Smartphone Applications to Support Tuberculosis Prevention and Treatment: Review and Evaluation

Background: Tuberculosis (TB) remains a major global health problem and is the leading killer due to a single infectious disease. Mobile health (mHealth)–based tools such as smartphone apps have been suggested as tools to support TB control efforts (eg, identification, contact tracing, case management including patient support). Objective: The purpose of this review was to identify and assess the functionalities of mobile apps focused on prevention and treatment of TB. Methods: We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (eg, inform, instruct, record), and searches were conducted to identify peer-review publications of rigorous testing of the available apps. Results: A total of 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n=17); few (n=4) apps were patient focused. Most apps (n=17) had 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Of more concern, some apps provided potentially harmful information to patients, such as links to natural remedies for TB and natural healers. One-third of the apps (8/24) had not been updated for more than a year and may no longer be supported. Peer-reviewed publications were identified for only two of the included apps. In the gray literature (not found in the app stores), three TB-related apps were identified as in progress, being launched, or tested. Conclusions: Apps identified for TB prevention and treatment had minimal functionality, primarily targeted frontline health care workers, and focused on TB information (eg, general information, guidelines, and news) or data collection (eg, replace paper-based notification or tracking). Few apps were developed for use by patients and none were developed to support TB patient involvement and management in their care (eg, follow-up alerts/reminders, side effects monitoring) or improve interaction with their health care providers, limiting the potential of these apps to facilitate patient-centered care. Our evaluation shows that more refined work is needed to be done in the area of apps to support patients with active TB. Involving TB patients in treatment in the design of these apps is recommended

Sexual risk and preventive behaviors of men : Results from a Portuguese online survey

Pretendeu-se com a pesquisa realizada estudar e comparar padrões de testagem em relação ao VIH; resultados do teste para o VIH; e comportamentos sexuais preventivos de homens homo, hetero e bissexuais. Os dados foram recolhidos através de um questionário on-line. A amostra foi constituída por 732 participantes com idade média de 32,2 anos, dos quais 53,7% identificaram-se como homossexual/gay; 27,4%, como heterossexual; e 18,3%, como bissexual, refletindo a divulgação privilegiada do estudo junto a organizações de lésbicas, gays, bissexuais e transgênero (LGBT). Nunca tinham realizado o teste para o VIH 26,6% dos participantes; 7,2% indicaram ser portadores do HIV. Homens gays apresentaram níveis significativamente mais elevados de testagem para o VIH e de soropositividade, quando comparados com os restantes. No geral, verificou-se ainda que homens gays indicaram ter mais comportamentos preventivos. Todos os grupos estudados apresentaram padrões comportamentais específicos e diferenciados em relação ao VIH. Conclui-se que são de grande importância intervenções comportamentais desenhadas à medida das necessidades dos diferentes grupos estudados, em particular junto aos homens heterossexuais e gays.ABSTRACT: The purpose of this study was to analyse and compare gay, heterosexual and bisexual men’s HIV testing patterns, HIV test results, and sexual preventive behaviours. Data were collected through an online survey. The study’s sample included 732 participants who met the selection criteria. Average age of participants was 32.2 years; 53.7% self-identified as gay, 27.4% as heterosexual, and 18.3% as bisexual. This distribution reflects the fact that the study was mostly publicized using LGBT networks. A total of 26.6% had never tested for HIV; 7.2% said they were HIV-positive. Gay men had significantly higher levels of HIV testing as well as rates of HIV infection when compared with the other groups. Overall, gay men displayed a larger variety of prevention strategies. All the groups under study showed specific and differentiated behavioural profiles with regard to HIV. We conclude that more efficient and tailored campaigns need to be developed to address each group’s specific HIV prevention needs, in particular heterosexual and gay men’s

Comportamentos sexuais de risco e preventivos masculinos: resultados de uma amostra recolhida através da internet em Portugal

