1. Among 3647 MSM not using SMS prior to PS interview. Bold = p<0.05.
Uptake and Impact of Short Message Service (SMS) Reminders via STI Partner Services (PS) on HIV/STI Testing Frequency among Men Who Have Sex with Men (MSM)
Keshet Ronen1, Matthew R. Golden1,2, Julia C. Dombrowski1,2, Roxanne P. Kerani1,2, Teal R. Bell3, David A. Katz1,2
1 University of Washington, 2 Public Health – Seattle & King County, 3 Washington State Department of Health
Contact:
Background
Table 1. Characteristics of MSM offered SMS testing reminders through STI PS,
Table 2. Correlates of SMS testing reminder uptake
STI PS are an opportunity to provide HIV/STI prevention interventions to high-risk MSM.
Use of SMS testing reminders has been proposed as a means of increasing HIV/STI testing frequency, but limited data exist on its efficacy, especially from implementation in public health practice.
In King County, WA, PS attempt to reach all MSM with early syphilis and those with gonorrhea or chlamydia as resources allow.
Since July 2013, PS have offered quarterly SMS testing reminders to interviewed MSM.
Among 3647 MSM not using SMS prior to PS interview. Bold = p<0.05.
Univariable
Multivariable
RR (95% CI)
Calendar year of diagnosis
0.57 ( )
0.59 ( )
Age
10-24
Ref
25-34
0.62 ( )
0.81 ( )
35-44
0.48 ( )
0.65 ( )
45+
0.42 ( )
0.56 ( )
Race/ethnicity
White
Black
1.35 ( )
1.30 ( )
Asian
1.50 ( )
1.27 ( )
Latino
1.55 ( )
1.24 ( )
Other
1.63 ( )
1.27 ( )
STI
Gonorrhea (no syphilis)
Any syphilis
0.15 ( )
0.27 ( )
Chlamydia only
1.38 ( )
1.50 ( )
HIV status
HIV-negative not on PrEP
HIV-negative on PrEP
0.25 ( )
0.30 ( )
HIV-positive
0.51 ( )
0.35 ( )
Diagnosed by HIV/STD specialist
1.23 ( )
1.08 ( )
Insured
0.52 ( )
0.77 ( )
Used methamphetamine
0.91 ( )
Used inhaled nitrates
0.15 ( )
1.04 ( )
Injected drugs
1.05 ( )
Number of sex partners in last year
1.00 ( ) N
n (%) or median (IQR)
Age
3908
≤24
1070 (27.4)
25-34
1611 (41.2)
35-44
771 (19.7)
≥45
756 (19.3)
Race/ethnicity a
3883
White
2413 (62.1)
Black
258 (6.6)
Asian
282 (7.3)
Latino
705 (18.2)
Other
225 (5.8)
STI
3909
Gonorrhea (no syphilis)
2255 (57.7)
Any syphilis
431 (11.0)
Chlamydia only
1223 (31.3)
HIV status
Negative
2968 (75.9)
Previous positive
910 (23.3)
Newly diagnosed positive
31 (0.8)
PrEP user b
2429
743 (30.6)
Diagnosed by HIV/STD specialist
2699 (69.1)
Insured
3683
3088 (83.8)
Used methamphetamine
3651
295 (8.1)
Used inhaled nitrates
3658
964 (26.4)
Injected drugs
3639
134 (3.7)
Number of sex partners in last year
3406
6 (3-12)
Objectives
To evaluate level and correlates of SMS reminder uptake among all MSM interviewed by PS.
To evaluate impact of SMS reminders on STI testing frequency among HIV-negative MSM.
Methods
Data from PS interviews in July 1, 2013 – January 17, 2018 were used.
Starting in February 2014, clients who refused SMS reminders were asked if they used another type of reminder.
Correlates of SMS acceptance among all MSM were identified by Poisson regression with robust standard errors. All variables associated in univariable analysis at p<0.1 we included in multivariable analysis.
The impact of reminders on testing frequency was evaluated by comparing time from last HIV test to asymptomatic STI diagnosis among HIV-negative MSM by Mann-Whitney test. Asymptomatic STI was defined as rectal or pharyngeal chlamydia or gonorrhea, urethral chlamydia without symptoms, or early latent syphilis.
For clients with multiple recorded PS visits at which they were offered SMS reminders, the first non-null response was included in this analysis.
a Individuals of any race who identify as Latino are classified as Latino. All other groups are non-Latino.
b Among HIV-negative
Figure 1. Uptake of SMS and other testing reminders
Table 3. Association between reminder use and STI testing frequency
Uptake among 3909 MSM offered SMS
Other reminder use among 2485 who refused
Time from last HIV test to diagnosis of asymptomatic STI among HIV-negative MSM
Summary n
Months since last test
Median (IQR)
p-value
SMS reminder *
167
4.8 ( )
Ref
Non-SMS reminder
715
3.6 ( )
<0.001
Physical exam 50
9.6 ( )
0.003
No reminder
495
5.6 ( )
0.11
Unknown
488
5.1 ( )
Offering SMS testing reminders by PS was feasible, but uptake was low.
Uptake was associated with earlier calendar year of diagnosis, younger age, non-syphilis STI, HIV status and PrEP use.
MSM employed diverse methods to remind themselves to test or integrate testing into primary care.
MSM using non-SMS reminders had the shortest testing interval.
SMS testing reminders may be a useful tool to support testing among young HIV-negative MSM who are not engaged in other services.
* Includes SMS received via PS or through other means
We thank the Public Health Seattle & King County (PHSKC) disease intervention specialists for their work conducting partner services as well as PHSKC epidemiology and data management staff for their work on the supplemental database. This program and its evaluation were supported by the CDC [H25 PS004364]; the Washington State Department of Health; and PHSKC. The evaluation was also supported by the NIH [P30 AI027757].
Other reminders: smartphone app, phone calendar, note to self