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

Patrick S Sullivan, Robert Driggers, Joanne D Stekler, Aaron Siegler, Tamar Goldenberg, Sarah J McDougal, Jason Caucutt, Jeb Jones, Rob Stephenson, Patrick S Sullivan, Robert Driggers, Joanne D Stekler, Aaron Siegler, Tamar Goldenberg, Sarah J McDougal, Jason Caucutt, Jeb Jones, Rob Stephenson

Abstract

Background: Men 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.

Objective: The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention.

Methods: The 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).

Results: A 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).

Conclusions: A 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.

Keywords: condoms; homosexuality, male; mobile applications; pilot projects; pre-exposure prophylaxis; sexual minorities.

Conflict of interest statement

Conflicts of Interest: None declared.

©Patrick S Sullivan, Robert Driggers, Joanne D Stekler, Aaron J Siegler, Tamar Goldenberg, Sarah J McDougal, Jason Caucutt, Jeb Jones, Rob Stephenson. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.03.2017.

Figures

Figure 1
Figure 1
Percent of MSM participants that used features or viewed pages in the app during a 4-month pilot study, United States, 2015 (n=109). MSM: men who have sex with men.

References

    1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey CJ, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo SH, Rooney J, Nardone A, Fisher M, McOwan A, Phillips AN, Johnson AM, Gazzard B, Gill ON. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016 Jan 02;387(10013):53–60. doi: 10.1016/S0140-6736(15)00056-2. S0140-6736(15)00056-2
    1. Molina J, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall J, Cua E, Pasquet A, Raffi F, Pintado C, Chidiac C, Chas J, Charbonneau P, Delaugerre C, Suzan-Monti M, Loze B, Fonsart J, Peytavin G, Cheret A, Timsit J, Girard G, Lorente N, Préau M, Rooney JF, Wainberg MA, Thompson D, Rozenbaum W, Doré V, Marchand L, Simon M, Etien N, Aboulker J, Meyer L, Delfraissy J, ANRS IPERGAY Study Group On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015 Dec 03;373(23):2237–46. doi: 10.1056/NEJMoa1506273.
    1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker L, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell JJ, Zheng J, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV, iPrEx ST. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010 Dec 30;363(27):2587–99. doi: 10.1056/NEJMoa1011205.
    1. Sullivan P, Wolitski R. HIV infection among gaybisexual men. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal Oppportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. New York: Oxford University Press; 2007. pp. 220–47.
    1. CDC. 2013. [2017-02-14]. HIV/AIDS Surveillance Report 2011 .
    1. Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of prevalent HIV infection, prevalent diagnoses, and new diagnoses among men who have sex with men in US States, metropolitan statistical areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016 May 17;2(1):e22. doi: 10.2196/publichealth.5684. v2i1e22
    1. Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, Lin LS, An Q, Mermin J, Lansky A, Hall HI, HIV Incidence Surveillance Group Estimated HIV incidence in the United States, 2006-2009. PLoS One. 2011;6(8):e17502. doi: 10.1371/journal.pone.0017502. PONE-D-10-02530
    1. Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, Karon J, Brookmeyer R, Kaplan EH, McKenna MT, Janssen RS, HIV Incidence Surveillance Group Estimation of HIV incidence in the United States. J Am Med Assoc. 2008 Aug 6;300(5):520–9. doi: 10.1001/jama.300.5.520. 300/5/520
    1. Koblin B, Mayer KH, Eshleman SH, Wang L, Mannheimer S, Rio CD, Shoptaw S, Magnus M, Buchbinder S, Wilton L, Liu T, Cummings V, Piwowar-Manning E, Fields SD, Griffith S, Elharrar V, Wheeler D. Correlates of HIV incidence among black men who have sex with men in 6 U.S. cities (HPTN 061) [2017-02-15]. .
    1. CDC. 2016. Sep 01, [2017-02-14]. HIV and AIDS among Gay and Bisexual Men .
    1. Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, Gau Z, Weinstock H, Su J, Crepaz N. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS J. 2012;6:98–107. doi: 10.2174/1874613601206010098. TOAIDJ-6-98
    1. Brookmeyer R, Boren D, Baral SD, Bekker L, Phaswana-Mafuya N, Beyrer C, Sullivan PS. Combination HIV prevention among MSM in South Africa: results from agent-based modeling. PLoS One. 2014;9(11):e112668. doi: 10.1371/journal.pone.0112668. PONE-D-14-24589
    1. Sullivan PS, Carballo-Diéguez A, Coates T, Goodreau SM, McGowan I, Sanders EJ, Smith A, Goswami P, Sanchez J. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012 Jul 28;380(9839):388–99. doi: 10.1016/S0140-6736(12)60955-6. S0140-6736(12)60955-6
