Response Rate, Acceptability and Effectiveness of an Intervention Offering HIV/STI Testing Via Apps Among Gay, Bisexual, and Other Men Who Have Sex With Men in Barcelona, Spain, from 2016 to 2020.

We evaluated the response rate, acceptability, and effectiveness of a preventive programme offering rapid HIV and other STI testing, as well as sexual counselling to gay, bisexual, and other men who have sex with men (GBMSM) via dating apps over a 4-year period. The programme was carried out in 9 out of the 10 districts in the city of Barcelona, Spain. The response rate was defined as the proportion of people responding to the message sent, acceptability as the proportion of those responding favourably, and effectiveness as the proportion of users requesting a test. We performed univariate analysis and multivariate logistic regression in relation with the response rate, acceptability and effectiveness. A total of 5,254 messages were send to different users. The response rate was 33.1% (n = 1,741), acceptability was 86.2% (n = 1,500), and effectiveness was 10.1% (n = 532). The factors associated with user response were recent connection to the app (aOR = 1.85; CI:1.39-2.46) and the presence of a profile photograph (aOR = 1.34; CI:1.11-1.64). Acceptability was associated with recent connection to the app (aOR = 1.98; CI:1.09-3.58). Effectiveness was associated with lower reported age (aOR = 0.98; CI:0.97-0.99), contact before 14:00 (aOR = 2.47; CI: 1.77-3.46), and recent connection to the app (aOR = 4.89; CI:1.98-12.08). Effectiveness was also greater in districts that were more disadvantaged or had fewer sexual health services. This study demonstrates that the use of these apps is an acceptable and effective method of prevention and sexual health promotion in GBMSM in this setting and identifies the associated factors that could guide such interventions.

Determinants of Repeating an HIV Test Among Gay, Bisexual, and Other Men Who have Sex with Men, and Transgender People Who Use an Online-Requested Self-Sampling Program and Attending Community-Based Testing Venues in Spain (2018-2021).

Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG.

Trends in Sexual Health of Gay, Bisexual, and Other Men Who Have Sex with Men, and Transgender Individuals: Apps Driven Testing Program for HIV and Other STIs in Barcelona, Spain (2016-2023).

Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18-2.64), active syphilis was 3.37% (CI 2.46-4.50) and acute HCV was 0.40% (CI 0.11-1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58-48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02-9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14-5.29), inconsistent condom use (aOR = 3.38; CI 1.37-8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24-6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies.

[Age as time-scale: an application to the survival analysis of chronic diseases]. / La edad como escala de tiempo en el análisis de la supervivencia por trastornos crnicos.

BACKGROUND: Cohort study survival analysis does not take into account the age at which an individual dies, but rather the age throughout which the individual has been included in the follow-up. This study is aimed at assessing the resulting differences in the calculation of the relative risk (RR) when the age is used instead of follow-up as a timescale in the chronic diseases survival analysis. METHODS: The five-year cohort follow-up data for the Catalan Health Interview Survey (COHESCA) is analyzed. Cox models are adjusted to the follow-up time ("standard" approach) and the age ("alternative" approach) as the timescale. The main covariable used is the comorbility index, which is adjusted by demographics, lifestyles and self-perceived health. RESULTS: Among men in the 40-64 age range, using the "standard" approach, no significant increase in the RR of death was found. Among women within the 40-64 age range with a 3-4 score on the index, there was a significant increase in the RR. Among those over age 64, a significant increase in the risk was found for the 3-4 score (RRmen = 2.1 (1.3-2.5); RRwomen = 2.1 (1.2-3.7)) and > = 5 on the index (RRmen = 3.4 (1.7-6.9); RRwomen = 4.0 (2.1-7.7)). Using the "alternative" approach, the RR was 1.0 (0.7-1.4) among men with a score of 1-2, 1.5 (1.0-2.3) for those with a score of 3-4 and 2.6 (1.4-4.9) for those with a score of > = 5. Among women, the RR were respectively 0.8 (0.5-1.2), 1.7 (1.1-2.7) and 2.6 (1.5-4.8). CONCLUSIONS: Both approaches showed an increase in the RR according to the comorbility index. However, in the "alternative" approach, it is adjusted by the confounding effect of age.

