SMARTtest: A Smartphone App to Facilitate HIV and Syphilis Self- and Partner-Testing, Interpretation of Results, and Linkage to Care

  • Iván C. BalánEmail author
  • Javier Lopez-Rios
  • Samiksha Nayak
  • Cody Lentz
  • Siddarth Arumugam
  • Bryan Kutner
  • Curtis Dolezal
  • Ongun Uzay Macar
  • Tejit Pabari
  • Alexander Wang Ying
  • Michael Okrah
  • Samuel K. Sia
Original Paper


Acceptability of rapid HIV self-testing is high but potential users remain concerned about correct use, interpretation of test results, and linkage to care. This article describes user preferences for a smartphone app to mitigate these challenges and how these were integrated into the SMARTtest app to support self- and partner-testing using the INSTI Multiplex®. Sixty men and transgender women who have sex with men self-tested for HIV and syphilis while guided by a prototype app that provided a video, pictorial step-by-step instructions, and sample test results presented textually (“positive,” “negative”). Subsequently, participants provided feedback on revisions and additional app content. Participants recommended offering different user modes (self, partner, both), and retaining the video, step-by-step instructions, and textual test results. They strongly favored the ability to save and send test results to sexual partners or providers. These features were integrated into the SMARTtest app to facilitate HIV/syphilis self- and partner-testing, HIV/syphilis status awareness and disclosure, and linkage to care.


HIV/STI testing Smartphone technology HIV/STI prevention Linkage to care 


La aceptabilidad de las auto-pruebas rápidas del VIH es alta pero sigue habiendo preocupaciones sobre el uso correcto, la interpretación de los resultados, y el enlace a la atención médica. Este artículo describe las preferencias de usuarios para una aplicación de teléfonos inteligentes para mitigar estos retos y como estas fueron integradas a la app SMARTtest para apoyar las auto-pruebas y pruebas con parejas para VIH y sífilis con el INSTI Multiplex®. Sesenta hombres y mujeres transgénero que tienen sexo con hombres se auto-realizaron una prueba de VIH y sífilis guiados por una app prototipo que proveyó instrucciones paso-a-paso en forma de video y foto, y resultados presentados en forma de texto (“positivo,” “negativo”). Después, los participantes fueron entrevistados a fondo para proveer retroalimentación sobre posibles revisiones y contenido adicional de la app. Los participantes sugirieron incorporar diferentes modos de usuarios (Yo, Mi pareja, Ambos), recomendaron retener el video, las instrucciones paso-a-paso, y los resultados en forma textual. Ellos favorecieron fuertemente la capacidad de guardar y enviar los resultados de las pruebas a parejas o a proveedores de salud. Todas estas funciones fueron integradas en la versión final de SMARTtest para facilitar el uso de pruebas de VIH/sífilis con parejas y para auto-pruebas, el conocimiento y divulgación de estados de VIH/sífilis, y el enlace a la atención médica.



This research was supported by grants from the U.S. National Institutes of Health: R01-HD088156 (PI: I. Balán) and P30-MH43520 (PI: R. Remien). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