    1. Sullivan PS, Jones J, Kishore N, Stephenson R. The roles of technology in primary HIV prevention for men who have sex with men. Curr HIV/AIDS Rep. 2015 Dec;12(4):481–8. doi: 10.1007/s11904-015-0293-5.10.1007/s11904-015-0293-5
    1. Jenness SM, Goodreau SM, Rosenberg ES, Beylerian E, Hoover K, Smith DK, Sullivan P. Impact of the Centers for Disease Control's HIV pre-exposure prophylaxis guidelines for men who have sex with men in the United States. J Infect Dis. 2016 Jul 14;214(12):1800–1807.
    1. Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, Sullivan PS. The annual American men's internet survey of behaviors of men who have sex with men in the United States: protocol and key indicators report 2013. JMIR Public Health Surveill. 2015 Apr 17;1(1):e3. doi: 10.2196/publichealth.4314.
    1. Sullivan PS, Sineath C, Kahle E, Sanchez TH. Awareness, willingness and use of oral pre-exposure prophylaxis (PrEP) among a national sample of US men who have sex with men. AIDS Impact; July 2015; Amsterdam. 2015.
    1. Sullivan PS, Grey JA, Simon Rosser BR. Emerging technologies for HIV prevention for MSM: what we have learned, and ways forward. J Acquir Immune Defic Syndr. 2013 Jun 1;63(Suppl 1):S102–7. doi: 10.1097/QAI.0b013e3182949e85. 00126334-201306011-00017
    1. CDC Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60(03):65–8.
    1. Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE, US Department of Health and Human Services Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the US Department of Health and Human Services. MMWR Recomm Rep. 2005 Jan 21;54(RR-2):1–20. rr5402a1
    1. Williams ML, Bowen AM, Horvath KJ. The social/sexual environment of gay men residing in a rural frontier state: implications for the development of HIV prevention programs. J Rural Health. 2005;21(1):48–55.
    1. Bowen AM, Williams ML, Daniel CM, Clayton S. Internet based HIV prevention research targeting rural MSM: feasibility, acceptability, and preliminary efficacy. J Behav Med. 2008 Dec;31(6):463–77. doi: 10.1007/s10865-008-9171-6.
    1. Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a mobile HIV prevention app for men who have sex with men. JMIR Mhealth Uhealth. 2014;2(4):e47. doi: 10.2196/mhealth.3745. v2i4e47
    1. Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Building a mobile HIV prevention app for men who have sex with men: an iterative and community-driven process. JMIR Public Health Surveill. 2015;1(2):e18. doi: 10.2196/publichealth.4449. v1i2e18
    1. Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991;50:248–87. doi: 10.1016/0749-5978(91)90022-L.
    1. CDC. 2014. [2017-02-14]. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2014 .
    1. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE, Centers for Disease ControlPrevention (CDC) Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22;55(RR-14):1–17. rr5514a1
    1. Khanna A, Goodreau SM, Wohlfeiler D, Daar E, Little S, Gorbach PM. Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California. Ann Epidemiol. 2015 Jan;25(1):1–6. doi: 10.1016/j.annepidem.2014.09.012. S1047-2797(14)00437-2
    1. Bangor A, Kortum P, Miller J. The system usability scale (SUS): An empirical evaluation. Int J Hum Comput Interact. 2008;24(6):574–94. doi: 10.1080/10447310802205776.
    1. Jordan PW. Usability evaluation in industry. London: Taylor & Francis; 1996. SUS-A quick and dirty usability scale.
    1. Centers for Disease Control and Prevention (CDC) HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men - United States. MMWR Morb Mortal Wkly Rep. 2013 Nov 29;62(47):958–62. mm6247a4
    1. Smith A. Pew Research Center. 2015. [2017-02-15]. US Smartphone Use in 2015
    1. Xu Q, Erman J, Gerber A, Mao Z, Pang J, Venkataraman S. Identifying diverse usage behaviors of smartphone apps. Proceedings of the 2011 ACM SIGCOMM conference on Internet measurement conference; ACM SIGCOMM Conference on Internet Measurement; November, 2011; Berlin, Germany. 2011.
    1. Khosropour C, Sullivan PS. Receipt and use of free condoms among US men who have sex with men. Public Health Rep. 2013;128(5):385–92.
    1. Kelley CF, Kahle E, Siegler A, Sanchez T, Del RC, Sullivan PS, Rosenberg ES. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015 Nov 15;61(10):1590–7. doi: 10.1093/cid/civ664.civ664
    1. Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: Adding an adjective rating scale. J Usability Stud. 2009;4(3):114–23.
    1. Horvath KJ, Alemu D, Danh T, Baker JV, Carrico AW. Creating effective mobile phone apps to optimize antiretroviral therapy adherence: perspectives from stimulant-using HIV-positive men who have sex with men. JMIR mHealth and uHealth. 2016;4(2):-.
    1. Sullivan PS, Khosropour CM, Luisi N, Amsden M, Coggia T, Wingood GM, DiClemente RJ. Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. J Med Internet Res. 2011 May;13(2):e38. doi: 10.2196/jmir.1797. v13i2e38

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit