1. “A hora é agora”- The Time is Now: HIVST to reach men who have sex with men in Brazil” Raquel B. De Boni, MD, PhD PI: Beatriz Grinsztejn, MD, PhD National Institute of Infectology- FIOCRUZ, Brazil

2. Dr. De Boni has no conflicts of interest to declare

3. Overview 1 of 3 projects under the scope of the ‘A hora é agora” program designed to increase HIV testing among MSM Implemented in Curitiba, Brazil 1.75 million inhabitants HIV prevalence among MSM=6.9% (Kerr et al., 2013) 1.75 million inhabitants HIV prevalence among MSM=6.9% (Kerr et al., 2013)

4. Aims To develop, implement and evaluate the feasibility of a Web-based intervention that Promotes HIV prevention Provides free anonymous HIVST Promotes linkage to care for MSM from Curitiba, ≥ 18 years and with HIV status unknown/negative E-testing

5. Website/app Available at https://www.ahoraeagora.org/ and IOS and Androidhttps://www.ahoraeagora.org/ 5 modules: General information, HIVST request, Delivery, Administration and Monitoring General information HIV prevention Self assesment of risk Adapted from The HIV incidence Risk Index for MSM, CDC guideline for PrEP HIV testing facilities

6. HIVST HIVST kits Oral fluid (OraQuick®) Two HIVST may be requested every 6 months Delivered by regular mail (identification needed) or retrieved in public pharmacy (anonymous) Step-by-step video and written test instructions 24/7 hotline is available

7. Feasibility From February 6, 2015 to January 31, 2016: 67,225 Hits in the website 17,786 unique visitors (Google Analytics) 7,341 Questionnaires were initiated 5,552 Fulfilled inclusion criteria 3,885 HIVST requests initiated 2,535 Valid requests 2,527 Requests delivered (4342 tests)

8. Deliveries – Up to January 31, 2016 Deliveries by mail (n=1944)/Total requests to deliver by mail (n=2340) Month/Year %

9. HIVST results – January 31, 2016 Individuals who requested HIVST were asked to return their results either on the site or by pre-paid mail Result 1 SiteMail* Total43288 Non-Reactive40283 Reactive194 Indeterminate111 1 Prevalence may not be estimated because of possible duplicates.*Individuals could have also returned on site. 17% upload results on the site (n=432/2527 requests delivered)

10. Confirmatory test Individuals with HIVST reactive/indeterminate were oriented to perform confirmatory test at the COA 20% of those who reported a non-reactive result on the site were randomly invited to perform confirmatory testing Confirmatory test at COA ReactiveNon-reactive Total307 ResultSite Total432 Non-Reactive402 Reactive19 Indeterminate11

11. Feedback from HIVST users Up to January 31, 2016 N=96

12. Unexpected events No psychological crises or violent reactions from partners were reported 1 individual felt ashamed

13. Conclusions & Lessons learned The e-testing strategy was feasible MSM were interested in HIVST Most tests were delivered by mail Results uploaded in the platform were lower than expected (20%) no incentives are allowed by Brazilian IRB response by mail was low Monitoring & Evaluation protocol should evaluate cost- effectiveness

14. CDC-RFA-GH13-1343 Grant number: U2GGH01152 INI- FIOCRUZ Valdilea G. Veloso Nilo Martinez Fernandes Ronaldo I. Moreira ENSP-FIOCRUZ Marly Cruz Secretaria Municipal de Curitiba César Titton Juliane Oliveira Liza Rosso MoH Department of STD, AIDS and Viral Hepatitis Renato Girade Correa CDC Brasil Aristides Barbosa Nena Lentini Raquel Miranda CDC Atlanta Trista Bingham NGO Grupo Dignidade Tony Reis Funding & Acknowledgements

15. Thank you! raquel.boni@ini.fiocruz.br