By Dr. Nickolas Zaller
Dr. Nickolas Zaller is an Associate Professor in the Department of Health Behavior and Health Education and Director of the Office of Global Health at the University of Arkansas for Medical Sciences. On November 7th he was in Nashville and gave a talk at the Vanderbilt Institute for Global Health weekly Grand Rounds.
Dr. Zaller’s talk focused on mHealth to promote HIV self-testing among men who have sex with men (MSM) in Hefei, Anhui Province, China. Interestingly, HIV started in China primarily with unsafe practices surrounding rural blood donations for money. Currently, HIV risk is highest among MSM in China with rates growing compared to other high-risk populations such as sex workers. This is compounded by low rates of HIV testing among MSM.
It is in this context that Dr. Zaller and his team hope to develop a mobile platform to promote self-testing among MSM as a potentially scalable model applicable in other locations. He sees this as breaking the cycle in which the stigma of even going to a testing site combined with the fear of a positive result prevent men from getting tested. By offering self-testing at home, there is no stigma associated with going to a testing location and the barrier to entry is lower.
The natural tradeoff that comes with self-testing is the inability to counsel patients during a clinic visit. Dr. Zaller hopes to preempt this with a mobile education platform to improve HIV knowledge. Taking into account local context, this platform will be built through WeChat. While not very common in the United States, WeChat is the most common messaging platform in the world, and 25% of adult Internet users report using it. It is also by far the most common in the region.
The ultimate goal is to push educational information directly to users’ phones to both promote testing and improve HIV knowledge in this high-risk group. Dr. Zaller plans to complete a randomized controlled trial among men over 18 who self-identify as MSM with some receiving the messages and others not. Testing rates as well as other metrics—such as high-risk behavior—will be compared between the two groups. Once the content has been refined, it is potentially scalable to other cities and contexts.
The group has already performed qualitative interviews with potential participants to begin getting feedback on self-testing and the learning platform. People generally thought the test was easy and reported that it afforded improved privacy over going to a testing center. Participants were concerned about the accuracy of home testing and stated there was an inherent loss of privacy in physically purchasing the test. While they acknowledged the potential to buy tests online, they had less faith in these tests because of the potential for fakes. For the learning platform, they emphasized the need for a mix of both formal educational materials and fresh content to keep people interested. They also emphasized the need for privacy when content is pushed to a person’s phone to make sure others would not see it.
In summary, Dr. Zaller and his team aim to improve testing coverage among MSM in a scalable model using a mobile learning platform and self-testing.