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

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.

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.

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).

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."