5 myers hiv self-testing in new york city

HIV SELF-TESTING IN
NEW YORK CITY (NYC)
Julie Myers, MD, MPH
Director, HIV Prevention
New York City Department of Health and Mental Hygiene
Instructor in Medicine
Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center
CROI – Innovations in HIV Self-Testing, February 23, 2015

Overview
¨  Context in NYC
¤  Acceptability
¤  Availability and accessibility in pharmacies
¤  Attitudes and practices among pharmacists
¨  Self-Test Giveaway Pilot

Acceptability of Rapid Home HIV Test
¨  2006 Community Health Survey (CHS) (n=9,683)
¤  Annual telephone survey of adult NYC residents (age≥18)
¤  Landline telephones only
¨  Primary outcome: "If a rapid home test kit for HIV was available
and you could get results within 20 minutes at home, would you
use such a kit?“
¨  Results: Overall, 56.2% (95%CI: 54.7, 57.7) of adult NYC
respondents (18-64 years) who answered this question
reported that they would use a rapid home HIV test
Myers, J. et al., AJPH 2014.

Factors Associated with Acceptability of
Use of Rapid Home HIV Test Kits†
Characteristic Adjusted OR
(95%CIs)
Age group (years)
18-24 2.08 (1.58, 2.74)***
25-44 1.47 (1.27, 1.70)***
45-64 Referent
Race/ethnicity
White, non-Hispanic Referent
Black, non-Hispanic 3.52 (2.92, 4.25)***
Hispanic 4.10 (3.42, 4.92)***
Other 1.31 (1.04, 1.64)*
Sexual partners in past 12 mos.
None Referent
One 0.99 (0.83, 1.19)
Two or more 2.29 (1.73, 3.05)***
HIV test in past 12 mos. 1.37 (1.16, 1.61)**
† Controlling for sex and MSM behavior.
*p<0.05, **p<0.001, ***p<0.0001 Myers, J. et al., AJPH 2014.

Financial Consideration?
¨  Among those who would use a rapid home test kit:
¤  41% had a household income <200% of the federal poverty level
¤  25% did not get needed medical care/fill a prescription due to cost in
previous 12 mos.
52% might encounter financial barriers
to kit purchase at retail prices
Myers, J. et al., AJPH 2014.

¨  Conducted in-person during June-August, 2013
¤  Requested kit at pharmacy counter
¤  Visually inspected entire pharmacy for kit
¨  Definitions:
¤  Availability: Rapid HIV self-test kit present in store on day of survey;
¤  Accessibility: Doesn’t require interaction with the pharmacist/pharmacy
technician before purchase (i.e., not behind pharmacy counter; not locked in
any way);
¤  Price: Retail price on box/on shelf.
Survey of HIV Self-Tests in NYC Pharmacies
Myers, J. et al., CROI 2014.

2568
875
Pharmacies in High MN*
Pharmacies Included in Sample
844
Pharmacies in Mid MN*
849
Pharmacies in Low MN*
250
Pharmacies sampled
250
Pharmacies sampled
Not sampled
>99% of eligible
pharmacies were
surveyed.
161
Pharmacies
surveyed
200
Pharmacies
surveyed
100% of eligible
pharmacies were
surveyed.
•  Of all NYC pharmacies (n=2568), 19% were sampled.
•  >99% of eligible pharmacies in the sample were surveyed.
•  Of surveyed pharmacies, 24% were chain pharmacies.
*Low MN, low morbidity neighborhoods; High MN, high morbidity neighborhoods Myers, J. et al., CROI 2014.

