title: A novel Online-to-Offline (O2O) model for pre-exposure prophylaxis and HIV testing scale up.
abstract: PrEP awareness and uptake among men who have sex with men (MSM) and transgender women (TG) in Thailand remains low. Finding ways to increase HIV testing and PrEP uptake among high-risk groups is a critical priority. This study evaluates the effect of a novel Adam's Love Online-to-Offline (O2O) model on PrEP and HIV testing uptake among Thai MSM and TG and identifies factors associated with PrEP uptake.
  
  
  
  The O2O model was piloted by Adam's Love (www.adamslove.org) HIV educational and counselling website. MSM and TG reached online by PrEP promotions and interested in free PrEP and/or HIV testing services contacted Adam's Love online staff, received real-time PrEP eCounseling, and completed online bookings for receiving services at one of the four sites in Bangkok based on their preference. Auto-generated site- and service-specific e-tickets and Quick Response (QR) codes were sent to their mobile devices enabling monitoring and check-in by offline site staff. Service uptake and participant's socio-demographic and risk behaviour characteristics were analyzed. Factors associated with PrEP uptake were assessed using multiple logistic regression.
  
  
  
  Between January 10th and April 11th, 2016, Adam's Love reached 272,568 people online via the PrEP O2O promotions. 425 MSM and TG received eCounseling and e-tickets. There were 325 (76.5%) MSM and TG who checked-in at clinics and received HIV testing. Nine (2.8%) were diagnosed with HIV infection. Median (IQR) time between receiving the e-ticket and checking-in was 3 (0-7) days. Of 316 HIV-negative MSM and TG, 168 (53.2%) started PrEP. In a multivariate model, higher education (OR 2.30, 95%CI 1.14-4.66;p= 0.02), seeking sex partners online (OR 2.05, 95%CI 1.19-3.54;p= 0.009), being aware of sexual partners' HIV status (OR 2.37, 95%CI 1.29-4.35;p= 0.008), ever previously using post-exposure prophylaxis (PEP) (OR 2.46, 95%CI 1.19-5.09;p= 0.01), and enrolment at Adam's Love clinic compared to the other three sites (OR 3.79, 95%CI 2.06-6.95;p< 0.001) were independently associated with PrEP uptake.
  
  
  
  Adam's Love O2O model is highly effective in linking online at-risk MSM and TG to PrEP and HIV testing services, and has high potential to be replicated and scaled up in other settings with high Internet penetration among key populations.
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Tarandeep
authors.initials: T
authors.lastname: Anand
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Chattiya
authors.initials: C
authors.lastname: Nitpolprasert
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Deondara
authors.initials: D
authors.lastname: Trachunthong
authors.affiliation: HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.|The Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.affiliation: Service Workers in Group Foundation, Bangkok, Thailand.
authors.forename: Surang
authors.initials: S
authors.lastname: Janyam
authors.affiliation: Rainbow Sky Association of Thailand, Bangkok, Thailand.
authors.forename: Danai
authors.initials: D
authors.lastname: Linjongrat
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Hightow-Weidman
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.affiliation: SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.|SEARCH, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
mesh_terms: D000328:Adult; D001364:Awareness; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D012309:Risk-Taking; D012747:Sexual Partners / Q000523:psychology; D013785:Thailand; D055815:Young Adult
keywords: MSM; PrEP scale up; PrEP uptake; Thailand; innovative model; pre-exposure prophylaxis; technology; transgender women