Accepted for/Published in: JMIR Formative Research
Date Submitted: Jan 10, 2024
Date Accepted: Jul 14, 2024
Adaptation of a Theory-Based Mobile Application to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Findings
ABSTRACT
Background:
Globally, trans women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of trans women are living with HIV. Available interventions designed specifically to meet trans women needs for HIV prevention are limited. mHealth, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching trans women and delivering interventions to reduce HIV vulnerability.
Objective:
This study aimed to adapt a theory-based mHealth HIV prevention smartphone app, HealthMindr, to meet the unique needs of trans women in Malaysia. We conducted theater testing of the HealthMindr app with trans women and key stakeholders and explored barriers to trans women’s uptake of HIV pre-exposure prophylaxis.
Methods:
Six focus group (FG) sessions were conducted with 29 participants, including 4 FG sessions with trans women (n=18) and two FG sessions with stakeholders (n=11) between March and April 2022. Barriers to pre-exposure prophylaxis (PrEP) uptake and gender-affirming care services among trans women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and how existing features should be adapted to meet the needs of trans women, as well as any features that should be removed or added. Each focus group was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software and analyzed to identify and interpret emerging themes.
Results:
Six sub-themes related to PrEP barriers were found, including stigma and discrimination, limited knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations on the attributes and app features that would be the most useful for trans women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional features (appointment booking, e-consultation, online pharmacy, medicine tracker, mood tracker, resources, and service sir locator) and communication features (peer support group, live chat, and discussion forum).
Conclusions:
Results revealed key barriers to PrEP uptake and use among trans women in Malaysia. The findings further demonstrate detailed recommendations for successfully adapting the HealthMindr app to the Malaysian trans women context with a potential solution in delivering tailored HIV prevention and increased accessibility to gender-affirming care services for trans women in Malaysia.
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