NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.
JMIR Mhealth Uhealth. 2021 Apr 13;9(4):e19511. doi: 10.2196/19511.
eHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM).
This study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China.
We performed a mobile phone-based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju-an online survey platform-was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform.
In total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference -2.5; 95% CI -5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87%, n=66/76 vs 70%, n=54/77 respectively; odds ratio 2.81, 95% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90%, n=77/86 vs 79%, n=65/82 respectively; odds ratio 2.20, 95% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US $131.60 on reducing 1 sexual partner and US $19.70 for a 1% increment in condom usage with casual partners.
A comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic.
Chinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271.
基于风险分层的电子健康干预措施尚未广泛应用于 HIV 阴性的男男性行为者（MSM）的 HIV 行为干预。
本研究旨在评估一种基于 HIV 风险预测工具的手机干预措施在中国 HIV 阴性 MSM 中促进 HIV 检测和减少高危行为的效果。
我们进行了一项为期 12 周的基于手机的随机对照临床试验。开发了一个综合干预包，部署在 Jinshuju 在线调查平台上，包括 4 个部分：（1）经过验证的 HIV 风险预测工具，提供个性化降低风险干预的信息；（2）基于地理位置的个性化 HIV 检测设施地图；（3）免费提供 HIV 预防资源的二维码，包括避孕套和 HIV 自检套件；（4）HIV 健康教育的一般资源。从微信/QQ 群组招募的 MSM 参与者以 1:1 的比例随机分配到干预组或对照组。工作人员通过微信向干预组的 MSM 发送综合干预包的二维码，仅向对照组的 MSM 发送 HIV 健康教育资源的二维码。在基线和 12 周随访时，通过 Jinshuju 在线调查平台收集与 HIV 相关的风险行为和 HIV 检测行为数据。
共招募了 192 名 MSM，并将其分配到干预组或对照组（每组 96 名）。在第 12 周时，总临床试验保留率为 87.5%。过去 3 个月中 MSM 的男性性伴侣人数在干预组明显低于对照组（3.51，SD 4.1 与 6.01，SD 11.4，分别；平均差异-2.5；95%CI-5.12 至 0.12；P=.05）；与偶然性伴侣使用安全套的比例在干预组高于对照组（87%，n=66/76 与 70%，n=54/77，分别；优势比 2.81，95%CI 1.23-6.39；P=.01）。干预组在接下来的 30 天内打算接受 HIV 检测的人数比例略高于对照组（90%，n=77/86 与 79%，n=65/82，分别；优势比 2.20，95%CI 0.90-5.35；P=.07）。电子健康干预减少 1 个性伴侣的增量成本效益比为 131.60 美元，增加 1%偶然性伴侣使用避孕套的增量成本效益比为 19.70 美元。
基于 HIV 风险预测工具的综合干预措施可以减少 MSM 的男性性伴侣数量，并提高与偶然性伴侣使用避孕套的比例。因此，这种干预措施是 HIV 预防策略中非常有前途的方法，尤其是在 HIV 流行明显的地区。
中国临床试验注册中心 ChiCTR1800017268；http://www.chictr.org.cn/showprojen.aspx?proj=29271.