The purpose of this study was to analyse and compare gay, heterosexual and bisexual men's HIV testing patterns, HIV test results, and sexual preventive behaviours. Data were collected through an online survey. The study's sample included 732 participants who met the selection criteria. Average age of participants was 32.2 years; 53.7% self-identified as gay, 27.4% as heterosexual, and 18.3% as bisexual. This distribution reflects the fact that the study was mostly publicized using LGBT networks. A total of 26.6% had never tested for HIV; 7.2% said they were HIV-positive. Gay men had significantly higher levels of HIV testing as well as rates of HIV infection when compared with the other groups. Overall, gay men displayed a larger variety of prevention strategies. All the groups under study showed specific and differentiated behavioural profiles with regard to HIV. We conclude that more efficient and tailored campaigns need to be developed to address each group's specific HIV prevention needs, in particular heterosexual and gay men's.Pretendeu-se com a pesquisa realizada estudar e comparar padrões de testagem em relação ao VIH; resultados do teste para o VIH; e comportamentos sexuais preventivos de homens homo, hetero e bissexuais. Os dados foram recolhidos através de um questionário on-line. A amostra foi constituída por 732 participantes com idade média de 32,2 anos, dos quais 53,7% identificaram-se como homossexual/gay; 27,4%, como heterossexual; e 18,3%, como bissexual, refletindo a divulgação privilegiada do estudo junto a organizações de lésbicas, gays, bissexuais e transgênero (LGBT). Nunca tinham realizado o teste para o VIH 26,6% dos participantes; 7,2% indicaram ser portadores do HIV. Homens gays apresentaram níveis significativamente mais elevados de testagem para o VIH e de soropositividade, quando comparados com os restantes. No geral, verificou-se ainda que homens gays indicaram ter mais comportamentos preventivos. Todos os grupos estudados apresentaram padrões comportamentais específicos e diferenciados em relação ao VIH. Conclui-se que são de grande importância intervenções comportamentais desenhadas à medida das necessidades dos diferentes grupos estudados, em particular junto aos homens heterossexuais e gays

HIV testing practices among men who have sex with men in Buenos Aires, Argentina

The objective of the study was to explore HIV-testing practices among men who have sex with men (MSM) in Buenos Aires, Argentina, in light of current international health guidelines that recommend frequent HIV testing for MSM who engage in high-risk behavior. Participants, who were recruited using respondent-driven sampling (RDS), were 500 mostly young, nongay-identified MSM of low socioeconomic status, high levels of unemployment, living mainly in the less-affluent areas surrounding Buenos Aires, and lacking health insurance. They provided blood samples for HIV testing and responded to a Computer Assisted Self Interview. Fifty-two percent had never been tested for HIV, and 20% had been tested only once; 17% were found to be HIV infected, of whom almost half were unaware of their status. Main reasons for never having tested previously were: not feeling at risk, fear of finding out results, and not knowing where to get tested. Among those previously tested, men had been tested a median of 2 times with their most recent test having occurred a median of 2.7 years prior to study enrollment. Of those who had not tested positive before entering the study, only 41% returned for their results. HIV testing was infrequent and insufficient for early detection of infection, entry into treatment, and protection of sexual partners. This was particularly the case among nongay-identified MSM. Testing campaigns should aim to help MSM become aware of their risk behavior, decrease fear of testing by explaining available treatment resources and decreasing the stigma associated with HIV, and by publicizing information about free and confidential testing locations. Rapid HIV testing should be made available to eliminate the need for a return visit and make results immediately available to individuals who are tested.Fil: Carballo Diéguez, Alex. Columbia University; Estados UnidosFil: Balán, Iván C.. Columbia University; Estados UnidosFil: Dolezal, Curtis. Columbia University; Estados UnidosFil: Pando, María de los Ángeles. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia para el Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Marone, Ruben. Nexo Asociación Civil; ArgentinaFil: Barreda, Victoria. Nexo Asociación Civil; ArgentinaFil: Ávila, María Mercedes. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia para el Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentin

The Internet profiles of men who have sex with men within bareback websites

The Internet has become a venue for men who have sex with men to search for sexual partners. Some of these men intentionally seek unprotected anal intercourse with other men (‘bareback’ sex). This paper focuses on the creation, use, and content of Internet personal profiles of men who have sex with men in the greater New York City metropolitan area who use bareback sites for sexual networking. We used a mixedmethods approach to examine data from a cybercartography of Internet sites conducted during the first phase of the research (199 personal profiles) and from in-depth interviews conducted during its second phase (120 men who have sex with men who sought partners online for bareback sex). Results indicate that men generally followed offline stereotypical patterns in their online profiles. However, men who disclosed being HIV-positive were more likely to include face and head pictures. Overall, the images they used were heavily sexualised in accordance with group norms perceived and reinforced by the websites’ design and imagery. Bottom-identified men tended to be more explicit in the exposition of their sexual and drug use interests online. This paper highlights how certain virtual and social performances play upon and reinforce other, in the flesh, performances

Presentación del estudio “Links” de hombres que tienen sexo con hombres en Buenos Aires, Argentina

