Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 19, 2024
Date Accepted: Nov 29, 2024
The effects of MyChoices and LYNX mobile applications on HIV testing and PrEP use by young U.S. sexual minority men: results from a national, randomized controlled trial
ABSTRACT
Background:
Young sexual minority men (YSMM) have amongst the highest rates of HIV in the United States (U.S.), yet use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among YSMM.
Objective:
To test the efficacy of two mobile apps—LYNX and MyChoices—to increase HIV testing and PrEP uptake among YSMM.
Methods:
Between October 2019-May 2022, we implemented a three-arm, parallel randomized controlled trial to test the efficacy of two mobile apps—LYNX and MyChoices—against standard of care (SOC) among YSMM (ages 15-29) reporting sexual risk for HIV in 9 U.S. cities. Randomization was 1:1:1, and was stratified by site and participant age; there was no masking. The co-primary outcomes were: self-reported HIV testing and PrEP initiation over 6 months of follow-up.
Results:
381 YSMM were randomized. The mean age was 22.4 (SD=3.17). Nearly one-fifth were Black, non-Hispanic and Hispanic/Latino men (18% each), and 60% identified as gay. Half (53%) resided in the U.S. South. At baseline, 29% had never had an HIV test and 85% had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (59%), participants randomized to MyChoices (74%; P=.010) were more likely to have received at least one HIV test over 6 months of follow up; those randomized to LYNX also had higher proportion of testing (70%) but it was marginally statistically different (P=.078). Participants in both MyChoices (21%) and LYNX (20%) arms had higher rates of starting PrEP compared to SOC (16%); yet these differences were not statistically significant (P=.516).
Conclusions:
Given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25% relative increase in HIV testing among YSMM, as seen in this study, could meaningfully reduce HIV incidence in the U.S. Additional refinements to each app might further enhance their efficacy on PrEP initiation. Clinical Trial: The COMPARE protocol is registered at ClinicalTrials.gov (NCT03965221).
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