La edad como escala de tiempo en el análisis de la supervivencia por trastornos crónicos / Age as time-scale: an application to the survival analysis of chronic diseases

Fundamento: El análisis de supervivencia de estudios de cohortesno tiene en cuenta la edad a la que un individuo muere sino duranteel cual ha estado siendo incluido en el seguimiento. El objetivo deeste trabajo es valorar las diferencias que resultan en el cálculo delriesgo relativo cuando se utiliza la edad en lugar de seguimientocomo escala de tiempo en el análisis de supervivencia de los trastornoscrónicos.Métodos: Se analizan los datos de la cohorte de seguimiento de5 años de la encuesta de salud de Cataluña (COHESCA). Se ajustanmodelos de Cox con el tiempo de seguimiento (enfoque «habitual»)y la edad (enfoque «alternativo») como escala de tiempo. Comoprincipal covariable se usa el índice de comorbilidad y se ajusta porvariables demográficas, estilos de vida y salud auto-percibida.Resultados: En los hombres de 40-64 años en el enfoque "habitual"no se observa aumento significativo del riesgo relativo de morir.En las mujeres de 40-64 años con puntuación 3-4 del índice hay unincremento significativo del riesgo relativo. En las personas mayoresde 64 años se observa un aumento significativo del riesgo para la puntuación3-4 [RRhombres=2,1 (1,3-2,5); RRmujeres=2,1 (1,2-3,7)] y>=5 del índice (RRhombres=3,4 (1,7-6,9); RRmujeres=4,0 (2,1-7,7).En el enfoque «alternativo», el riesgo relativo fue de 1,0 (0,7-1,4) enlos hombres con una puntuación de 1-2, 1,5 (1,0-2,3) para los de 3-4y 2,6 (1,4-4,9) para los de >=5. En las mujeres, los RR fueron respectivamente0,8 (0,5-1,2), 1,7 (1,1-2,7) y 2,6 (1,5-4,8).Conclusiones: Ambos enfoques muestran un aumento del riesgorelativo según el índice de comorbilidad. Sin embargo, en el enfoque«alternativo», se ajusta por el efecto confundidor de la edad(AU)

Background: Cohort study survival analysis does not take intoaccount the age at which an individual dies, but rather the agethroughout which the individual has been included in the follow-up.This study is aimed at assessing the resulting differences in the calculationof the relative risk (RR) when the age is used instead offollow-up as a timescale in the chronic diseases survival analysis.Methods: The five-year cohort follow-up data for the CatalanHealth Interview Survey (COHESCA) is analyzed. Cox models areadjusted to the follow-up time («standard» approach) and the age(«alternative» approach) as the timescale. The main covariable usedis the comorbility index, which is adjusted by demographics, lifestylesand self-perceived health.Results: Among men in the 40-64 age range, using the «standard» approach, no significant increase in the RR of death wasfound. Among women within the 40-64 age range with a 3-4 score onthe index, there was a significant increase in the RR. Among thoseover age 64, a significant increase in the risk was found for the 3-4score (RRmen= 2.1(1.3-2.5); RRwomen=2.1(1.2-3.7)) and >=5 onthe index (RRmen= 3.4(1.7-6.9); RRwomen=4.0(2.1-7.7)). Usingthe «alternative» approach, the RR was 1.0 (0.7-1.4) among menwith a score of 1-2, 1.5 (1.0-2.3) for those with a score of 3-4 and 2.6(1.4-4.9) for those with a score of >=5. Among women, the RR wererespectively 0.8 (0.5-1.2), 1.7 (1.1-2.7) and 2.6 (1.5-4.8).Conclusions: Both approaches showed an increase in the RRaccording to the comorbility index. However, in the «alternative»approach, it is adjusted by the confounding effect of age(AU)