Results
Availability, Accessibility of Rapid HIV Self-Test Kit in Low MN vs. High MN
n=361 n=161 n=200
27%
30%
24%
10%
12%
8%
0%
5%
10%
15%
20%
25%
30%
35%
All Low MN High MN
Availability
Accessibility

Results
Chain vs. Independent Pharmacies
¨ Availability was greater in chain (vs. independent)
pharmacies (84% vs. 9%, p<0.01)
¨ Accessibility was greater in chain (vs. independent)
pharmacies (48% vs. 8%, p<0.01)

Results
Price
All
(n=97)
LowMN
(n=49)
HighMN
(n=48) P-value
n (%) n (%) n (%)
Price in USD median (range)
42.99
(32.99, 50.00)
42.00
(39.99, 49.99)
42.21
(32.99, 50.00) 0.70
Product Price in NYC Pharmacies in Low MN vs. High MN*
*Low MN, low morbidity neighborhoods; High MN, high morbidity neighborhoods

Survey of Pharmacists:
Attitudes and Practices
¨  Approach:
¤ Supervising pharmacists surveyed in 250 randomly-sampled
pharmacies in high-burden neighborhoods in NYC
¤ Surveys completed online, by fax during June-August, 2014
Reid, A. et al., NYC Epidemiology Forum, February 2015

Results: 42% Participation
¨  39% (41/104) reported having HIV self-test available
¤  Higher than earlier availability study (27%)
¨  Among the 41 pharmacies where the self-test was available:
¤  82% felt very comfortable explaining the self-test
¤  33% fielded questions about the test once a month or more
¤  84% very/somewhat likely to express interest in further training on
self-test
Reid, A. et al., NYC Epidemiology Forum, February 2015

Context in NYC: Summary
¨  Over half of NYC adults reported that they would use a rapid
HIV test kit at home
¨  Interest high among subpopulations with:
¤  Greatest burden of disease (e.g., young people, blacks, Hispanics)
¤  Self-reported risk behavior (e.g., multiple sex partners)
¤  Recent HIV testing
¨  Affordability of the kit may be an issue
¨  Self-test only available in fraction of pharmacies
¨  Pharmacists comfortable providing information on self-testing
¤  However, consumer questions about self-test are infrequent

Self-Test Giveaway Pilot
¨  Hypothesis: Obstacles, including cost, inconvenience, and
stigma, continue to prevent at-risk persons in NYC from regular
HIV testing

Formative Work
Programs Reviewed
¨  NYC DOHMH Nicotine Patch and Gum Program
¨  London-area HIV Home Specimen Collection Programs
¨  Los Angeles Home Test Voucher Program
¨  Washington State DOH Home Test Giveaway
Conclusions
¨  Time-limited campaigns for promotion are highly effective1
¨  Home testing preferred to home collection2
¨  Pharmacy vouchers eliminate barrier of cost but not of stigma/discomfort3
¨  Passive distribution of follow-up surveys yields low response3,4
1Davis et al., Health Promotion Practice 2013; 2Brady, M., personal communication;
3Marlin et al., BMC Public Health 2014; 4Katz, D., personal communication.

Planned Pilot Details
¨  Approach:
¨  Distribution of 2,000 new HIV in-home HIV test kits at no charge by mail,
bypassing pharmacy and pharmacist interaction
¨  Focus on MSM and transgender women
¨  Promotion: MSM websites and apps, social media, NYC DOHMH
website
¨  Eligibility (online survey): Sexually-active MSM and transgender
women in NYC (by ZIP), age 18 and older, HIV-negative
¨  Timeline:
¤  Anticipated launch: Spring 2015
¤  End date: While supplies last

Views campaign
advertising and clicks
link to eligibility
questions
Answers basic eligibility
questions
(SurveyMonkey)
Receives promo code
(emailed) is directed to
OraSure website to
place order
(gives name/address)
Directed to NYC HIV
prevention and care
resources
Receives
follow-up
survey by
email
Receives test
package by
mail
If eligible
If ineligible
Pilot Flowchart
4-6 weeks
Incentive:
Chance to
win $500

Package Contents
The Kit
Testing Insert
PrEP/PEP insert

Evaluation
¨  Follow-up survey emailed 4-6 weeks after the order to determine:
¤ Ability to reach to target population
¤ Acceptability of self-testing modality
¤ HIV risk and prevention behaviors

