Mobile Phone Intervention Based on an HIV Risk Prediction Tool for HIV Prevention Among Men Who Have Sex With Men in China: Randomized Controlled Trial

Abstract

Background eHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM). Objective This study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China. Methods We performed a mobile phone–based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju—an online survey platform—was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform. Results In total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference −2.5; 95% CI −5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87%, n=66/76 vs 70%, n=54/77 respectively; odds ratio 2.81, 95% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90%, n=77/86 vs 79%, n=65/82 respectively; odds ratio 2.20, 95% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US $131.60 on reducing 1 sexual partner and US $19.70 for a 1% increment in condom usage with casual partners. Conclusions A comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic. Trial Registration Chinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271

HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010–2021)

“…Half of all studies (54%, 25/46) deployed website-based interventions. Results were largely in favor of digital strategies including e-testing websites [15] , [16] , [17] , [18] , [19] , study websites [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , online counselling [33] , [34] , [35] , [36] , [37] , [38] , and chatbots [39] .…”

“…Feasibility was reported as HIVST kit uptake by three studies delivering oral self-tests through study websites, and was found to be high at 90%−96% [28] , [29] , [30] . Conversely, due to a relatively low uptake of 48%, a telehealth intervention offering home-based HIVST and web-based video counselling may not represent the ideal HIVST strategy for transgender and non-binary youth; voice call or text message-based counselling may be a preferrable option for this population [36] .…”

Research Progress in the Epidemiology of HIV/AIDS in China

“…Some innovative interventions, including electronic or internet-based technologies, crowd-sourcing, preexposure prophylaxis (PrEP), and postexposure prophylaxis (PEP), have recently been evaluated among MSM ( 10 - 12 ). Yun et al conducted a randomized controlled trial (RCT) showing that mobile phone interventions based on an HIV risk prediction tool is promising in promoting HIV testing and reducing high-risk behavior among MSM ( 13 ). The same group also demonstrated that an assisted partner notification (PN) strategy could increase uptake of HIV testing among sexual partners of recently diagnosed MSM ( 14 ).…”

Evaluations of training and education interventions for improved infectious disease management in low-income and middle-income countries: a systematic literature review

“…Twelve out of the 17 studies on HIV reported on the cost-effectiveness of the intervention. Variables included were cost per infection averted, 34 36 42 87 cost per QALY, 42 cost per HIV case detected, 84 87 cost per DALY averted, 29 34 36 39 41 83 cost per averted loss-to-follow-up, 30 82 cost per YLS, 81 cost per reduction in male sexual partners 37 and cost per % increase in condom use. 37 …”

“…Variables included were cost per infection averted, 34 36 42 87 cost per QALY, 42 cost per HIV case detected, 84 87 cost per DALY averted, 29 34 36 39 41 83 cost per averted loss-to-follow-up, 30 82 cost per YLS, 81 cost per reduction in male sexual partners 37 and cost per % increase in condom use. 37 Cost-effectiveness thresholds, which indicates the maximum amount a country or organisation is willing to pay for a unit of health-outcome, were only applied in studies on HIV. The thresholds ranged between one to five times gross domestic product per capita per DALY averted 29 36 39 41 or per YLS.…”