JMIR Publications

ABSTRACT

Background:

A growing number of mobile health (mHealth) technologies are being developed to support the HIV PrEP continuum, however most of these tools have been focused on men who have sex with men (MSM), and few of these tools are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to people who speak Spanish and transgender women are critically needed.

Objective:

The aim of this study is to adapt and tailor two mHealth technologies, PrEPmate and DOT Diary, to support PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools.

Methods:

PrEPmate, an interactive, bidirectional text-messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and to optimize functionality of these tools.

Results:

Participants in focus groups liked the “human touch” of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended several changes to better tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback, and thought the calendar functions were easy to use. They recommended that the sexual diary be simplified, and motivational badges included. In the technical pilot of the refined tools, mean system usability scores (SUS) were 81.2 out of 100 for PrEPmate and 76.4 for DOT Diary (p=0.48), falling in the “good” to “excellent” range, and mean Client Satisfaction Questionnaire (CSQ-8) scores were 28.6 and 28.3 for PrEPmate and DOT Diary respectively (maximum possible score = 32). Use of both tools was high over the 1-month pilot (an average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the app for DOT Diary), indicating good feasibility for both tools.

Conclusions:

Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support PrEP use among Spanish-speaking MSM and English and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial.