PrEP from staying on it," Dr. Sullivan, the study's principal investigator, said in his talk.

The men use the PrEP@Home app to answer a survey that indicates their risk and they learn the likelihood of qualifying to receive PrEP. They also provide pharyngeal and rectal swabs, urine and blood samples, with help from a video, and they mail the samples to a lab.

Participants receive negative results by email or text message, but if a retest is needed or a result is positive, they are called by phone. A healthcare provider evaluates the lab and behavioral survey results and prescribes further testing, telephone counseling, or PrEP.

Dr. Sullivan explained that over 85% of men provide specimens of acceptable quality and that 4 of 15 men rated themselves as more likely to stay on PrEP if a home kit was available.

"We would need to get about 40% coverage of PrEP with 50% or higher adherence in order to prevent a quarter of new HIV transmissions in MSM," Dr. Sullivan said.

He explained that, using propensity scoring and adjusting for confounding, his research team was able to ascribe about 1 in 7 HIV infections to rectal STIs. "So were it not for rectal STI's, one in seven HIV transmissions in men who have sex with men would not exist."

"We need to figure out how to align the public health systems, which really have the responsibility and have traditionally provided these services, with some intermediaries where the expertise of the Health Department and its resources can get the services to the men who need it the most," Dr. Sullivan told Contagion.

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.

DISCLOSURES: The studies are supported by the National Institutes of Health, the Centers for Disease Control and Prevention, and the MAC (Make-Up Art Cosmetics) AIDS Fund.

SOURCES:

• 2016 CDC STD Prevention Conference Program p55 (https://www.cdc.gov/stdconference/2016/STD_Conference_2016_Pro)
• Audio recording and slides from Dr. Sullivan's talk
• In-person interview with Dr. Sullivan

Study Presented:

Patrick S. Sullivan, PhD, DVM, professor in the Department of Epidemiology of the Rollins School of Public Health and co-director of the Prevention Sciences Core at the Center for AIDS Research (CFAR) at Emory University in Atlanta, Technology Innovations in STD Prevention and Control.