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. 2025 Jan 16;15(1):ibaf011.
doi: 10.1093/tbm/ibaf011.

Testing a Push-Pull model: community-based dissemination of oral HIV self-testing

Joseph A Catania  1 , M Margaret Dolcini  1 , Ashley C Schuyler  1 , Jonathan Garcia  1 , E Roberto Orellana  2 , Christina Sun  3 , Edgar Mendez  4 , Tony Diep  4 , Tara Casey  4 , Jesse Canchola  5 , Lance Pollack  6 , Christopher Hamel  7 , Mia Tognoli  1 , Nell Carpenter  4 , Jeffrey D Klausner  8
Affiliations

Testing a Push-Pull model: community-based dissemination of oral HIV self-testing

Joseph A Catania et al. Transl Behav Med. .

Abstract

Background: The Push-Pull-Infrastructure (PPI) model is proposed as a strategy for disseminating health innovations. Using a PPI model, we developed and examined the feasibility of a community-based intervention to disseminate oral human immunodeficiency virus (HIV) self-testing (OHST) to men who have sex with men in Portland, OR.

Methods: We disseminated OHST kits through a network of commercial businesses (n = 6) serving the Lesbian, Gay, Bisexual, Transgender, and Queer plus community. Data were collected weekly on the number of kits distributed. Street intercepts were conducted with customers to assess the impact of promotional efforts on intervention awareness. Using a quasi-experimental design, we examined variation in the intensity of the promotional component on OHST dissemination.

Results: Over a 24-week period, we disseminated 2698 OHSTs. Dissemination rates were found to vary significantly with the intensity of the promotional campaign in a dose-response manner (e.g. high intensity = more dissemination). Customer awareness of the campaign increased significantly in the first 9 weeks (from 22% to 60%, P < .001). Within the geographic area studied, we found our dissemination rate to be comparable to or in excess of rates obtained by other county-level HIV-testing programs (i.e. 2698 OHSTs vs. 2561 in-person clinic-based tests; vs. 78 OHSTs disseminated online).

Conclusions: A PPI model based on a community commercial network approach was highly successful. The promotional component successfully increased customers' awareness of the intervention. Formative work, using a single-case changing-intensity design, provided evidence that warrants more extensive research on strategies for mounting a promotional component that builds on the principle of "more for less."

Keywords: HIV self-testing; LGBTQ+; community engagement; dissemination; men who have sex with men (MSM).

Plain language summary

The sale of oral human immunodeficiency virus (HIV) self-test kits through retail outlets (e.g. pharmacies) has been unsuccessful. We examined the feasibility of using Lesbian, Gay, Bisexual, Transgender, and Queer plus commercial businesses to distribute free oral HIV self-test kits to their customers. We successfully distributed 2698 kits in a 6-month period, which exceeds the number of free test kits distributed through Internet services (78 kits) and is comparable to the number of tests performed by county health clinics (2561 tests). Additionally, our promotional campaign was successful in increasing customer awareness from 22% to 60% in a 9-week period. A community-network approach is recommended as a supplemental testing system pending further study of the intervention’s ability to be sustained over longer timeframes.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

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References

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