JMIR Publications

ABSTRACT

Background:

Young sexual minority men (YSMM) are disproportionately impacted by HIV in the United States (US). HIV/STI testing rates and PrEP uptake are amongst the lowest in this priority population. Novel strategies are needed to increase the reach and access to HIV/STI prevention services among YSMM.

Objective:

The aim of this study is to describe the development and assess the feasibility and acceptability of LYNX, a mobile app to increase HIV testing and PrEP uptake among YSMM in the US.

Methods:

Informed by the Information, Motivation, Behavioral Skills model, the LYNX app was refined through iterative focus groups (n= 4 groups, n=30 YSMM) in 2 US cities among YSMM aged 15-24. The LYNX app includes SexPro, an innovative tool that provides a personalized sexual health protection score; a sex diary to help YSMM track sexual partners and patterns; HIV/STI testing information and reminders; and access to home HIV/STI test kits and geospatial-based testing and PrEP clinic site information. The refined app was then tested for initial feasibility and acceptability in a 2-month technical pilot (n=17 YSMM). Baseline and 2-month follow-up assessments and exit interviews were completed. Transcripts from focus groups and exit interviews were coded using a deductive approach, and a thematic analysis was conducted to identify key elements for app refinement. Self-reported app acceptability and use based on paradata were also reported.

Results:

In iterative focus groups (mean age 20, 20% Black, 43% Hispanic/Latinx), the app’s design was well-received by YSMM. Participants recommended providing information on how the SexPro score was calculated and how they could improve their score; changes to the language in the sex diary tailored for YSMM and adding a free-text notes section to the diary; a chat feature to facilitate communicate with staff and app users regarding testing and PrEP access; and gamification features to increase overall youth engagement of the app. These recommendations were incorporated into the app. In the technical pilot (mean age 22.4, 25% Black, 47% Hispanic/Latinx), the mean system usability score was 70/100, falling in the “good” range. Use of the app was high over the 2-month pilot (app opened an average of 8.5 times, average duration 3.8 minutes per session), indicating good feasibility. The most commonly used features included the testing feature, activity calendar, and diary. In exit interviews, there was a high level of acceptability of content, interface, and features of LYNX.

Conclusions:

Following a user-centered design approach, we tailored the LYNX app to increase HIV/STI testing and PrEP uptake among YSMM in the US. Our positive findings in a technical pilot support further testing of this mHealth tool in an upcoming effectiveness trial in broader youth populations. Clinical Trial: Clinicaltrials.gov NCT03177512