Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 26, 2020
Date Accepted: Jul 21, 2021
Adaptation of a theory-based social networking and gamified app-based intervention to improve PrEP adherence among young men who have sex with men in Bangkok, Thailand
ABSTRACT
Background:
In Thailand, HIV disproportionately affects men who have sex with men (MSM). Recent studies indicate a high incidence and prevalence of HIV in Bangkok among MSM, with higher risk of infection for young men who have sex with men (YMSM). Pre-exposure prophylaxis (PrEP) is a safe and efficacious method for preventing transmission of HIV. The Thai national guidelines have recommended PrEP since 2014 for key poulations nationwide and the government has piloted free PrEP coverage since October 2019. Smartphone based mHealth interventions provide an optimal platform to deliver innovative PrEP adherence interventions for Thai YMSM.
Objective:
This study aimed to conduct formative research to adapt the P3 (Prepared, Protected, emPowered) app, developed with MSM and transwomen in the United States to improve PrEP adherence and persistence, for YMSM in the Thai context.
Methods:
We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand to better understand: a) PrEP adherence facilitators and barriers b) preferences for functions and features in mHealth apps among YMSM; and c) how to best adapt the P3 app to the Thai context. We conducted 4 FGDs with 4-8 participants per group and 15 KIIs in Bangkok, Thailland.
Results:
For FGDs, a total of 23 YMSM participated with a mean age of 20 years (range 18-21), 96% enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60); most were publicly employed health service providers with the majority of them being counselors (40%) and physicians (40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM in the US and other parts of the world. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3T adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand (P3T), these findings were balanced with resource limitations resulting in prioritization of minor modifications in app aesthetics and changes in the presentation and content of information in two of the app’s features.
Conclusions:
The core features of the P3 app address the main PrEP facilitators and barriers for Thai YMSM, However, substantive changes to the stylistic presentation and content were needed to appropriately tailor and customize the app for the Thai context. Based on the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end-users and key informants provides a promising way forward. However, partnerships with local app designers and developers could improve the adaptation process and final product. Clinical Trial: ClinicalTrials.gov Identifier: NCT04413708
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