Adapting a mobile HIV prevention app to increase uptake of HIV and STI testing among rural men who have sex with men

摘要

Abstract Uptake of HIV/STI testing among men who have sex with men (MSM) in the rural southern US is low. However, HIV/STI testing is a fundamental gateway to preventive services, such as pre-exposure prophylaxis (PrEP), and treatment provision. Thus, it is critical that we identify methods to increase uptake of HIV/STI testing among this population that is disproportionately affected in terms of HIV and STI incidence. Because of the biological synergy in transmission and acquisition risk between HIV and STIs, programs that target both HIV and STIs will have a greater epidemiological impact compared to programs that treat these infections in isolation. We propose to adapt an existing, efficacious HIV prevention app, HealthMindr, for MSM in rural areas to address issues specific to this population such as increased experiences of stigma and reduced access to culturally competent care. We will then test the efficacy of the adapted HealthMindr app to increase uptake of HIV/STI testing over 24 months of follow-up among MSM in the rural South. The app will include components for self-administered risk assessments, developing and supporting a plan for frequent HIV/STI testing, and the ability to order HIV/STI at-home self-test kits. Previous trials of app-based HIV prevention have provided self- test kits free of charge. It is an open question whether men would use self-test kits if they were available at a charge. Additionally, despite the availability of free HIV/STI self-test kits, large proportions of men still do not complete HIV tests and even fewer complete STI tests. Thus, we will evaluate the effect of two different intervention components on HIV/STI uptake in a 2x2 factorial trial design: cost of HIV/STI self-test kits ordered through the app (free versus self-pay) and a motivational interview to enhance the existing app content and increase self-efficacy to develop and follow through with a testing plan. All participants will receive the new MyHealth app, redeveloped from the HealthMindr app for rural MSM. Men in the control arm (Arm 1) will have access to self-pay HIV/STI self-test kits and will not receive a motivational interview, men in Arm 2 will have access to self-pay HIV/STI self-test kits and will receive a motivational interview, men in Arm 3 will have access to free HIV/STI self-test kits and will not receive an motivational interview, and men in Arm 4 will have access to both free HIV/STI self-test kits and a motivational interview. This study design will allow us to observe the main effects of the cost of HIV/STI self-test kits and the motivational interview, as well as the interaction between the two interventions, on HIV/STI testing uptake over 24 months of follow up.