Sullivan Patrick S, Driggers Robert, Stekler Joanne D, Siegler Aaron, Goldenberg Tamar, McDougal Sarah J, Caucutt Jason, Jones Jeb, Stephenson Rob
Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
Department of Medicine, University of Washington, Seattle, WA, United States.
JMIR Mhealth Uhealth. 2017 Mar 9;5(3):e26. doi: 10.2196/mhealth.7199.
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.
The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention.
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).
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).
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.
男男性行为者（MSM）是受人类免疫缺陷病毒（HIV）疫情影响最严重的群体，也是美国唯一一个新HIV诊断病例数未呈下降趋势的亚组。为实现美国国家HIV/AIDS（获得性免疫缺陷综合征）战略中减少25%新诊断病例的目标，城乡地区都需要多种HIV预防干预措施的高覆盖率（如30%-50%）。手机“应用程序”是一种重要渠道，通过它可以大规模且以较低边际成本提供预防服务。
本研究旨在评估一款基于理论的安卓手机HIV预防应用程序的可用性和可接受性。
该应用程序包括自我评估工具；预防建议；商品（避孕套、HIV自检试剂）订购；向MSM提醒基本的HIV预防服务、HIV检测、避孕套使用、暴露前预防（PrEP）筛查和非职业性暴露后预防（nPEP）；以及预防和治疗服务提供者定位器。该研究招募了亚特兰大和西雅图使用安卓手机的HIV阴性MSM，要求他们使用该应用程序4个月并完成使用后调查。我们测量了应用程序及其功能的使用情况、商品订购情况、建立HIV检测计划的自我报告、在社区进行HIV检测的情况以及开始PrEP或使用nPEP的情况。使用系统可用性量表（SUS）评估可用性。
共招募了121名MSM（59.5%，72/121来自亚特兰大；40.5%，49/121来自西雅图）。中位年龄为28岁。近一半（48.8%，59/121）为非白人，大多数（85.9%，104/121）自我认同为同性恋。大多数人过去曾进行过HIV检测（85.1%，103/121），52人（43.0%，52/121）有定期进行HIV检测的计划。男性在最初4个月平均使用该应用程序17.7分钟。在4个月期间，超过一半的人在应用程序上订购了避孕套（63.6%，77/121）和HIV检测试剂盒（52.8%，64/121）。86名符合PrEP条件的MSM中有8人（9%）在4个月期间开始使用PrEP；其中，8人中有6人报告该应用程序影响了他们开始使用PrEP的决定。SUS的平均得分是73（高于平均水平）。
一款基于理论的手机应用程序为MSM所接受，且可用性评级高于平均水平。在4个月的评估期内，大多数男性使用了该应用程序的商品订购功能，近十分之一符合PrEP条件的男性开始使用PrEP，大多数人将他们开始使用PrEP的决定部分归因于该应用程序。有必要对该应用程序对MSM预防行为采用情况影响进行更广泛的随机对照研究。
