JMIR Publications

ABSTRACT

Background:

Despite policy-level progress, the implementation of oral pre-exposure prophylaxis (PrEP) for HIV prevention remains limited in Latin America. In Peru, men who have sex with men (MSM) represent the majority of new HIV diagnoses, yet PrEP uptake remains low. The widespread use of smartphones and digital platforms among MSM presents an opportunity to expand PrEP access through mobile health (mHealth) interventions. There are limited data, however, on user preferences to guide the design of such tools in Spanish-speaking, Latin American contexts.

Objective:

To assess preferences for digital communication channels and mHealth features to support PrEP use among Peruvian MSM and examine their association with progression along the PrEP cascade.

Methods:

We conducted a cross-sectional online survey between June and August 2023 with 600 HIV-negative, cisgender MSM residing in Peru, recruited via Facebook, Instagram, and geosocial apps. The survey assessed communication use, interest in 11 mHealth features, and PrEP cascade progression. Exploratory factor analysis was used to identify domains of mHealth interest. Logistic regression models examined associations between factor scores and PrEP cascade outcomes, including decision to use PrEP, seeking PrEP, and initiating PrEP.

Results:

Digital access was nearly universal, with 98.2% owning a smartphone. WhatsApp was the most frequently used and preferred platform for PrEP support, with 91.2% reporting frequent use and 50.3% ranking it as their top choice. Participants expressed interest in multiple mHealth features, particularly information on PrEP access and costs (74.0%), detailed PrEP education (68.8%), and appointment reminders (66.7%). Factor analysis revealed three domains with high internal consistency: Informational Support (Cronbach α=0.94), Self-Management Tools (Cronbach α=0.94), and Interactive Communication (Cronbach α=0.91). Higher scores in Informational Support and Self-Management Tools were independently associated with greater odds of deciding to use PrEP (Informational Support: adjusted Odds Ratio [aOR] 4.54, 95% CI 3.36–6.28, P<.001; Self-Management Tools: aOR 3.23, 95% CI 2.51–4.22, P<.001), seeking PrEP (Informational Support: aOR 1.43, 95% CI 1.10–1.89, P=.001; Self-Management Tools: aOR 1.34, 95% CI 1.06–1.70, P=.016), and initiating PrEP (Informational Support: aOR 1.64, 95% CI 1.16–2.44, P=.009; Self-Management Tools: aOR 1.49, 95% CI 1.11–2.05, P=.011). Interactive Communication was associated with the decision to use PrEP (aOR 2.74, 95% CI 2.15–3.53, P<.001), marginally associated with seeking PrEP (aOR 1.25, 95% CI 1.00–1.57, P=.053), and not significantly associated with PrEP initiation.

Conclusions:

Among Peruvian MSM, interest in mHealth tools to support PrEP use is high and associated with PrEP engagement. Informational content and self-management features appear especially important across the cascade. These findings support the development of culturally tailored, user-centered digital implementation solutions, such as WhatsApp-based tools or integrated apps, to strengthen PrEP delivery in Peru and other Latin American settings.