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STI Online First, published on April 6, 2018 as 10.1136/sextrans-2017-053348
Digital communications and sexual health

Original article

Acceptability and effectiveness of using mobile

applications to promote HIV and other STI
testing among men who have sex with men in
Barcelona, Spain
Miguel Alarcón Gutiérrez,1,2 Manuel Fernández Quevedo,1 Silvia Martín Valle,3
Constanza Jacques-Aviñó,1 Elia Díez David,3,4 Joan A Caylà,1,4
Patricia Gracía de Olalla1,4

1
Servei d’Epidemiologia, Abstract HIV transmission, and improving morbidity and
Agència de Salut Pública de Objective To evaluate the acceptability and mortality rates,1 2 with a strong impact on the inci-
Barcelona, Barcelona, Spain
2
Universitat Pompeu Fabra, effectiveness of a pilot intervention programme using dence of HIV infection at the community level.3
Barcelona, Spain gay geosocial mobile applications (apps) to offer rapid However, late diagnosis of HIV infection is esti-
3
Servei de Programes i HIV and other STI tests to men who have sex with men mated to occur in 47% of patients in the European
Intervencions Preventives, (MSM) in Barcelona between December 2015 and March Union (EU), and as many as 17% of infected indi-
Agència de Salut Pública de viduals are unaware of their serological status.4 In
2016.
Barcelona, Barcelona, Spain
4
Centro de Investigación Methodology We offered rapid HIV, syphilis and 2015, late diagnosis of HIV accounted for 46.5%
Biomédica en Red de hepatitis C testing by sending private messages on apps and 39% of cases in Spain and Barcelona, respec-
Epidemiología y Salud Pública for sexual and social encounters. Acceptance was defined tively.5 6
(CIBERESP), Barcelona, Spain as the proportion of users who favourably responded Since 2005, the principal cause of HIV trans-
to the message and effectiveness was defined as the mission in the EU has been sexual relations among
Correspondence to men who have sex with other men (MSM). In
proportion of users who attended our facilities among
Dr Miguel Alarcón Gutiérrez,
Servei d’Epidemiologia, Agència those who were interested in attending. To identify 2015, 42% of new HIV cases occurred in MSM,
de Salut Pública de Barcelona, variables associated with the response to the messages, the only group that showed an increase.7 During
Barcelona 08023, Spain; ​ multivariate logistic regression was used. Adjusted the same year in Spain, 53.6% of new HIV cases
malarcon@​aspb.​cat OR (ORa) and 95% CIs were calculated. We collected were attributed to MSM,5 and this proportion
Received 12 July 2017 information on sociodemographics, sexual behaviours was even greater in large cities such as Barcelona
Revised 19 February 2018 and app usage from the contacted user profiles and from (72.6%).6
Accepted 12 March 2018 users who attended our facilities. A descriptive analysis HIV diagnostic testing outside the typical health-
was carried out. care circuit is a valuable strategy for reducing HIV
Results 2656 individual messages were sent. Overall, diagnosis delay in high-risk groups such as MSM.8
a 38.4% response rate was obtained, 83.0% of them Since 2009, a rapid HIV test has been offered by
found it acceptable to receive the unsolicited message, pharmacies in Catalonia, with 9344 tests conducted
and 73.2% effectiveness was obtained. Responders by 2014 (of which 1.0% were positive). In 2014,
had higher odds of being 45 years or older (ORa=1.48; community centres in Catalonia conducted 10 868
95% CI 1.06 to 2.08), being connected at the moment HIV tests with a 2.0% incidence of new cases.
the message was sent or during the previous hour Moreover, the Barcelona’s Public Health Agency
(ORa=1.92; 95% CI 1.38 to 2.68), having a profile photo (ASPB) has a programme that offers rapid HIV and
not exposing bare chest or abdomen (ORa=1.44; 95% CI syphilis tests in gay saunas for the MSM collective,
1.07 to 1.92) and using the Grindr app (ORa=1.39; 95% performing 463 tests between 2012 and 2013, with
CI 1.12 to 1.73). Of those who were tested and took the an annual incidence of 4.7% and 6.1% per year,
survey (n=77), 45.5% had not taken an HIV test in over respectively.9
a year, 24.7% had had a previous STI diagnosis, 51.4% The MSM population has pioneered the use
had reported anal sex without condom and 52% had of social networks and the internet to search for
consumed alcohol or drugs for sex. information about sexual health, arranging dates
Conclusions The response rate, acceptance and and sexual encounters, and looking up pornog-
effectiveness observed in this study indicate that this raphy.10 In addition, smartphone use has boosted
strategy could be a useful tool for promoting STI testing the development of applications (apps) intended
among high-risk MSM population. for sex encounters. Most of these apps use the
To cite: Alarcón Gutiérrez M, global positioning system (GPS) to provide infor-
Fernández Quevedo M,
mation about the geographical proximity of users,
Martín Valle S, et al.
Sex Transm Infect Epub ahead thereby facilitating personal encounters. The MSM
of print: [please include Day Introduction users of these apps have a high prevalence of risky
Month Year]. doi:10.1136/ Early diagnosis of HIV infection allows patients to sexual practices, and accordingly a high incidence
sextrans-2017-053348 undergo timely antiretroviral therapy, decreasing of STIs.11–17
Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348 1
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Digital communications and sexual health

