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Reducing the discussion divide by digital questionnaires in healthcare settings: Disruptive innovation for HIV testing and pre-exposure prophylaxis (PrEP) screening.

BACKGROUND
Healthcare provider assessment of patient sexual behavior and substance use is essential for determining appropriate prevention interventions-including HIV pre-exposure prophylaxis (PrEP)-for sexual minority men (SMM). We sought to explore acceptability and utility of using electronic surveys to conduct health behavior assessments in clinical settings among SMM.


METHODS
Among a U.S. nationwide sample of SMM (n=4187; mean age = 38.3 years; 60% White; 82% HIV-negative), we examined associations of demographics, recruitment venue, sexual behavior characteristics, and recent substance use with participants' comfort communicating verbally and via electronic survey with a healthcare provider about sexual and substance use behavior.


RESULTS
On average, SMM had greater comfort communicating via electronic survey vs. verbally. In our fully-adjusted analysis, preference favoring electronic surveys more strongly than verbal communication differed by age (β=-0.07, p≤0.001). SMM with a Bachelor's degree or more (β=0.04, p<0.05), those recruited from non-clinical settings (β=0.06, p≤0.001), and those without primary care providers (β=0.04, p<0.05) favored electronic surveys more strongly in the fully-adjusted multivariable model. SMM who reported any recent casual sex partners (β=0.05, p<0.01), those never tested for HIV (β=0.03, p<0.05), and HIV-negative/unknown men not on PrEP (compared to PrEP users; β=0.09, p≤0.001) also favored electronic surveys in the fully-adjusted model.


CONCLUSIONS
Reducing communication barriers by incorporating electronic surveys into patient assessments could help identify HIV testing and PrEP needs for SMM most susceptible to HIV acquisition. Nonetheless, no one screening strategy is likely to work for a vast majority of SMM and multiple approaches are needed.