Estudios previos en Buenos Aires reportaron altas prevalencias de HIV entre HSH, con valores que oscilan entre 9 y 14% durante casi 10 años de continuo testeo. El objetivo principal de este estudio fue la evaluación de factores relacionados al comportamiento de alto riesgo para transmisión del HIV entre HSH entre los que se incluyen el conocimiento y factores emocionales, socioculturales y ambientales. Por otro lado se realizó la estimación de prevalencia e incidencia de HIV utilizando RDS (Respondent Driven Sampling), así como la presencia de otras infecciones de transmisión sexual. Por último se evaluaron los hábitos de testeo para HIV indagando que factores facilitan o impiden su realización. El estudio constó de dos fases, en primer lugar una fase cualitativa y posteriormente una fase cuantitativa con una duración total de 4 años y medio. Durante la fase cualitativa se realizaron 44 entrevistas individuales en profundidad, 8 grupos focales y 10 observaciones etnográficas (hoteles, baños públicos (“teteras”), cines pornográficos, fiestas privadas, dark rooms y discotecas). Durante la fase cuantitativa del estudio se realizó el reclutamiento de 500 participantes que provinieron de la Ciudad Autónoma de Buenos Aires, así como del Gran Buenos Aires. El reclutamiento se comenzó con 16 participantes llamados semillas. Se realizó el diagnóstico de infección por HIV, hepatitis B y C (HBV y HCV), Treponema pallidum, Virus Papiloma Humano (HPV) y Chlamidias.Fil: Carballo Diéguez, Alex. Columbia University; Estados Unidos. New York State Psychiatric Institute; Estados UnidosFil: Avila, Maria Mercedes. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Balán, Iván C.. Columbia University; Estados Unidos. New York State Psychiatric Institute; Estados UnidosFil: Marone, Rubén. Nexo Asociación Civil; ArgentinaFil: Pando, Maria de Los Angeles. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Barreda, Victoria. Nexo Asociación Civil; Argentin

Cartographic Analysis of Antennas and Towers: A Novel Approach to Improving the Implementation and Data Transmission of mHealth Tools on Mobile Networks

Background: Most mHealth tools such as short message service (SMS), mobile apps, wireless pill counters, and ingestible wireless monitors use mobile antennas to communicate. Limited signal availability, often due to poor antenna infrastructure, negatively impacts the implementation of mHealth tools and remote data collection. Assessing the antenna infrastructure prior to starting a study can help mitigate this problem. Currently, there are no studies that detail whether and how the antenna infrastructure of a study site or area is assessed. Objective: To address this literature gap, we analyze and discuss the use of a cartographic analysis of antennas and towers (CAAT) for mobile communications for geographically assessing mobile antenna and tower infrastructure and identifying signal availability for mobile devices prior to the implementation of an SMS-based mHealth pilot study. Methods: An alpha test of the SMS system was performed using 11 site staff. A CAAT for the study area’s mobile network was performed after the alpha test and pre-implementation of the pilot study. The pilot study used a convenience sample of 11 high-risk men who have sex with men who were given human immunodeficiency virus test kits for testing nonmonogamous sexual partners before intercourse. Product use and sexual behavior were tracked through SMS. Message frequency analyses were performed on the SMS text messages, and SMS sent/received frequencies of 11 staff and 11 pilot study participants were compared. Results: The CAAT helped us to successfully identify strengths and weaknesses in mobile service capacity within a 3-mile radius from the epicenters of four New York City boroughs. During the alpha test, before CAAT, 1176/1202 (97.84%) text messages were sent to staff, of which 26/1176 (2.21%) failed. After the CAAT, 2934 messages were sent to pilot study participants and none failed. Conclusions: The CAAT effectively illustrated the research area’s mobile infrastructure and signal availability, which allowed us to improve study setup and sent message success rates. The SMS messages were sent and received with a lower fail rate than those reported in previous studies

HIV status disclosure among infected men who have sex with men (MSM) in Buenos Aires, Argentina

Five hundred men who have sex with men were recruited in Buenos Aires using respondent driven sampling. Of them, 46 respondents (24 of them not gay identified) who were HIV infected were asked questions on serodisclosure. The sample was characterized by indicators of low socioeconomic status. Most of the respondents reported being in good to excellent health despite 42% of them having been diagnosed with AIDS. Only 10% of respondents had not disclosed their serostatus to at least one person. Coworkers and lovers or main sexual partners were those most likely to know the respondents' serostatus. Reactions to disclosure were for the most part supportive. Those who had not disclosed anticipated less favorable reactions than those who had disclosed. No significant differences were observed between gay and non-gay identified respondents. The progressive social environment of Argentina that includes federal laws recognizing gay marriage may contribute to create a climate favorable for serostatus disclosure.Fil: Carballo Diéguez, Alex. HIV Center for Clinical and Behavioral Studies; Estados UnidosFil: Balan, Iván C.. HIV Center for Clinical and Behavioral Studies; Estados UnidosFil: Dolezal, Curtis. HIV Center for Clinical and Behavioral Studies; Estados UnidosFil: Ibitoye, Mobolaji. HIV Center for Clinical and Behavioral Studies; Estados UnidosFil: Pando, Maria de Los Angeles. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Marone, Ruben. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Nexo Asociación Civil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Barreda, Victoria. Nexo Asociación Civil; ArgentinaFil: Avila, Maria Mercedes. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Microbiología. Centro Nacional de Referencia del Sida; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Use of Respondent Driven Sampling (RDS) Generates a Very Diverse Sample of Men Who Have Sex with Men (MSM) in Buenos Aires, Argentina

