Implementation of an online HIV prevention and treatment cascade in Thai men who have sex with men and transgender women using Adam's Love Electronic Health Record system

Electronic health record (EHR) systems have been infrequently used to support HIV service delivery models to optimise HIV prevention and treatment cascades. We have studied the implementation, uptake and use of an EHR among Thai men who have sex with men (MSM) and transgender (TG) women. Participants, e-counselled via the Adam's Love ( www.adamslove.org) support platforms, after having completed risk behaviour questionnaires and being assessed for their HIV risk by online counsellors, were enrolled based on their preference into one of three EHR-supported arms: (1) private clinic-based HIV testing and counselling (HTC); (2) online pretest counselling and private clinic-based HIV testing (hybrid); and (3) online supervised HIV self-testing and counselling (eHTC). Between December 2015 and May 2016, of a total of 489 MSM and TG women were introduced to the study, 186 (38%) enrolled into the study, with 89, 72 and 25 participants joining the HTC, hybrid and eHTC arms, respectively. Seeking sex online was reported by 83.9%. HIV prevalence was highest (16%) in the eHTC arm, and participants in this arm were more likely to be younger (median age 25 vs 29 vs 27 years; P=0.01), bisexual (16% vs 9.7% vs 5.6%; P=0.005), with an unknown history of HIV or first-time HIV testers (48% vs 25% vs 19.1%; P=0.01) or had tested >1 year ago (15.8% vs 4.8% vs 3.4%, P=0.04), compared with those in the hybrid and HTC arms. Around half (48.3%) of them revisited the EHR at least once to access laboratory results, read post-test summaries and make an appointment for another HIV test. The participants in the eHTC arm had reduced odds of revisiting the EHR twice or more as compared with participants in the HTC [odds ratio (OR) 0.14, 95% confidence interval (CI) 0.03-0.67, P=0.01] and hybrid arms (OR 0.10, 95% CI 0.02-0.44, P=0.003). Overall the EHR satisfaction was high at 4.4 (SD 0.68) on a Likert scale of 5. Young and high-risk MSM and some TG women engaged successfully with the Adam's Love EHR system, showing its potential to support innovative service delivery models and target hard-to-reach and vulnerable populations