Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study

Abstract

Background Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. Objective The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. Methods A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. Results From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. Conclusions This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV.

Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey

“…Our findings indicate that there is considerable interest in specific mHealth strategies, such as receiving information related to HIV (345/376, 91.8%), receiving medication reminders (336/376, 89.4%), screening and monitoring sex activity (306/376, 81.4%) and illicit drug use (281/376, 74.7%), and monitoring drug cravings (280/376, 74.5%). In the absence of public dialogue about these issues in Malaysia, it is not surprising that Malaysian men who have sex with men, similar to men who have sex with men in other settings [62][63][64][65][66][67], and specifically, for HIV prevention, in China [68], Vietnam [69], and Indonesia [66], expressed interest. In our sample, men expressed interest in the use of mHealth apps to receive daily reminders to take medications; however, weekly and monthly reminders were preferred for other activities, with smartphone apps being the preferred platform.…”

Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review

“…Among the 17 quantitative studies included, there were 4 RCTs [42,43,63,70] and 13 nonrandomized studies (including 4 comparative studies [65,68,69,72], 8 non-comparative single-arm studies [14,15,[58][59][60][61]67,73], and 1 non-interventional study [30]). Across the five domains of RoB 2, the selected RCT studies were convincing.…”

“…Four other studies provided app-based content for knowledge gains related to HIV and PrEP and increased test readiness. This was true for the US MOTIVES [70,71], evaluated in a quasi-experimental randomized pilot study of 218 service users (largely MSM sample, including 30.2% and 36.7% trans women in the intervention groups with mean ages of 34.8 and 35.2 years, respectively), the Indonesian RUMAH SELA [72] non-randomized study project with 168 participants (largely MSM and drug user sample, of which 29.17% were trans women with a mean age of 25.6 years), and the US TGD-specific non-randomized usability study project Trans Women Connected [45] with 16 trans women and non-binary individuals (mean age 34.5 years). Two US studies focused on increasing the utilization of HIV-related health care, namely, weCare [39] (process evaluation with 32 participants, average age 25.2 years and including 27.78% trans women), and an unnamed eNavigation [73] addressed to 120 participants (largely MSM sample, including 14.17% trans women with an average age of 27.75 years).…”

“…For the videoconferencing services, service users had to have access to an internet-enabled device with a microphone and camera (e.g., laptop). While another 6 studies [39,45,[70][71][72][73] dealt with mobile health apps, as mentioned above, for the remaining 10 included studies [38,46,58,59,61,[63][64][65][66][67], web-accessible computers were in the foreground due to concepts such as games, educational programs, or forums.…”

“…Information content in the included e-health studies was primarily text or video based. In some community-based educational programs, these services were supported by quizzes or tests to reinforce learning objectives [46,66,[70][71][72]. The same applies to HCPfocused programs with questions and self-reflection tasks [58], module-based feedback [61], interactive role play sessions [60], or learning groups [59].…”