Prior research focusing on men who have sex with men (MSM) conducted in Buenos Aires, Argentina, used convenience samples that included mainly gay identified men. To increase MSM sample representativeness, we used Respondent Driven Sampling (RDS) for the first time in Argentina. Using RDS, under certain specified conditions, the observed estimates for the percentage of the population with a specific trait are asymptotically unbiased. We describe, the diversity of the recruited sample, from the point of view of sexual orientation, and contrast the different subgroups in terms of their HIV sexual risk behavior.500 MSM were recruited using RDS. Behavioral data were collected through face-to-face interviews and Web-based CASI.In contrast with prior studies, RDS generated a very diverse sample of MSM from a sexual identity perspective. Only 24.5% of participants identified as gay; 36.2% identified as bisexual, 21.9% as heterosexual, and 17.4% were grouped as "other." Gay and non-gay identified MSM differed significantly in their sexual behavior, the former having higher numbers of partners, more frequent sexual contacts and less frequency of condom use. One third of the men (gay, 3%; bisexual, 34%, heterosexual, 51%; other, 49%) reported having had sex with men, women and transvestites in the two months prior to the interview. This population requires further study and, potentially, HIV prevention strategies tailored to such diversity of partnerships. Our results highlight the potential effectiveness of using RDS to reach non-gay identified MSM. They also present lessons learned in the implementation of RDS to recruit MSM concerning both the importance and limitations of formative work, the need to tailor incentives to circumstances of the less affluent potential participants, the need to prevent masking, and the challenge of assessing network size

High Substance Use and HIV Risk Behavior Among Young Argentine Men Who Have Sex with Men

In the United States young men who have sex with men have higher rates of substance use, higher HIV incidence, and less frequent HIV testing than their heterosexual counterparts and older MSM. Less is known about comparable populations in Latin America. As part of an epidemiological study, MSM were recruited through Respondent Driven Sampling in the metropolitan area of Buenos Aires, Argentina and answered a computerized behavioral survey. From the total of 500 MSM enrolled, a sub-sample of 233 aged 18?25 was analyzed. The sample was concentrated among lower socioeconomic strata, and only 16% identified as gay. Nearly half reported male, female, and transvestite sexual partners. Reported substance use was widespread ranging from 61% for marijuana to 20% for pasta base (cocaine sulfate). Seventy percent of the sample had never been tested for HIV infection; 3% tested positive for HIV and 8% for syphilis during the study.En los Estados Unidos, los hombres jóvenes que tienen sexo con hombres (JHSH) tienen tasas de uso de sustancias más altas de los HSH de mayor edad y de sus pares heterosexuales, además de una mayor incidencia del VIH y menor frecuencia de hacerse el examen del VIH. De las poblaciones comparables en América Latina, se conoce menos. Como parte de un estudio epidemiológico, 500 HSH fueron reclutados a través del método de Muestreo Dirigido por los Participantes (en inglés RDS) en el área metropolitano de Buenos Aires, Argentina y contestaron una encuesta conductual computarizada. Una submuestra de 233 hombres de 18 a 25 años de edad fue analisada. Se concentró en estratos socioeconómicos más bajos y sólo el 16% se identificaron como gay. Casi la mitad de la submuestra reportó haber tenido parejas sexuales masculinas, femeninas y travestíes. El uso de sustancias fue común, desde 61% consumidores de marihuana hasta 20% sulfato de cocaína (pasta base). El 70% de la muestra nunca se había hecho una prueba para el VIH: 3% resultaron positivos para VIH y 8% para sífilis en el transcurso del estudio.Fil: Balán, Iván C.. New York State Psychiatric Institute; Estados Unidos. Columbia University; Estados UnidosFil: Frasca, Timothy. New York State Psychiatric Institute; Estados UnidosFil: Pando, María de los Ángeles. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Marone, Ruben. Nexo Asociación Civil; ArgentinaFil: Barreda, Victoria. Nexo Asociación Civil; ArgentinaFil: Dolezal, Curtis. New York State Psychiatric Institute; Estados Unidos. Columbia University; Estados UnidosFil: Carballo Diéguez, Alex. New York State Psychiatric Institute; Estados Unidos. Columbia University; Estados UnidosFil: Ávila, María Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentin