Web-Based HIV Testing in Abruzzo, Italy: Analysis of 15-Month Activity Results

Undiagnosed cases of HIV infection in developed countries are estimated at 20-30% of individuals living with HIV. Web-based strategies may represent a new approach to easier, wider, and unrestricted access to early testing. The Abruzzo Region, Italy, developed a Web-based tool to recruit persons at high risk of HIV and other sexually transmitted infections (STIs). At the Website www.failtestanchetu.it, browsers found information on STIs (HIV, hepatitis B and C, and syphilis), a structured questionnaire called "risk calculator" to assess one's own risk behaviors and direct booking of their test at one of six sites throughout the region. The Website was advertised on local media and in pharmacies, high schools, sports facilities, and factories. Between February 1, 2014, and May 31, 2015, about 6000 users visited the Website; 3046 people attended a visit for counseling on risk behaviors, signs, or symptoms of STIs and accepted blood drawing for HIV, hepatitis B Virus (HBV), hepatitis C Virus (HCV), and syphilis tests. Fifty-eight (1.90%) subjects were positive for HCV, 56 (1.84%) for HBsAg, 90 (2.95%) for Treponema pallidum antibodies, and 28 (0.92%) for HIV. Ninety-two percent of HIV-positive patients were successfully linked to care. Late presenters were less frequent in this sample than in the population diagnosed with HIV in Italy in 2014. An overall 7% proportion of HIV, HBV, HCV, and syphilis-unaware cases were all transferred to care, with the exception of three people. HIV seropositivity among testers was higher than 2/1000, the cost-effectiveness threshold suggested for effective testing. Therefore, our Web-based unrestricted and free access methodology appears worth further and wider evaluation.