Abstract
We present experiences of transgender women (TW) who have sex with men with SMARTtest, a smartphone app to accompany the INSTI Multiplex®, a one-minute, dual blood-based HIV/syphilis rapid test. TW participants (N = 11) received 10 INSTI Multiplex® tests to take home for self- and/or partner-testing and installed the SMARTtest app on their phones. The SMARTtest app aimed to support INSTI Multiplex users in correctly performing the test, interpreting the results, and connecting with care following a positive HIV or syphilis screening. After 3 months, users completed in-depth interviews on their experiences. A total of 9 TW used SMARTtest with partners. App feedback was positive, but refining is necessary. Specifically, TW reported that SMARTtest is easy to use and convenient; instructions on how to use the INSTI Multiplex presented on the app were helpful to complete procedures correctly; the most frequently used feature on SMARTtest was the information on clinics that offered confirmatory testing; and participants and their partners were not concerned about app privacy but reported that this could change if INSTI Multiplex detected an HIV-positive result. Further, participants provided recommendations on how to improve SMARTtest, and changes were mostly related to features, content, functionality, navigation, and overall “look” of the app. SMARTtest is promising to facilitate INSTI Multiplex® use in TW. User feedback should be integrated in future versions.
This is a preview of subscription content, log in via an institution to check access.
Data Availability
Not applicable.
Code Availability
Not applicable.
References
Balan, I. C., Lopez-Rios, J., Nayak, S., Lentz, C., Arumugam, S., Kutner, B., Dolezal, C., Macar, O. U., Pabari, T., Wang Ying, A., Okrah, M., & Sia, S. K. (2020). SMARTtest: A smartphone app to facilitate HIV and syphilis self-and partner-testing, interpretation of results, and linkage to care. AIDS and Behavior, 24(5), 1560–1573. https://doi.org/10.1007/s10461-019-02718-y
Balan, I. C., Rios, J. L., Lentz, C., Arumugam, S., Dolezal, C., Kutner, B., Rael, C. T., Ying, A. W., Macar, O. U., & Sia, S. K. (2022). Acceptability and use of a dual HIV/syphilis rapid test and accompanying smartphone app to facilitate self- and partner-testing among cisgender men and transgender women who have sex with men. AIDS and Behavior, 26, 35–46. https://doi.org/10.1007/s10461-021-03322-9
Becasen, J. S., Denard, C. L., Mullins, M. M., Higa, D. H., & Sipe, T. A. (2018). Estimating the prevalence of HIV and sexual behaviors among the US transgender population: A systematic review and meta-analysis, 2006–2017. American Journal of Public Health, 109, e1–e8. https://doi.org/10.2105/AJPH.2018.304727
Carballo-Dieguez, A., Giguere, R., Balan, I. C., Brown, W., 3rd., Dolezal, C., Leu, C. S., Lopez Rios, J., Sheinfil, A. Z., Frasca, T., Rael, C. T., Lentz, C., Crespo, R., Iribarren, S., Cruz Torres, C., & Febo, I. (2020). Use of rapid HIV self-test to screen potential sexual partners: Results of the ISUM study. AIDS and Behavior, 24(6), 1929–1941. https://doi.org/10.1007/s10461-019-02763-7
CDC. (2021). HIV and STD criminalization laws. Retrieved March 3, from https://www.cdc.gov/hiv/policies/law/states/exposure.html.
Figueroa, C., Johnson, C., Verster, A., & Baggaley, R. (2015). Attitudes and acceptability on HIV self-testing among key populations: A literature review. AIDS and Behavior, 19(11), 1949–1965. https://doi.org/10.1007/s10461-015-1097-8
Giguere, R., Brown, W., III., Balan, I. C., Dolezal, C., Ho, T., Sheinfil, A., Ibitoye, M., Lama, J. R., McGowan, I., Cranston, R. D., & Carballo-Dieguez, A. (2018). Are participants concerned about privacy and security when using short message service to report product adherence in a rectal microbicide trial? Journal of the American Medical Informatics Association, 25(4), 393–400. https://doi.org/10.1093/jamia/ocx081
Itaborahy, L. P., & Zhau, J. S. (2013). State-sponsored homophobia: A world survey of laws: Criminalization, protection and recognition. UCLA School of Law Williams Institute. Retrieved March 3, from https://williamsinstitute.law.ucla.edu/publications/statesponsored-homophobia/
Kcomt, L. (2019). Profound health-care discrimination experienced by transgender people: Rapid systematic review. Social Work in Health Care, 58(2), 201–219. https://doi.org/10.1080/00981389.2018.1532941
Rael, C., Lopez Rios, J., Lentz, C., Dolezal, C., Kutner, B., & Balan, I. (2021). Transgender women’s expereinces using a blood-based combination HIV/syphilis at-home rapid test kit that delivers results in 60-seconds (INSTI Multiplex) for self-and partner-testing HIV Research for Prevention (R4P), Virtual.
Rael, C. T., Giguere, R., Lopez-Rios, J., Lentz, C., Balan, I. C., Sheinfil, A., Dolezal, C., Brown, W., 3rd., Frasca, T., Torres, C. C., Crespo, R., Iribarren, S., Leu, C. S., Febo, I., & Carballo-Dieguez, A. (2020). Transgender women’s experiences using a home HIV-testing kit for partner-testing. AIDS and Behavior, 24(9), 2732–2741. https://doi.org/10.1007/s10461-020-02829-x
Rael, C. T., Martinez, M., Giguere, R., Bockting, W., MacCrate, C., Mellman, W., Valente, P., Greene, G. J., Sherman, S., Footer, K. H. A., D’Aquila, R. T., & Carballo-Dieguez, A. (2018). Barriers and facilitators to oral PrEP use among transgender women in New York city. AIDS and Behavior, 22(11), 3627–3636. https://doi.org/10.1007/s10461-018-2102-9
Acknowledgements
The authors wish to acknowledge all participants in this study for their valuable contributions to advance this research.
Funding
The first author is supported by a K01 Award (K01 MH115785; Principle Investigator: Christine Tagliaferri Rael, Ph.D.) and the second author by a K23 Award (K23MH124569, Principal Investigator: Bryan Kutner, Ph.D., MPH) from the National Institute of Mental Health at the University of Colorado College of Nursing (first author), and HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (second author; P30 MH43520; Center Principle Investigator: Robert Remien, Ph.D.) The research presented in this paper and Dr. Iván Balán, the Principal Investigator, are supported by R01 HD088156. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.
Author information
Authors and Affiliations
Contributions
CTR drafted this manuscript and performed primary analysis duties; BAK acted as second coder; and CD put together information presented in demographic tables for this manuscript. JLR and CL were responsible for primary data collection and verifying transcripts against audio recordings for accuracy. IB was the Principal Investigator of the study presented and provided oversight of manuscript preparation. SS and SA developed, tested, and refined the SMARTtest app presented in this manuscript. All authors listed in this citation contributed to critical revision of this work.
Corresponding author
Ethics declarations
Conflicts of interest
The authors have no conflicts to declare.
Ethical Approval
IRB approval was obtained from the New York State Psychiatric Institute IRB (#7260).
Informed Consent
All participants provided written informed consent prior to enrolling.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rael, C.T., Kutner, B.A., Lentz, C. et al. Transgender Women’s Experiences Using SMARTtest, a Smartphone Application to Facilitate Self- and Partner-HIV/Syphilis Testing Using the INSTI Multiplex. Arch Sex Behav 52, 1961–1968 (2023). https://doi.org/10.1007/s10508-023-02602-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-023-02602-w