avoiding repeating users already contacted. We clearly expressed
that all services were free of charge and totally confidential.
We also gathered self-reported characteristics from each user
profile, such as the type of photograph, age and time since the
last connection. We provided inperson pretest and post-test
counselling to users who agreed to take a test or get vaccinated.
Data on sociodemographics, sexual health, app usage and sexual
practices were collected through personal interviews with the
users who were tested. We also asked these users to complete a
self-administered satisfaction survey, rating general satisfaction
in a scale of 1–10 and collecting intention to recommend the
intervention. Individuals who obtained a positive result on a test
were referred to the healthcare system facilities according to a
pre-established protocol.

Analysis
We performed a descriptive analysis of the characteristics of the
contacted users, computing the prevalence of categorical vari-
ables and median (and IQR) of discrete quantitative variables.
The programme was defined as feasible if the investigators’
profiles remained active on the apps for longer than 1 week;
Figure 1 Flow chart of the 2656 contacted users of the application- this is because most of these apps could remove profiles who
based pilot intervention programme in Barcelona, Spain (2016). *From offer services. The response rate was calculated by dividing the
users who favourably rated the message, 258 users had recent testing number of users who responded to the private message by the
or regularly attended other testing programmes, and 480 did not total number of users contacted. Acceptance was defined as
mention reasons for not attending. **The stock of syphilis tests was the number of users who favourably responded to the private
depleted temporarily during the intervention period. message sent via the apps, divided by the number of users who
responded to the message. We classified user responses as posi-
tive if the user provided gratefulness, congratulation or interest
Some studies have shown that most users of these apps are response, negative if the user showed any kind of disagreement,
willing to participate in prevention measures advertised by the and indifferent if it was impossible to classify the response into
apps18 19; thus, these apps provide an opportunity to implement either one of these two categories. We calculated effectiveness
prevention strategies and promote sexual health.11 20–22 as the number of users who actually took the tests or got vacci-
The objective of this study was to evaluate the feasibility, nated, divided by the number of users who responded to the
response, acceptance and effectiveness of a pilot programme message showing an interest in doing so. Because variables were
offering rapid HIV and other STI tests to MSM who use apps categorical, we used the Pearson χ2 test to compare the profile
for sex encounters in the city of Barcelona. Furthermore, this of users who responded to the private message with that of
study allowed us to describe the epidemiological characteristics users who did not respond. To identify factors associated with
of the contacted users. user response, we performed a multivariate logistic regression
analysis using all possible equations method.23 Adjusted OR and
Methods 95% CIs were calculated.
We performed a community-based, cross-sectional study in A descriptive analysis of the characteristics of users who
Barcelona, Spain, between December 2015 and March 2016. We took the test or got vaccinated was performed. Also, we did a
contacted MSM users of apps for sexual and social encounters descriptive analysis of the satisfaction survey responses. For both
who were over the age of 18, and were either using the app at descriptive analyses we present proportions for categorical varia-
the time the message was sent or had used the app during the bles and the median (and IQR) for discrete quantitative variables.
previous 7 days. All statistical analyses were carried out using the Stata V.13
program.
Process description
We created a blank user profile in the most commonly used apps Results
among MSM in Spain (Grindr, PlanetRomeo and Wapo).11 The The three investigator profiles created were active during the
user profile can provide basic demographic information and free entire study period, and contacted a total of 2656 app users
text. The launch screen of each app displays a photographic (1029 in Grindr, 768 in PlanetRomeo and 859 in Wapo). The
list of the users ordered by geographical proximity. The ASPB median age of these users was 32 years (IQR: 27–39). Of the
has two different geographical locations: Lesseps Square in the 1149 users whose profile caption indicated their reason for
north, and Drassanes Avenue in the inner city. As these apps using the app, 72.2% explicitly indicated they were looking for
use GPS, we decided to focus on the two locations available. a sexual encounter.
The investigators sent a private picture message to all near users Of the 2656 users contacted by the investigators, 1019
through the ‘chat’ option, in order of proximity to at least 50 responded to the message and 846 responded favourably.
users, offering them the possibility to take rapid HIV, syphilis Thus, the global response rate was 38.4% (42.2% in Grindr,
and hepatitis C tests, as well as to be vaccinated against hepatitis 35.4% in PlanetRomeo and 36.4% in Wapo; P=0.005), and
A and B in one of our two centres. The message was sent in work the global acceptance was 83.0% (83.2% in Grindr, 81.3% in
days and schedules from the centres’ facilities (09:00–19:00), PlanetRomeo and 84.4% in Wapo; P=0.606). Of those who
2 Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348
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Digital communications and sexual health