  1. 1.
    World Health Organization (2016). WHO recommends HIV self-testing. Accessed 10 Dec 2017.
  2. 2.
    Centers for Disease Control. (2017). HIV/AIDS special studies and diagnostics team. Accessed 10 Dec 2017.
  3. 3.
    UNAIDS. (2017). WHO, UNAIDS statement on HIV testing services: new opportunities and ongoing challenges. Accessed 10 Dec 2017.
  4. 4.
    Pai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, Peeling RW. Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. PLoS Med. 2013;10(4):e1001414.CrossRefGoogle Scholar
  5. 5.
    Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13(1):735.CrossRefGoogle Scholar
  6. 6.
    Bilardi JE, Walker S, Read T, Prestage G, Chen MY, Guy R, Bradshaw C, Fairley CK. Gay and bisexual men’s views on rapid self-testing for HIV. AIDS Behav. 2013;17(6):2093–9.CrossRefGoogle Scholar
  7. 7.
    Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015. Scholar
  8. 8.
    Fisher M, Wayal S, Smith H, Llewellyn C, Alexander S, Ison C, Brighton Home Sampling Kit Project Steering Group. Home sampling for sexually transmitted infections and HIV in men who have sex with men: a prospective observational study. PLoS ONE. 2015. Scholar
  9. 9.
    Belza MJ, Rosales-Statkus ME, Hoyos J, Segura P, Ferreras E, Sánchez R, The Madrid Rapid HIV Testing Group. Supervised blood-based self-sample collection and rapid test performance: a valuable alternative to the use of saliva by HIV testing programmes with no medical or nursing staff. Sex Transm Infect. 2012. Scholar
  10. 10.
    Lippman, S.A., Moran, M.E., Ventura, A, Castillo, L.S., Buchbinder, S., Treves-Kagan, S., & Sevelius, J. Home HIV testing among transgender women in San Francisco: A pilot feasability and acceptability study. (2015, July). Poster presented at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. Vancouver, Canada.Google Scholar
  11. 11.
    Carballo-Dieguez A, Frasca T, Dolezal C, Balán I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49(4):379–87.CrossRefGoogle Scholar
  12. 12.
    Sharma A, Chavez PR, MacGowan RJ, McNaghten AD, Mustanski B, Gravens L, Sullivan PS. Willingness to distribute free rapid home HIV test kits and to test with social or sexual network associates among men who have sex with men in the United States. AIDS Care. 2017;29(12):1499–503.CrossRefGoogle Scholar
  13. 13.
    Carballo-Dieguez A, Frasca T, Balán I, Ibitoye M, Dolezal C. Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. AIDS Behav. 2012;16(7):1753–60.CrossRefGoogle Scholar
  14. 14.
    Balán IC, Carballo-Diéguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav. 2014;18(2):254–62.CrossRefGoogle Scholar
  15. 15.
    New York City Department of Health and Mental Hygiene. (2013, updated 2015). New York City HIV/AIDS surveillance slide sets. Accessed 15 Aug 2019.
  16. 16.
    Centers for Disease Control and Prevention. (2015). HIV among transgender people. Accessed 15 Aug 2019.
  17. 17.
    Center for Disease Control and Prevention. Primary and Secondary Syphilis-united State—2005–2013. MMWR Morb Mortal Wkly Rep. 2014;63(18):402–6.Google Scholar
  18. 18.
    Centers for Disease Control and Prevention. (2014). STDs in men who have sex with men. Accessed 17 Dec 2018.
  19. 19.
    Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015;19(11):1949–65.CrossRefGoogle Scholar
  20. 20.
    Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13(1):735.CrossRefGoogle Scholar
  21. 21.
    Balán I, Frasca T, Ibitoye M, Dolezal C, Carballo-Diéguez A. Fingerprick versus oral swab: acceptability of blood-based testing increases if other STIs can be detected. AIDS Behav. 2017;21(2):501–4.CrossRefGoogle Scholar
  22. 22.
    Figueroa C, Johnson C, Ford N, Sands A, Dalal S, Meurant R, Baggaley R. Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis. The Lancet HIV. 2018;5(6):e277–90.CrossRefGoogle Scholar
  23. 23.
    Jaspard M, Le Moal G, Saberan-Roncato M, Plainchamp D, Langlois A, Camps P, Prazuck T. Finger-stick whole blood HIV-1/-2 home-use tests are more sensitive than oral fluid-based in-home HIV tests. PLoS ONE. 2014;9(6):e101148.CrossRefGoogle Scholar
