JMIR Publications

ABSTRACT

Background:

Men who have sex with men (MSM) in China have a low perceived risk of acquiring human immunodeficiency virus (HIV) and this interrupts adequate testing rates.

Objective:

We aimed to improve HIV testing and reduce sexual risk behaviors in MSM through a gay geosocial networking (GSN) application.

Methods:

This 12-month double-blinded randomized controlled trial (RCT) assessed the effectiveness of self-HIV risk assessment and feedback using the GSN application, Blued. Participants from Beijing China were recruited from Blued in October 2017 if they were MSM and provided informed consent. From October 2017 to September 2018, eligible participants were randomly assigned to either Group 1 (access to HIV risk assessment tool with tailored feedback based on their scores), Group 2 (access to HIV risk assessment only), or controls (received government-recommended HIV education). All interventions were remotely delivered via the mobile phone-based app Blued and participants were followed up at 1, 3, 6, and 12 months from baseline. The number of HIV tests over the twelve-month study was the primary outcome and was assessed using an intention-to-treat analysis with an incident rate ratio (IRR). Unprotected anal intercourse (UAI) over six months was assessed by modified intention-to-treat analysis and was the secondary outcome. All statistical analyses were conducted in SAS 9.3 (SAS Institute, Inc. USA) and a P value <0.05 was considered statistically significant.

Results:

In total, 9,280 MSM were recruited from baseline and were randomly assigned to Group 1 (n=3,028), Group 2 (n=3,065), or controls (n=3,187) and after follow-up 1,034 (34.1%), 993 (32.4%) and 1,103 (34.6%) remained in each group, respectively. Over the twelve-month study period, Group 1 took 391 tests (mean of 2.51 tests/person), Group 2 took 352 tests (mean of 2.01 tests/person), and the controls took 295 tests (mean of 1.72 tests/person). Group 1 had significantly more HIV testing than the Control group (IRR: 1.32, 95%CI:1.09-4.58; P=0.01) while Group 2 did not differ significantly from the controls (IRR:1.06, 95%CI: 0.86-1.30; P=0.60). The proportion of UAI was not statistically different among the three groups, but all three groups had UAI which declined from baseline.

Conclusions:

This RCT showed repeated HIV risk assessments coupled with tailored feedback via GSN applications improved HIV testing. Such interventions should be considered a simple way of improving HIV testing among MSM in China, thereby increasing the number of individuals aware of their HIV status. Clinical Trial: ClinicalTrials.gov NCT03320239; https://clinicaltrials.gov/ct2/show/NCT0332023.