JMIR Publications

ABSTRACT

Background:

Adolescents may avoid HIV testing because of stigma, confidentiality concerns, low perceived risk, and limited access to youth-friendly information. A web-based HIV self-testing (HIVST) education intervention may provide private, repeatable, and standardized learning that supports testing intention and prevention behaviors.

Objective:

This study evaluated the effectiveness, digital engagement, and implementation of a web-based HIVST education intervention for improving HIV testing intention and HIV prevention-related outcomes among junior high school students in Bandung, Indonesia.

Methods:

A controlled quasi-experimental pretest-posttest study was conducted in December 2025 among 600 ninth-grade students at SMP Muhammadiyah 6 Bandung. Participants were allocated to an intervention group (n=300), which received web-based HIVST education, or a control group (n=300), which continued usual school activities during the study period. The primary outcome was HIV testing intention, operationalized as willingness to undergo HIVST. Secondary outcomes included HIV knowledge, HIV self-testing literacy, perceived HIV stigma, prevention self-efficacy, perceived HIV risk appraisal, and HIV prevention-related outcomes. Digital outcomes included module completion, time spent on the platform, quiz performance, repeated access, technical support requests, and a composite engagement score. Outcomes were assessed at baseline, immediate posttest, and 1-month follow-up. Digital engagement and implementation were assessed using platform logs, facilitator checklists, quiz completion records, and brief user feedback. Linear mixed models with fixed effects for group, time, and the group-by-time interaction were used to evaluate intervention effects across repeated measurements.

Results:

The intervention group improved across the primary outcome, secondary outcomes, and digital engagement indicators. Linear mixed models showed significant group-by-time effects favoring the intervention group for HIVST willingness total score (F2,1194=121.080, P<.001, partial η²=.169), behavioral control (F2,1194=116.370, P<.001, partial η²=.163), attitudes toward HIVST (F2,1194=54.080, P<.001, partial η²=.083), subjective norms and psychosocial barriers (F2,1194=16.920, P<.001, partial η²=.028), HIVST literacy (F2,1194=102.350, P<.001, partial η²=.146), HIV knowledge (F2,1194=82.470, P<.001, partial η²=.121), and perceived HIV stigma (F2,1194=64.380, P<.001, partial η²=.097). Digital engagement results indicated that 291 of 300 participants (97.0%) accessed the platform, 276 of 300 (92.0%) completed all assigned modules, median time on platform was 46 minutes (IQR 35-62), 282 of 300 (94.0%) completed the quiz with a mean score of 82.4 (SD 10.6), 36 of 300 (12.0%) requested technical support, and the mean engagement score was 84.6 (SD 11.2) of 100.

Conclusions:

Web-based HIVST education improved HIV testing intention and multiple HIV prevention-related domains among junior high school adolescents. The findings support a digitally delivered, adolescent-centered approach to school-based HIV prevention education, provided that implementation includes privacy protections, technical support, age-appropriate content, and clear referral pathways for confirmatory testing and counselling.