Table 1 Associated factors of the message response of the 2656 users contacted with the application-based pilot intervention programme,
Barcelona 2016
Answered Unanswered
Variables n % n % Total, N OR P values* ORa† 95% CI P values
Age (years)
 <25 129 36.1 228 63.9 357 1 1
 25–34 381 38.6 605 61.4 986 1.11 0.403 1.14 0.88 to 1.47 0.326
 35–44 248 38.5 396 61.5 644 1.11 0.408 1.19 0.90 to 1.57 0.213
 45 or more 113 44.0 144 56.0 257 1.39 0.050 1.48 1.06 to 2.07 0.022
Time since last connection
 Within the last hour 959 39.7 1456 60.3 2415 1.99 <0.001 1.93 1.38 to 2.69 <0.001
 Over an hour ago 60 24.9 181 75.1 241 1 1
Profile photo
 No photo 102 29.6 242 70.4 344 1 1
 Bare chest or abdomen 295 29.0 511 31.2 806 1.37 0.023 1.21 0.89 to 1.66 0.216
 Other (only face, dressed, 621 41.3 883 58.7 1504 1.67 <0.001 1.43 1.08 to 1.92 0.014
landscapes and others)
Application used
 Grindr 434 42.2 595 57.8 1029 1.33 0.004 1.39 1.21 to 1.73 0.003
 PlanetRomeo 272 35.4 496 64.6 768 1 1
 Wapo 313 36.4 546 63.6 859 1.04 0.668 1.14 0.91 to 1.42 0.247
Schedule of sent message
 08:00–14:00 283 35.8 507 64.2 790 1
 14:00–17:00 387 40.6 567 59.4 954 1.22 0.043
 17:00–19:00 349 38.3 563 61.7 912 1.11 0.298
Place attended for intervention
 Lesseps 525 40.0 787 60.0 1312 1.14 0.084
 Drassanes 494 36.8 850 73.2 1344 1
Total 1019 38.4 1637 61.6 2656
*Univariate logistic regression.
†Multivariate logistic regression, adjusted by age, time of last connection, type of photograph and application used.
ORa, adjusted OR.

