JMIR Publications

ABSTRACT

Background:

Leveraging Internet based communication tools (e.g, messaging apps, SMS, email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in stigmatized settings such as India, but there are limited models for such online interventions.

Objective:

To determine the feasibility, acceptability, and preliminary impact of a peer delivered Internet based messaging intervention for HIV testing and prevention.

Methods:

The CHALO! pilot engaged MSM in India in an online behavioral intervention to investigate the feasibility, acceptability, and preliminary impact of an Internet-based peer delivered messaging intervention to promote HIV-testing and consistent condom use. Messages addressed barriers to HIV testing and condom use and were theoretically based on the Information-Motivation-Behavioral Skills model. Between February-March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and reported being HIV-negative or unknown) were randomized to receive educational and motivational messages framed as either: Approach (i.e., a good outcome to be achieved) or Avoidance (a bad outcome to be avoided) over 12 weeks via WhatsApp, SMS, or email. Participants completed online surveys at baseline and immediately post-intervention.

Results:

Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82% of participants (n=200) were retained, and 53% (n=130) completed the follow-up survey. Of those completing the follow-up survey, 82% liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (32% to 44%; P=.04). When including those who reported intentions to test, this percentage increased from 45% at baseline to 65% at follow-up (P< .01). When examining intentions to test among those without prior HIV testing, intentions increased from only 32% of the sample at baseline, to 56% of the sample at follow-up (P=.02) Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use also did not significantly differ between Approach and Avoidance conditions at follow-up.

Conclusions:

In one of the first studies of an online HIV prevention intervention for MSM in India, CHALO! demonstrated preliminary efficacy for increasing HIV testing rates, was very feasible to implement by a community based organization, and highly acceptable to participants. This online outreach model is well suited for rapid scale-up, particularly in stigmatized and low-resource settings, and warrants further efficacy testing prior to widespread roll-out.