Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability

• Type of Material: Article
• Authors: Roman Shrestha, University of Connecticut; Frederick L Altice, Yale School of Medicine; Antoine Khati, University of Connecticut; Iskandar Azwa, University of Malaya; Kamal Gautam, University of Connecticut; Sana Gupta, University of Connecticut; Patrick Sullivan, Emory University; Zhao Ni, Yale School of Nursing; Adeeba Kamarulzaman, University of Malaya; Panyaphon Phiphatkunarnon, Love Foundation; Jeffrey A Wickersham, Yale School of Medicine
• Language: English
• Date: 2023-01-01
• Publisher: JMIR mHealth and uHealth (
• Publication Version: Final Published Version
• Copyright Statement: ©Roman Shrestha, Frederick L Altice, Antoine Khati, Iskandar Azwa, Kamal Gautam, Sana Gupta, Patrick Sean Sullivan, Zhao Ni, Adeeba Kamarulzaman, Panyaphon Phiphatkunarnon, Jeffrey A Wickersham. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 16.02.2023.
• Final Published Version (URL): http://dx.doi.org/10.2196/44468
• Title of Journal or Parent Work: JMIR mHealth and uHealth
• Volume: 11
• Start Page: e44468
• End Page: e44468
• Grant/Funding Information: This work was supported by a career development and research award from the National Institute on Drug Abuse (K01 DA051346) and a research award from the Fogarty International Center (R21TW011665) for Roman Shrestha.
• Keywords: prevention; mobile phone; usability; gay; men who have sex with men; HIV Infections; Homosexuality, Male; HIV prevention; HIV Testing; mobile health; Mobile Applications; sexual minority; Humans; Malaysia; Male; MSM; homosexual; acceptability; HIV; pre-exposure prophylaxis; mHealth; Pre-Exposure Prophylaxis; Adult; Sexual and Gender Minorities
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants' mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42%) ordered an HIVST more than once. Almost all participants (46/50, 92%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65%); of these, 16/46 (35%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia.