Developing an mHealth Intervention to Increase Uptake of HIV Pre-exposure Prophylaxis (PrEP) among Gay, Bisexual and other Men Who Have Sex with Men in China

HIV pre-exposure prophylaxis (PrEP) as a safe and effective prevention tool has not been widely adopted by gay, bisexual and other men who have sex with men (GBMSM) in China, who are disproportionately impacted by the HIV epidemic. Little is known about using mobile health for PrEP promotion in Chinese populations. Informed by the Information-Motivation-Behavioral Skills Model and the Transtheoretical Model (Stages of Change), my dissertation fills the gap by developing and testing a mobile app-enabled intervention – the PrEP mini-app – to increase PrEP uptake among Chinese GBMSM. This is a two-phase mixed-methods intervention study (2020-2021, Guangzhou, China) that includes (1) a formative assessment using one-to-one in-depth interviews (n=31) to assess GBMSM’s perceived barriers and facilitators to PrEP uptake and usability test of the original PrEP mini-app; (2) a 12-week two-arm pilot randomized controlled trial (RCT) (n=70) to assess feasibility and preliminary efficacy of the refined PrEP mini-app in increasing GBMSM’s intention to use PrEP and PrEP initiation. Qualitative analysis indicated individual-level barriers to PrEP uptake include uncertainty in PrEP efficacy, concerns over side effects and financial cost, and difficulties in identifying authentic PrEP medications. Structural barriers include lack of PrEP education, limited formal PrEP care, the thriving informal PrEP market and the minority stress. RCT results showed that 49% of the participants positively rated the usability of the mini-app. Compared to the standardized HIV prevention care, the PrEP mini-app shows promise in shortening GBMSM’s hesitating time between study enrollment and PrEP initiation, facilitating their progress towards PrEP initiation along the stages of change, and improving their PrEP-related psychosocial variables (e.g., intention to use PrEP, PrEP self-efficacy, and PrEP stigma). Desired future app refinements include regular updates of the app contents, between-user interactive features, and educational materials in enriched media forms. More efforts are needed to understand optimal strategies to identify and implement alternative PrEP provision models in highly stigmatized settings. While integrating mobile health into the current HIV prevention system may be feasible and effective for increasing PrEP uptake among GBMSM in China, future interventions should consider the full PrEP cascade in designing support features and outcome measures.