responded favourably, 108 (12.8%) were interested in attending (7.8% and 6.5%, respectively). Of the 75 HIV tests performed,
the programme facilities, 258 (30.5%) stated they were going one 26-year-old man gave a positive result, representing 1.3%
to take the tests elsewhere or had already taken them, and the prevalence (95% CI 0.17 to 9.24). There were no reactive tests
remaining 480 (56.7%) provided no information (figure 1). for syphilis and hepatitis C. The characteristics of the users who
Among the 108 users who were interested in attending the facil- attended the intervention and took the survey are summarised
ities, 79 attended, which gives an effectiveness of 73.2% without in table 2.
differences between apps (P=0.920). Regarding sexual practices, 51.4% of survey respondents
who engaged in anal sex with casual partners claimed to have
Factors associated with user response had anal penetration without a condom during the previous 12
After multivariate adjustment, the following variables were asso- months, of whom 75.3% did not know the serological status of
ciated with user response: (1) being 45 years of age or older any of their casual partners. They had a median of 10 sexual
(adjusted OR (ORa)=1.48; 95% CI 1.06 to 2.08), (2) being partners in the previous 12 months (IQR: 6–20), and 72.7% had
connected at the moment the intervention message was sent or
met their last casual sex partner via an app. Approximately half
during the previous hour (ORa=1.92; 95% CI 1.38 to 2.68), (3)
(50.7%) of survey respondents said that they had used drugs,
having a profile photo not exposing a bare chest or abdomen
alcohol (≥4 standard units of alcohol) or sexual stimulants for
(ORa=1.44; 95% CI 1.07 to 1.92), and (4) using the Grindr app
their sexual encounters (table 2).
(ORa=1.39; 95% CI 1.12 to 1.73) (table 1).
We found that 59.7% of survey respondents used these apps
on a daily basis (or on at least 6 days per week), and that 71.4%
Users who attended the intervention facilities
Of the 79 users who attended for testing or vaccination, 42.5% did so during the evening. Looking for sex was the main reason
did so on the same day or the day after the intervention message for connecting to the apps (44.2%), and 67.5% of respondents
was sent. Of the 77 individuals who took the survey, 46.7% claimed that their number of sexual partners had increased
were born abroad, 62.3% had a university-level education and since installing the apps. Grindr was the most widely used app
81.8% were employed. Of the users who took the HIV test, (62.3%) (table 3).
7.8% of them had never previously done so and 45.4% had not The satisfaction survey, taken by 70 users (90.9%), presented
taken one for over a year. Approximately 25% reported having an average score of 9.7 out of 10. All individuals (100%) who
an STI during the 12-month period prior to the test. The most took this survey stated they would recommend this service to
common infections were Pthirus pubis (crabs) and gonorrhoea friends and acquaintances.
Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348 3
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Table 2 Characteristics of the 79 users who attended HIV and other STI testing facilities in the application-based pilot intervention programme,
Barcelona 2016
Variables Median IQR n % Variables n %
Sociodemographic characteristics Place where last non-steady partner was met
Age (years) 32 26–37 77  Web (chat) 4 5.2
Country of origin  Application 56 72.7
 Spain 41 53.3  Friends 4 5.2
 Other 36 46.7  Sauna 2 2.6
City of residence  Disco/bar 7 9.1
 Barcelona 73 92.2  Other 4 5.2
 Other 6 7.8 Drugs used for sex† (last 12 months)
Highest educational level Any drug 40 52.0
 Primary 5 6.5 Used drugs (multiple selection)
 Secondary 14 18.2  Erection enhancers 10 13.0
 Professional training 10 13  Alcohol 21 27.3
 University 48 62.3  Poppers 23 29.9
Employment status  Cannabis/hash 12 15.6
 In paid employment 63 81.8  Ecstasy/MDMA 2 2.6
 Unemployed 5 6.5  Crystal methamphetamine 1 1.3
 Retired/impairment 2 2.6  Amphetamines 2 2.6
 Student 7 9.1  GHB/GBL 3 3.9
Sexual orientation  Ketamine 2 2.6
 Homosexual 59 76.6  LSD 2 2.6
 Bisexual 15 19.5 HIV and STIs
 Heterosexual 1 1.3 HIV previous serological status
 NA 2 2.6  Negative 69 89.6
Steady sex partner (more than 2 months)  Positive 2 2.6
 Have steady partner 17 22.1  Unknown 6 7.8
 Condomless anal sex in the last 12 months* 14 82.4 Results of HIV tests performed
Non-steady sex partners (last 12 months)  Negative 74 98.7
 Has had non-steady partner(s) 77 100  Positive 1 1.3
HIV status of non-steady partner(s) Time since last HIV test
 Negative 6 7.8  Less than 6 months 22 28.6
 Positive 13 16.9  6–11 months 20 26.0
 Unknown 58 75.3  More than 1 year 35 45.4
Condomless anal sex in the last 12 months* 37 51.4 Any STI during the last 12 months 19 24.7
Number of sexual partners in the last month 2 1–4 77
Number of sexual partners in the last 12 months 10 6–10 77
*Both insertive and receptive, among users who reported to practise anal sex.
†Intentional drug use before or during sex.
NA: not answered. MDMA: 3,4-Methylenedioxymethamphetamine . GHB: gamma-Hydroxybutyric acid . GBL: gamma butyrolactone . LSD: Lysergic acid diethylamide .

