HIV self-test: a tool to expand test uptake among men who have sex with men who have never been tested for HIV in São Paulo, Brazil.

OBJECTIVES: HIV self-testing is an effective tool to improve diagnostic coverage in key populations, enabling linkage to care and access to antiretroviral therapy. Its implementation requires better understanding of patients' perspectives on this novel strategy. The aim of the study was to investigate the perception of men who have sex with men (MSM) regarding the HIV oral fluid self-test (HIVST) in São Paulo, Brazil, and to analyse the sociodemographic characteristics and testing strategy preferences of individuals registered to undertake HIVST. METHODS: Preceding the implementation of HIVST use as public policy in 2019, we recruited MSM living in São Paulo to undertake HIVST using a digital platform, and investigated their sociodemographic profiles, testing experiences and testing preferences. Results were compared according to reported lifetime HIV testing. RESULTS: A total of 6477 MSM (median age 28 years) were recruited to the study from April 9th to December 31st, 2018. Seventy-eight per cent reported previous HIV testing. The opening hours of health facilities (53%), concern about disclosing intimate personal information to health care providers (34%) and fear of stigma (21%) were reported as the main barriers to testing. Older age, higher education, illicit drug use and self-identifying as gay were associated with prior HIV testing (P < 0.001). Most participants (67%) were unaware that HIVST was available before enrolling in the study. Preference for HIVST over other testing technologies was higher among those never tested (71%) than among participants with previous HIV testing (61%; P < 0.001). CONCLUSIONS: HIVST was found to be an effective tool to improve testing uptake among MSM, particularly those who had never been tested before. Characterization of the most likely users of HIVST among MSM will help to inform implementation and scaling up of this novel testing method in the Brazilian public health system.

Construção de um aplicativo móvel para Profilaxia Pós-Exposição ao HIV / Elaboración de una aplicación móvil para la profilaxis post-exposición al VIH / Building a mobile application for HIV Post-Exposure Prophylaxis

Resumo Objetivo Descrever o processo de construção de um aplicativo móvel para o apoio à Profilaxia Pós-Exposição ao HIV e analisar como os profissionais de saúde respondem aos atributos de sua usabilidade. Métodos Estudo de produção tecnológica, construído em quatro fases, entre 2016 e 2018: composição do conteúdo central do app; reunião de um conjunto de ferramentas para o protótipo; testagem do protótipo; teste dos atributos de usabilidade por meio do método empírico. O aplicativo PEPtec foi construído baseado nas diretrizes nacional e internacional para profilaxia pós-exposição ao HIV. As respostas dos profissionais de saúde acerca dos atributos de usabilidade (facilidade, utilidade, interface e uso do app) foram analisadas por meio de um questionário semiestruturado aplicado em 28 profissionais dos serviços de atendimento às pessoas com Infecções Sexualmente Transmissíveis de uma Coordenadoria de Saúde do município de São Paulo (SP), Brasil. Resultados O aplicativo foi disponibilizado para os sistemas operacionais Android e iOS. Foi personalizado para o celular do profissional de saúde para apoio na tomada de decisão na indicação da Profilaxia Pós-Exposição ao HIV. Sobre a interface do aplicativo, os profissionais consideraram que as cores e os ícones eram agradáveis e de fácil identificação. Na análise da usabilidade, os profissionais relataram facilidade no seu uso, ganharam habilidades e conseguiram navegar por todas as telas. Conclusão O aplicativo móvel responde aos interesses desses profissionais no desfecho da indicação à Profilaxia Pós-Exposição ao HIV por meio desta ferramenta tecnológica.

Resumen Objetivo Describir el proceso de elaboración de una aplicación móvil para el apoyo a la profilaxis post-exposición al VIH y analizar cómo responden los profesionales de la salud a los atributos de usabilidad. Métodos Estudio de producción tecnológica, elaborado en cuatro fases entre 2016 y 2018: composición del contenido central de la app, reunión del conjunto de herramientas para el prototipo, prueba del prototipo, prueba de los atributos de usabilidad mediante el método empírico. La aplicación PEPtec fue elaborada con base en las directrices nacionales e internacionales para la profilaxis post-exposición al VIH. Las respuestas de los profesionales de la salud acerca de los atributos de usabilidad (facilidad, utilidad, interfaz y uso de la app) fueron analizadas mediante un cuestionario semiestructurado aplicado a 28 profesionales de los servicios de atención a personas con Infecciones de Transmisión Sexual de una Coordinación de Salud del municipio de São Paulo, estado de São Paulo, Brasil. Resultados La aplicación fue ofrecida para los sistemas operativos Android e iOS. Se personalizó para los celulares de los profesionales de la salud para apoyar la toma de decisiones sobre la indicación de la profilaxis post-exposición al VIH. Respecto a la interfaz de la aplicación, los profesionales consideraron que los colores e íconos eran agradables y de fácil identificación. En el análisis de usabilidad, los profesionales relataron la facilidad de uso, adquirieron habilidades y pudieron navegar por todas las pantallas. Conclusión La aplicación móvil responde a los intereses de estos profesionales en los eventos de indicación de profilaxis post-exposición al VIH mediante esta herramienta tecnológica.

Abstract Objective To describe the process of building a mobile application to support HIV Post-Exposure Prophylaxis and analyze how healthcare professionals respond to the attributes of its usability. Methods A technological production study, built in four phases, between 2016 and 2018: composition of the app's central content; gathering a set of tools for the prototype; prototype testing; testing usability attributes using the empirical method. The PEPtec application was built based on national and international guidelines for post-exposure prophylaxis for HIV. Healthcare professionals' responses about usability attributes (ease, utility, interface and use of the app) were analyzed using a semi-structured questionnaire applied to 28 professionals from the services for people with Sexually Transmitted Infections of a Health Coordination of the municipality of São Paulo (SP), Brazil. Results The application was made available for Android and iOS. It was personalized for healthcare professionals' cell phones to support decision-making in the indication of HIV Post-Exposure Prophylaxis. Regarding the application interface, the professionals considered that the colors and icons were pleasant and easy to identify. In the usability analysis, professionals reported ease of use, gained skills and were able to navigate through all screens. Conclusion The mobile application responds to the interests of these professionals in the outcome of indication for Post-Exposure HIV Prophylaxis through this technological tool.