  24. 24.
    Payne HE, Lister C, West JH, Bernhardt JM. Behavioral functionality of mobile apps in health interventions: a systematic review of the literature. JMIR mHealth uHealth. 2015;3(1):e20.CrossRefGoogle Scholar
  25. 25.
    Donker T, Petrie K, Proudfoot J, Clarke J, Birch MR, Christensen H. Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res. 2013;15(11):e247.CrossRefGoogle Scholar
  26. 26.
    Huang ETY, Williams H, Hocking JS, Lim MS. Safe sex messages within dating and entertainment smartphone apps: a review. JMIR mHealth uHealth. 2016;4(4):e124.CrossRefGoogle Scholar
  27. 27.
    Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods, randomized pilot study. J Acquir Immune Defic Syndr. 2015;69(1):S80.CrossRefGoogle Scholar
  28. 28.
    Amyai N, Darling KEA, D’acremont V, Castro E, Ebert S, Diserens MM, Cavassini M. A prospective multicentre study of healthcare provider preference in rapid HIV testing kits: determine versus INSTI. Int J STD AIDS. 2018;29(1):51–6.CrossRefGoogle Scholar
  29. 29.
    Bwana P, Mwau M. Performance and usability evaluation of the INSTI HIV self-test in Kenya for qualitative detection of antibodies to HIV. PLoS ONE. 2018;13(9):e0202491.CrossRefGoogle Scholar
  30. 30.
    Carballo-Dieguez A, Giguere R, Balan IC, Dolezal C, Brown W, Lopez-Rios J, Febo I. Few aggressive or violent incidents are associated with the use of HIV self-tests to screen sexual partners among key populations. JAIDS: In Press; 2019.Google Scholar
  31. 31.
    Laksanasopin T, Guo TW, Nayak S, Sridhara AA, Xie S, Olowookere OO, Sia SK. A smartphone dongle for diagnosis of infectious diseases at the point of care. Sci Transl Med. 2015;7(273):273re1.CrossRefGoogle Scholar
  32. 32.
    Lank E, Withee K, Schile L, Parker T. User centered rapid application development. In rapid integration of software engineering techniques. Berlin: Springer; 2006. p. 34–49.CrossRefGoogle Scholar
  33. 33.
    Kumar S, Sharma T. User centric rapid application development. Int J Res. 2014;1(10):959–64.Google Scholar
  34. 34.
    Martin J. Rapid application development. Englewood Cliffs: Prentice-Hall; 1992.Google Scholar
  35. 35.
    Årsand E, Demiris G. User-centered methods for designing patient-centric self-help tools. Inform Health Soc Care. 2008;33(3):158–69.CrossRefGoogle Scholar
  36. 36.
    Dabbs ADV, Myers BA, Mc Curry KR, Dunbar-Jacob J, Hawkins RP, Begey A, Dew MA. User-centered design and interactive health technologies for patients. Computers Inform Nurs CIN. 2009;27(3):175.CrossRefGoogle Scholar
  37. 37.
    DiNenno EA, Prejean J, Irwin K, Delaney KP, Bowles K, Martin T, Lansky A. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States. MMWR Morb Mortal Wkly Rep. 2017;66:830–2.CrossRefGoogle Scholar
  38. 38.
    Frasca T, Balan I, Ibitoye M, Valladares J, Dolezal C, Carballo-Diéguez A. Attitude and behavior changes among gay and bisexual men after use of rapid home HIV tests to screen sexual partners. AIDS Behav. 2014;18(5):950–7.CrossRefGoogle Scholar
  39. 39.
    Masters SH, Agot K, Obonyo B, Mavedzenge SN, Maman S, Thirumurthy H. Promoting partner testing and couples testing through secondary distribution of HIV self-tests: a randomized clinical trial. PLoS Med. 2016;13(11):e1002166.CrossRefGoogle Scholar
  40. 40.
    Maman S, Murray KR, Mavedzenge SN, Oluoch L, Sijenje F, Agot K, Thirumurthy H. A qualitative study of secondary distribution of HIV self-test kits by female sex workers in Kenya. PLoS ONE. 2017;12(3):e0174629.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Iván C. Balán
    • 1
    Email author
  • Javier Lopez-Rios
    • 1
  • Samiksha Nayak
    • 2
  • Cody Lentz
    • 1
  • Siddarth Arumugam
    • 2
  • Bryan Kutner
    • 1
  • Curtis Dolezal
    • 1
  • Ongun Uzay Macar
    • 3
  • Tejit Pabari
    • 3
  • Alexander Wang Ying
    • 2
  • Michael Okrah
    • 2
  • Samuel K. Sia
    • 2
  1. 1.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkUSA
  2. 2.Department of Biomedical EngineeringColumbia UniversityNew YorkUSA
  3. 3.Department of Computer ScienceColumbia UniversityNew YorkUSA

Personalised recommendations