HealthMindr App to Increase Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex With Men (MSM)

Theoretically Based Mobile App to Increase PrEP Uptake Among MSM

This study is a randomized controlled clinical trial of a theoretically based mobile app, HealthMindr, to increase pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) to prevent human immunodeficiency virus (HIV). Participants in the intervention arm will receive access to the HealthMindr app, with information about PrEP and other HIV prevention methods in addition to provider locators. Participants randomized to the control arm will receive standard of care. The primary aim for this study is to assess PrEP uptake in the intervention arm compared to the control arm.

Study Overview

• Status: Completed
• Conditions: HIV Infections
• Intervention / Treatment: Behavioral: HealthMindr App; Behavioral: Control App

Detailed Description

MSM are disproportionately impacted in terms of HIV prevalence and incidence. Electronically delivered or supported prevention services are effective, are acceptable to MSM, and will likely reach heavily impacted men. The study is based on the premise that providing, through a mobile phone app, self-directed PrEP information; periodic behavioral screenings to identify HIV risk and PrEP indication objectively; referral to PrEP providers with directions; and related prevention services will increase the uptake of PrEP among at risk, HIV negative MSM to a greater extent than standard of care referrals to existing resources.

The study will examine the effectiveness of the HealthMindr app to increase uptake of PrEP among MSM. The study will enroll 657 men across the three sites - the metropolitan statistical areas (MSA) of Atlanta, Georgia (GA), Jackson, Mississippi (MS), and Washington, D.C. - into a randomized controlled trial. Participants in the intervention arm will receive access to the HealthMindr app and men in the control arm will receive standard of care HIV prevention information. PrEP uptake will be assessed during follow-up by self-report at months 3, 6, 9, and 12. Self-report will be confirmed by laboratory testing for the presence of tenofovir diphosphate (TFV-DP) and/or photograph of PrEP prescription or bottle.

At the beginning of the study, all participants will download a study mobile app. After completing a baseline survey, participants will be randomized to the intervention or control arm. For participants assigned to the intervention arm, additional app content will become available. This content will include information about basic prevention services (HIV test planning and test locators; risk assessment; HIV treatment locators; and condom, HIV test kit, and at-home sexually transmitted infection (STI) specimen collection kit distribution) plus monthly PrEP eligibility assessments, PrEP provider locator, enhanced information about PrEP, and referrals to local PrEP navigators. The app also provides links to health insurance exchanges, where men can seek health insurance or assistance to help cover PrEP costs. The control arm will be referred to existing online PrEP and HIV prevention information. Participants in the control arm will access the control version of the app that contains elements pertinent to their participation in the research study.

Additional follow-up surveys will be conducted at 3, 6, 9, and 12 months and participants will also complete monthly assessments. The monthly assessments will assess indications for PrEP and PrEP uptake (intervention arm) and other health-related behaviors (control arm). Participants reporting PrEP initiation will be asked to submit a dried blood spot self-collection kit to allow for measurement of tenofovir diphosphate (TFV-DP) levels and/or upload a photo of their PrEP prescription bottle to verify PrEP uptake.

Participants will primarily be recruited online from the main study sites in Atlanta, Georgia, Jackson, Mississippi, and Washington, District of Columbia (DC). Online recruitment will expand to other areas of the United States, as needed to meet recruitment targets.

• Study Type: Interventional
• Enrollment (Actual): 658
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington, District of Columbia, United States, 20052
      • George Washington University
  • Georgia
    • Atlanta, Georgia, United States, 30308
      • Emory University
  • Mississippi
    • Jackson, Mississippi, United States, 39216
      • University of Mississippi Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 34 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Cisgender male
• 18-34 years of age (inclusive)
• Resides in one of the study MSAs
• Intends to remain in study area for duration of the trial
• Owns an Android or Apple operating system (iOS) smartphone and willing to download study app
• Able to read and understand English without assistance
• Reports having anal sex with a man in the past 6 months
• Reports being HIV negative or never tested for HIV

Exclusion Criteria:

• Cisgender female, transgender male, transgender female, gender non-conforming
• Currently on PrEP
• < 18 or >34 years of age
• Reports being HIV positive
• Resides outside of the MSAs or plans to move outside study MSA within 12 months
• Current participant in another HIV prevention study
• Unable to download study app

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: HealthMindr App; Participants in the intervention arm will receive access to all HealthMindr app capabilities. The app information will cover the importance of testing, links to HIV prevention resources, resources to locate HIV testing and PrEP services, the Substance Abuse and Mental Health Services Administration (SAMHSA) substance abuse treatment resource locator, and other prevention information specific to their area.	Behavioral: HealthMindr App; Participants in the intervention arm will receive access to the HealthMindr app with basic prevention services (HIV test planning and test locators; risk assessment; HIV treatment locators; and condom, HIV test kit, and at-home STI specimen collection kit distribution) plus monthly PrEP eligibility assessments, PrEP provider locator, enhanced information about PrEP, and referrals to local PrEP navigators. The app also provides information about obtaining health insurance coverage and paying for PrEP.
Placebo Comparator: Control App; Participants in the control arm will be directed to download a study app that allows study staff to interact with them.	Behavioral: Control App; Men in the control arm will have access to an app with information pertinent to their participation in the study, including a study events timeline. The app will also allow participants and study staff to communicate via a messaging feature. The control arm app will not contain HIV prevention information.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in PrEP Uptake	PrEP uptake will be assessed at each follow-up timepoint (3, 6, 9, and 12 months) in the intervention and control groups. The primary measure of PrEP uptake will be self-report. Validation will occur through submission of a dried blood spot self-collection kit to detect tenofovir diphosphate (TFV-DP) and/or upload of a photo of a PrEP prescription bottle.	3, 6, 9, and 12 months post-randomization

Collaborators and Investigators

• Sponsor: Emory University
• Collaborators: National Institute on Drug Abuse (NIDA); National Institutes of Health (NIH)

Publications and helpful links

General Publications

• Jones J, Dominguez K, Stephenson R, Stekler JD, Castel AD, Mena LA, Jenness SM, Siegler AJ, Sullivan PS. A Theoretically Based Mobile App to Increase Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2020 Feb 21;9(2):e16231. doi: 10.2196/16231.

Study record dates

Study Major Dates

• Study Start (Actual): January 28, 2020
• Primary Completion (Actual): March 17, 2023
• Study Completion (Actual): March 17, 2023

Study Registration Dates

• First Submitted: December 3, 2018
• First Submitted That Met QC Criteria: December 3, 2018
• First Posted (Actual): December 4, 2018

Study Record Updates

• Last Update Posted (Actual): May 1, 2023
• Last Update Submitted That Met QC Criteria: April 27, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: Human Immunodeficiency Virus (HIV); Men who have sex with men (MSM); Pre-Exposure Prophylaxis (PrEP); HealthMindr
• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; Immunologic Deficiency Syndromes; Immune System Diseases; HIV Infections
• Other Study ID Numbers: IRB00102006; R01DA045612 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No