Abstract
BackgroundHIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions—particularly mobile health platforms—can provide tailored adherence interventions and allow YMSM to engage and connect with others.ObjectiveThe objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM.MethodsAllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability.ResultsMean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications.ConclusionsAllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM.
Highlights
HIV Infection Among Young Men Who Have Sex With Men in the United StatesIn the United States, men who have sex with men (MSM) experience the highest rates of new HIV diagnoses, with young MSM (YMSM) and MSM of color continuing to be significantly impacted [1]
Privacy features: these include avatars, pseudonyms, confidential pin number to open app, app time-out after 5 min of inactivity, and medication tracker that allows participants to choose any name they want for their medication reminder
We describe the development of a novel, theory-based antiretroviral therapy (ART) adherence app for young men who have sex with men (YMSM) that showed strong acceptability, feasibility, and preliminary impact on HIV self-management outcomes
Summary
In the United States, men who have sex with men (MSM) experience the highest rates of new HIV diagnoses, with young MSM (YMSM) and MSM of color continuing to be significantly impacted [1]. National HIV Behavioral Surveillance data on MSM from 20 cities found that among black MSM in the age range of 18 to 24 years tested in 2014, 26% were HIV positive, compared with 3% of white MSM This disparity in HIV prevalence between black and white MSM increased from 2008 to 2014, especially among YMSM [3]. HIV disproportionately impacts YMSM across the HIV care continuum, with disparities in linkage, retention, antiretroviral therapy (ART) adherence, and viral suppression [4,5]. Technology-based interventions— mobile health platforms—can provide tailored adherence interventions and allow YMSM to engage and connect with others
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