Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study

Abstract

BackgroundMen who have sex with men (MSM) are the group most impacted by the human immunodeficiency virus (HIV) epidemic and the only subgroup in the United States among which new HIV diagnoses are not decreasing. To achieve the US National HIV/AIDS (acquired immunodeficiency syndrome) Strategy goals of reducing new diagnoses by 25%, high (eg, 30-50%) coverage of multiple HIV prevention interventions is needed in both urban and rural areas. Mobile phone “apps” are an important channel through which prevention services could be provided at scale and at low marginal cost.ObjectiveThe aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention.MethodsThe app included self-assessment tools; prevention recommendations; commodity (condoms, HIV self-tests) ordering; reminders to MSM for basic HIV prevention services, HIV testing, condom use, screening for preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP); and prevention and treatment provider locators. The study recruited HIV-negative, Android-using MSM in Atlanta and Seattle who were asked to use the app for 4 months and complete a post-use survey. We measured the use of the app and its features, ordering of commodities, self-report of establishing an HIV testing plan, being HIV tested in the community, and starting PrEP or using nPEP. Usability was assessed using the system usability scale (SUS).ResultsA total of 121 MSM were enrolled (59.5%, 72/121 from Atlanta; 40.5%, 49/121 from Seattle). Median age was 28. Nearly half (48.8%, 59/121) were nonwhite, and most (85.9%, 104/121) were gay-identified. Most had tested for HIV in the past (85.1%, 103/121), and 52 (43.0%, 52/121) had a plan to test for HIV regularly. Men used the app for an average of 17.7 minutes over the first 4 months. Over the 4-month period, over half ordered condoms (63.6%, 77/121) and HIV test kits (52.8%, 64/121) on the app. Eight of 86 (9%) PrEP-eligible MSM started PrEP during the 4-month period; of those, 6 of the 8 reported that the app influenced their decision to start PrEP. The mean SUS was 73 (above average).ConclusionsA theory-based mobile phone app was acceptable to MSM and was rated as having above-average usability. Most men used the commodity-ordering features of the app during the 4-month evaluation period, and nearly 1 in 10 PrEP-eligible men started PrEP, with most attributing their decision to start PrEP in part to the app. A broader, randomized controlled study of the impact of the app on uptake of prevention behaviors for MSM is warranted.

Using technology to support HIV self-testing among MSM

“…Sullivan et al, conducted a pilot study to test the usability of a comprehensive, theory-based HIV prevention app for MSM [27**]. The HealthMindr app provides self-assessment tools, HIV prevention recommendations and reminders (e.g., condom use, HIV testing, PrEP screening), prevention and treatment service locators, and the ability to order free condoms and HIV test kits.…”

“…Two additional US-based studies focus on increasing HIV testing among MSM. One study is adapting the HealthMindr app [27**] to deliver in-app messages that encourage MSM to engage in prevention services. The app will include a feature that allows users to order free HST kits [PI: Sullivan].…”

Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial (Preprint)

“…However, despite the fact that there are over 800 medication adherence applications for a range of conditions, few have been widely studied [24]. Although some research is beginning to investigate use of daily text messaging to support PrEP adherence [25], a smartphone application targeting HIV prevention that includes PrEP screening [26], a smartphone application that incorporates PrEP adherence among MSM in an ongoing trial [27], to our knowledge there are no published studies on medication adherence smartphone applications for PrEP.…”

A Mobile-Based App (MyChoices) to Increase Uptake of HIV Testing and Pre-Exposure Prophylaxis by Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial (Preprint)

“…More than 20% of all new HIV infections in the US are among young people aged [13][14][15][16][17][18][19][20][21][22][23][24], and 92% of these new infections are diagnosed in YMSMmaking them one of the largest risk groups for HIV.…”

“…[16][17][18][19][20] Informed by extensive formative research, Dr. Patrick Sullivan of Emory University (one of iTech's Principal Investigators), with app developers from Keymind, developed and tested an HIV testing promotion app for adult MSM ("HealthMindr"). [21] Our initial formative research with YMSM [22] suggested interest in an HIV testing app like HealthMindr, but the youth agreed that it had to be adapted to be more culturally and developmentally appropriate for their peers.…”