ru2hot?: A public health education campaign for men who have sex with men to increase awareness of symptoms of acute HIV infection

Abstract

Objectives: Teach HIV-negative men who have sex with men (MSM) symptoms of acute HIV infection (AHI) and direct them to nucleic acid amplification testing (NAAT) though Public Health--Seattle & King County (PHSKC).

Design: Cross-sectional surveys, retrospective database analysis and chart review.

Methods: Beginning in June 2009, the ru2hot? campaign described AHI symptoms and NAAT. Two preintervention and two postintervention surveys assessed campaign visibility, symptom knowledge, and healthcare-seeking behaviour. Regression analyses evaluated secular trends in case-finding.

Results: 366 MSM completed surveys. In survey 4, 23% of 100 men reported seeing the campaign, and 25% knew 'ru2hot?' referred to AHI. From survey 1 to survey 4, the proportion of subjects who knew ≥2 symptoms or that AHI was a 'flu-like' illness was unchanged (61% vs 57%, p=0.6). However, in survey 4, 13 (72%) of 18 subjects who saw the campaign named fever as a symptom of AHI compared with 19 (35%) of 55 subjects who had not seen the campaign (p=0.005). From 9/2003 to 12/2010, 622 (2.2%) of 27 661 MSM tested HIV-positive, and 111 (18%) were identified by the Public Health--Seattle & King County NAAT programme. In terms of the impact of the campaign on case-finding, diagnosis of EIA-negative/NAAT-positive and OraQuick-negative/EIA-positive cases increased from six in 2004 to 20 in 2010 (p=0.01), but postcampaign numbers were unchanged. 23 (51%) of 45 cases identified before and 8 (44%) of 18 cases identified after the campaign reported symptoms at initial testing (p=0.6).

Conclusions: Although a quarter of MSM surveyed saw the campaign and knowledge of fever (the symptom of emphasis) was high, case-finding was unchanged. Increasing campaign visibility could have had greater impact.

Keywords: Education; Gay Men; Primary Hiv Infection.

Figure 1

Billboard image used in ru2hot?, an acute HIV infection public health education campaign targeting men who have sex with men in Seattle, Washington, USA. This figure is only reproduced in colour in the online version.

Figure 2

ru2hot? Timeline with Google Analytics. AHI: acute HIV infection; MSM: men who have sex with men; NAAT: nucleic acid amplification testing; PHSKC: Public Health—Seattle & King County. In 2003 the PHSKC pooled NAAT programme began testing serum samples from MSM to identify persons with AHI. AHI Survey 1 was conducted to assess knowledge of AHI symptoms among MSM prior to development of the campaign, which was initially launched in June 2009 and augmented in October 2010 with billboards and banner ads on Manhunt.net. From June 2009 to June 2011, 1164 unique individuals made 1753 visits to ru2hot.org, with the peak number of visitors occurring in December 2010, 2 months after the augmentation of the campaign. Access the article online to view this figure in colour.

Figure 3

PHSKC NAAT programme case identification and UW PIC referral, 2004–2010. NAAT: nucleic acid amplification testing; PHSKC: Public Health—Seattle & King County; UW PIC: University of Washington Primary Infection Clinic. Between 2004 and 2010, there was an increase in the number of specimens tested by the PHSKC HIV NAAT programme (p=0.008) and cases of persons with acute and early HIV infection (p=0.06) over time, but there was no change following the campaign initiation in 2009. During this timeframe, there were 104 persons enrolled at the UW PIC, but referrals did not change following the campaign (note: enrolment was temporarily discontinued in 2009 due to funding issues).