Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States.
The Humsafar Trust, Mumbai, India.
JMIR Public Health Surveill. 2020 Apr 16;6(2):e16494. doi: 10.2196/16494.
Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions.
The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model.
Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention.
Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up.
As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates.
利用基于互联网的通讯工具（例如，消息应用程序、短信和电子邮件）可能是向印度男男性接触者（MSM）传递艾滋病毒预防信息的有效途径，但针对此类基于互联网的干预措施，目前还没有太多的模型。
CHALO！试验是一项在线教育和行为干预措施，旨在确定一种由同伴提供的、基于互联网的信息传递干预措施对于在印度进行艾滋病毒检测和坚持使用安全套的 MSM 的可行性、可接受性和初步效果。这些信息针对的是艾滋病毒检测和使用安全套的障碍，并且在理论上基于信息-动机-行为技能模型。
在 2015 年 2 月至 3 月期间，我们通过移动约会应用程序和 Facebook 上的在线广告招募、纳入并随机分配了 244 名参与者。符合条件的男性（18 岁或以上，与其他男性发生过性行为，且自我报告艾滋病毒阴性或未知）被随机分配到 12 周内通过互联网消息平台接收以实现（即，要实现的理想结果）或避免（要避免的不理想结果）为框架的教育和激励信息。参与者在基线和干预后立即完成在线调查。
参与者在社会人口统计学和行为特征方面在各个组之间相似。超过 82.0%（200/244）的参与者保留了（即，查看了最后一条消息），其中 52.3%（130/244）完成了随访调查。在完成随访调查的参与者中，82.3%（107/130）喜欢或非常喜欢参与 CHALO！。结果显示，与基线相比，过去 6 个月内自我报告的艾滋病毒检测率从 41/130（31.5%）显著增加到 57/130（43.8%）（P=.04）。当包括那些报告有检测意向的人时，这一比例从基线时的 44.6%（58/130）增加到随访时的 65.4%（85/130）（P<.01）。在检查那些没有进行过艾滋病毒检测的人的检测意向时，在基线时的 32%（16/50）增加到随访时的 56%（28/50）（P=.02）。在肛交过程中使用安全套的比例从基线到随访没有显著变化。在随访时，艾滋病毒检测和使用安全套在实现和避免条件下没有显著差异。
作为印度 MSM 在线艾滋病毒预防干预措施的首批研究之一，CHALO！由一个社区组织实施是可行的，参与者对其也可接受，并显示出提高艾滋病毒检测率的潜力。