Discussion (rapid tests and vaccinations) to the MSM population, instead of

This study demonstrates that offering free, confidential HIV describing the usage of the app itself, which was the aim of the
and other STI tests via apps is feasible, widely accepted and also other study.15
effective. Acceptance and effectiveness of our study are quite satis-
factory. While we were unable to find other studies that
Pilot programme evaluation used the exact same methodology, our results appear to have
The feasibility of our method depended on whether the app higher rates than those of similar published studies.18 24 This
developers blocked the investigators’ profiles due to complaints improved acceptance and effectiveness could be because
from other users. During this study, the investigators’ profiles our programme follows the 2014 European guide recom-
were not blocked by the app developers at any point, and thus mendations for conducting HIV tests, for example, being
remained active throughout the study, as observed by other in close geographical proximity to the target popula-
studies targeting the MSM population using apps.15 19 However, tion, offering free tests within a short period of time and
to promote sexual health, it would be advantageous to estab- guaranteeing confidentiality.25 In fact, we believe that our
lish formal collaboration between the app developers and public method would have been even more effective if the testing
health organisations. had been performed in areas where services are scarce.
The response rate in our study exceeded the rate observed Indeed, a large portion of the users who responded favour-
in a previous study that directly contacted individuals through ably to our message claimed to use services available in the
one of these apps. This is likely because we offered a service geographical area.
4 Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348
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Digital communications and sexual health

