Remote HIV Testing, Phone Delivery of Results Has Potential Despite Drawbacks

Adult and adolescent men who have sex with men (MSM) continue to represent a disproportionate number of annual HIV diagnoses each year—almost 70% in 2017 alone, according to the CDC—but testing for the virus remains at a suboptimal level in the population. A recent study published in AIDS and Behavior investigated the utility of remote testing and phone delivery of test results among this patient group.

The results demonstrate the potential of remote testing to reduce barriers to the provision of HIV care-including confidentiality in a health care facility, stigma, and fear of testing positive—and increase access testing and support services.

“Improving HIV testing rates and increasing early detection among men who have sex with men (MSM) are critical strategies for enhancing overall health and decreasing HIV transmission,” the authors stated. “Remote testing and phone delivery of HIV test results may reduce barriers such as geographic isolation or HIV-related stigma.”

The study population of 50 cisgender men, transgender men, and transgender women who have sex with men were participants in the Together 5000 trial. All were enrolled between October 2017 and June 2018. In this trial, 195 participants originally received positive HIV results but just these 50 chose to complete a qualitative interview 3 months after phone delivery of their results. Their mean (SD) age was 31.7 (8.0) years, and a majority (52%) were men of color (Black, 16%; Latino, 24%; Asian/Pacific Islander, 12%). Just 34% were tested for HIV in the past year, with 52% having been previously tested more than a year ago and 14% never tested.

Results show that 39% preferred to receive their positive results over the phone compared with 45% who identified the delivery method as simply “acceptable.” Fifteen percent would have preferred to receive their results another way (eg, in person, online portal) because they viewed the phone experience as negative.

The following strengths of phone delivery were cited by the participants:

• The time, space, and comfort they had to digest their potential diagnosis
• The support they received from staff members who delivered their results
• The HIV information and referrals they received
• The convenience vs having difficulty scheduling an in-person medical visit
• Increased confidentiality compared with receiving results via email or letter

Among those who expressed dislike of the phone delivery method, these were the principal concerns:

• The timing of the call, especially if at work or in another nonprivate location
• Screening for unknown number could be a potential barrier to receiving results
• Lack of confidentiality (ie, confirming the identity of the caller, was the call being recorded)
• Personal safety, especially for those who don’t take their results well and could self-harm
• Feeling awkward or unprepared at receiving results over the phone

Suggestions for improving phone delivery were also suggested, and they included the following:

• There needs to be more frequent follow-up after the first call that delivers HIV-positive results
• Provide more emotional support is necessary, even if it’s just to listen
• Reiterate that HIV is a treatable, chronic disease with adherence to antiretroviral therapies

“The emergence of an array of testing options call for greater understanding of the acceptability of novel avenues of HIV results delivery,” the authors conclude. “Phone delivery of HIV-positive results may obviate some of the hurdles to in-person testing, while maintaining direct linkage to care and some of the features of emotional support afforded by in-person counseling.”

They suggest additional study in expanding telehealth into the HIV testing space, especially in light of the coronavirus disease pandemic; investigating the acceptability of remote delivery of HIV-positive results among diverse populations with a higher risk of contracting the virus; and determining the optimal level of contact for MSM receiving results over the phone.

Reference

D’Angelo AB, Morrison CA, Lopez-Rios J, et al. Experiences receiving HIV-positive results by phone: acceptability and implications for clinical and behavioral research. AIDS Behav. Published online September 11, 2020. doi:10.1007/s10461-020-03027-5​