More on Self-Testing in NYC
¨  Poster Session P-Y3, Wednesday, 2:30-4:00pm
¨  HIV Testing: Innovations and Scale-Up
Abstract: 1097
Home HIV Testing and Medical Care: Doing the Right Thing
Authors: Charulata J. Sabharwal; Sharmila Shah; Chi-Chi N. Udeagu
New York City Department of Health and Mental Hygiene, Queens, NY, US

Acknowledgements
¨  Demetre Daskalakis, MD, MPH
¨  Zoe Edelstein, PhD
¨  Amina Khawja, MPH
¨  Paul Kobrak, PhD
¨  Amanda Reid
¨  Julia Schillinger, MD, MSc
¨  Kent Sepkowitz, MD
¨  Benjamin Tsoi, MD

Thank you!
Contact:
Julie Myers, MD, MPH
NYC DOHMH, CUMC
Tel: (347) 396-7761
Email: jmyers@health.nyc.gov

Results
76%
70%
82%
24%
30%
16%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
All Low MN High MN
Independent
Chain
n=361 n=161 n=200
Characteristics of Surveyed Pharmacies

Acceptability of Home Rapid Test Kits for HIV Among NYC
Adults (18-64 yrs.) by Demographic Characteristic, 2006
56 57
70
59
46
40
71
73
44
0
10
20
30
40
50
60
70
80
90
100
Race/EthnicityAge (yrs.)Sex
AdjustedEstimate(%)

Acceptability of Home Rapid Test Kits for HIV Among NYC
Adults (18-64 yrs.) by Behavioral Characteristics, 2006
58
55
74 68
57
68
51
0
10
20
30
40
50
60
70
80
90
100
None One Two or
more
MSM Non-
MSM
Tested Not
tested
HIV test
(past 12 mos.)
Sexual behavior
(past 12 mos.)
Number of sex partners
(past 12 mos.)
AdjustedEstimate(%)

2568
875
Pharmacies in High MN
Pharmacies Included in Sample
844
Pharmacies in Mid MN
849
Pharmacies in Low MN
250
Pharmacies sampled
250
Pharmacies sampled
161
Pharmacies eligible
89
Ineligible pharmacies
-  3 closed
-  16 non-retail
-  70 too far from a subway
station
49
Ineligible pharmacies:
-  5 closed
-  16 non-retail
-  27 too far from a subway
station
-  1 insufficient info.
201
Pharmacies eligible
Not sampled
>99% of eligible pharmacies
were surveyed.
161
Pharmacies surveyed
200
Pharmacies surveyed
100% of eligible pharmacies
were surveyed.
•  Of all NYC pharmacies (n=2568), 19% were sampled.
•  >99% of eligible pharmacies in the sample were surveyed.
Low MN, low morbidity neighborhoods; High MN, high morbidity neighborhoods

Receive Questions on Home Test
Response Category n (%)
Never 9 (23.1)
< 1/mo 17 (43.6)
1/mo 10 (25.6)
1/wk 2 (5.1)
1/day 1 (2.6)
I prefer not to answer 1 (--)
MISSING 66 (--)
Total 106 (100.0)
Reid et al., (unpublished data), NYC Epidemiology Forum, February 2015

Results
15% 3%
82%
Very uncomfortable
Somewhat uncomfortable
Somewhat comfortable
Very comfortable
*Only assessed among pharmacists working in pharmacies with the self-test available
Pharmacist Comfort Explaining Self-Test*(N=39)
Reid et al., (unpublished data), NYC
Epidemiology Forum, February 2015

Results
3%
13%
31%
53%
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
Likelihood of Interest in Additional Training on the Self-Test* (N=38)
*Only assessed among pharmacists working in pharmacies with the self-test available
Reid et al., (unpublished data), NYC
Epidemiology Forum, February 2015

5 myers hiv self-testing in new york city

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5 myers hiv self-testing in new york city