intervention programmes should be tailored to the young MSM
Table 3 Characteristics of app usage by the 79 users who attended
population.
HIV and other STI testing facilities in the app-based pilot intervention
programme, Barcelona 2016
Variables Median IQR n %
Users who attended the intervention facilities
Almost half of participants turned up to the facilities within 2 days
App use characteristics of replying to the message, probably because we offered a very
History of use flexible schedule for performing testing and vaccination. Thus,
 Less than 1 year 14 18.2 speed, both in terms of user participation and message propa-
 1–3 years 28 36.4 gation, could be a primary advantage of our programme when
 4 or more years 34 44.2 compared with other intervention methods such as outreach in
 NA 1 1.3 gay venues or primary healthcare testing. This, together with the
Frequency of use during the last month short time spent in contact with thousands of users, enables a
 6–7 days a week 46 59.7 high level of efficiency, a variable that should also be evaluated
 2–5 days a week 29 37.7 in terms of cost-effectiveness.
 1 day a week or less 1 1.3 Most users who attended the facilities were young, employed,
 NA 1 1.3 resident in Barcelona and held university studies, which
Time of use during the day was consistent with other studies.14 27 Furthermore, a high
 Morning (06:00–12:00) 6 7.8
percentage of these individuals were born in other countries,
 Afternoon (12:00–18:00) 3 3.9
possibly because they have fewer resources to access the health-
care system and obtaining information about other test facilities.
 Evening/night (18:00–00:00) 55 71.4
Also, 45.4% had not taken the HIV test for at least a year and
 Early morning (00:00–06:00) 4 5.2
7.8% were taking it for the first time. This demonstrates that this
 Indifferent use 8 10.4
type of intervention can help to reduce late HIV diagnosis in the
 NA 1 1.3
MSM population.24
Day of use during the week The schedule of use of the apps reported matches with usual
 Weekdays 15 19.5 after-work or after-study hours. For future interventions, we
 Weekend 29 37.7 think the best time for reaching users is the late afternoon/early
 Indifferent 32 41.6 evening29.
 NA 1 1.3 As in other studies, the users who responded to our survey
Number of apps used 2 2–3 were highly satisfied with the intervention we offered.18 19 24
Last used app
 Grindr 48 62.3 Collateral benefits of the intervention
 PlanetRomeo 10 13.0 Direct contact between the users and the investigator through
 Wapo 9 11.7 the apps facilitates personalised counselling. This type of inter-
 Tinder 3 3.9 vention, described as Reaching Out Online, involves bringing
 Other 2 2.6 resources of the health system to virtual places where high-risk
 NA 5 6.5 populations interact30.
Apps, applications; NA, not answered. Apart from the individuals we directly tested and vaccinated,
our message likely had a ‘reminder effect’ for other MSM indi-
viduals who chose not to respond. While this added benefit
Characteristics of the app users is unmeasurable, it has been demonstrated that receiving a
Most users in our study said they connected to the apps to search preventative message results to an increase in routine testing
for sexual partners, reaffirming previous reports on the MSM among MSM.31
population.13 19 This puts this app-based intervention in a stra-
tegic position to promote sexual health, as these apps encourage Limitations
sexual encounters among individuals with a high prevalence of Due to the small sample size of users who attended, this study is
STI antecedents, multiple sexual partners and a high level of not representative of the overall MSM population in Barcelona
drug use during sex.17 19 who use the apps for sexual and social encounters. However, as
From our analysis, we identified the typical characteristics previously described, the characteristics of the app users reached
of users who responded to intervention messages. First, Grindr by this programme are in agreement with those reported in
users were more likely to reply to the message than those studies of other large cities.12 15 19
connected to the other apps, implying a relation with more use Regarding response rate, some contacts may have been dupli-
of this app in the Spanish population.11 Second, users who were cated because a number of individuals use more than one of the
connected at the moment the message was sent, or during the apps and/or have more than one profile on the same app. For
previous hour, were also more likely to respond, suggesting they example, in our study we found that more than 50% of indi-
had accessibility to establish contact. Third, individuals who had viduals used two or more of these apps. This means that our
no profile photo, or those who had a photo of a bare chest or response rate could be underestimated because an individual
abdomen, were less likely to respond, probably because this type with more than one profile would most likely only respond to
of user seeks anonymity, and as such is less likely to attend the our message once.
facilities. Finally, as seen in other studies, younger individuals This intervention was limited in terms of time and location,
had a lower response rate than older individuals, reflecting the in that we only conducted the intervention for 3 months in two
fact that the younger population is less willing to participate sites in Barcelona. Moreover, our method excludes individuals
in HIV prevention and screening programmes.26 Thus, future who only connected to the apps during the weekend or at night,
Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348 5
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making it impossible to extrapolate the results to all MSM users 4 Ecdc. ECDC SPECIAL REPORT The status of the HIV response in the European
of these apps. Union/European Economic Area, 2016. http://​ecdc.​europa.​eu/​en/​publications/​
Publications/​Status-​of-​HIV-​response-​in-​EU-​EEA-​2016-​30-​jan-​2017.​pdf (cited 11
May 2017).
Conclusion 5 Área de Vigilancia de VIH y Comportamientos de Riesgo. Vigilancia epidemiológica del
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the ASPB’s laboratory for allowing us to use their facilities, and also to Anna Esteve sample of men who have sex with men in Los Angeles County. Sex Transm Infect
(Centre d’Estudis Epidemiològics sobre les ITS i Sida de Catalunya) for professional 2014;90:567–72.
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review and editing. EDD: supervision, review and editing. JAC: resources, supervision, Lancet 2014;384:1415.
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Funding The authors have not declared a specific grant for this research from any AIDS Behav 2012;16:1816–20.
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Competing interests None declared. 2015;39:293–4.
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Ethics approval The study was approved by the ethical research committee of Parc
geosocial and sexual networking mobile applications to promote HIV and STD testing
de Salut Mar.
among men who have sex with men. AIDS Behav 2015;19:543–52.
Provenance and peer review Not commissioned; externally peer reviewed. 25 Gökengin D, Geretti AM, Begovac J, et al. 2014 European guideline on HIV testing. Int
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© Article author(s) (or their employer(s) unless otherwise stated in the text of the
26 The EMIS Network. EMIS 2010: the European Men-Who-Have- Sex-With-Men Internet
article) 2018. All rights reserved. No commercial use is permitted unless otherwise
Survey. Stockholm, 2013.
expressly granted.
27 Grosskopf NA, LeVasseur MT, Glaser DB. Use of the Internet and mobile-based
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6 Alarcón Gutiérrez M, et al. Sex Transm Infect 2018;0:1–6. doi:10.1136/sextrans-2017-053348

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Acceptability and effectiveness of using

mobile applications to promote HIV and other
STI testing among men who have sex with
men in Barcelona, Spain
Miguel Alarcón Gutiérrez, Manuel Fernández Quevedo, Silvia Martín
Valle, Constanza Jacques-Aviñó, Elia Díez David, Joan A Caylà and
Patricia Gracía de Olalla

Sex Transm Infect published online April 6, 2018

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