Feasibility of a Mobile Health Intervention for Providing a Continuum of HIV Services for MSM: Pilot Study of the WeTest Program in 3 Cities in China


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Abstract

Background:Men who have sex with men (MSM) in China have a high risk for HIV infection but experience suboptimal rates of HIV testing and service engagement due to various social and structural barriers. We developed a mobile health (mHealth) intervention entitled "WeTest-Plus" (WeTest+) as a user-centered "one-stop service" approach for delivering access to comprehensive information about HIV risk, HIV self-testing, behavioral and biomedical prevention, confirmatory testing, treatment, and care.

Objective:The goal of the current study was to investigate the feasibility of WeTest+ to provide continuous HIV services to high-risk MSM.

Methods:Participants completed a 3-week pilot test of WeTest+ to examine acceptability, feasibility, and recommendations for improvement. Participants completed a structured online questionnaire and qualitative exit interviews facilitated by project staff. "Click-through" rates were assessed to examine engagement with online content.

Results:28 participants were included, and the average age was 27.6 years (standard deviation = 6.8). Almost all participants (96.4%) remained engaged with the WeTest+ program over a 3-week observational period. The majority (92.9%) self-administered the HIV self-test and submitted their test results through the online platform. Overall click-through rates were high (average 67.9%). Participants provided favorable comments about the quality and relevance of the WeTest+ information content, the engaging style of information presentation, and the user-centered features.

Conclusion:This pilot assessment of WeTest+ supports the promise of this program for promoting HIV self-testing and linkage to in-person services for MSM in China. Findings underscore the utility of a user-centered approach to mHealth program design.

About the authors

Zhihui Zhu

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University

Email: info@benthamscience.net

Zhihua Zhang

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University

Author for correspondence.
Email: info@benthamscience.net

Nickolas Zaller

, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences

Email: info@benthamscience.net

Cui Yang

School of Public Health, The State University of New Jersey

Email: info@benthamscience.net

Shufang Sun

School of Public Health, Brown University

Email: info@benthamscience.net

Tao Liu

School of Public Health, Brown University

Email: info@benthamscience.net

Yehuan Sun

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University

Email: info@benthamscience.net

Jun Wang

Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University

Email: info@benthamscience.net

Hongbo Zhang

Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University

Email: info@benthamscience.net

Zhen Dai

, Chengdu Center for Disease Control and Prevention,

Email: info@benthamscience.net

Yanqiu Zhao

, Suzhou Center for Disease Control and Prevention

Email: info@benthamscience.net

Yue Zhao

, Suzhou Center for Disease Control and Prevention

Email: info@benthamscience.net

Cong Liu

, Wuhan Center for Disease Control and Prevention

Email: info@benthamscience.net

Nianhua Xie

, Wuhan Center for Disease Control and Prevention

Email: info@benthamscience.net

Xuejiao Hu

, Wuhan Center for Disease Control and Prevention

Email: info@benthamscience.net

Xiaodong Wang

, Chengdu Tongle Health Consulting Service Center,

Email: info@benthamscience.net

Pan Gao

, Youth Public Health Service Center, Luyang District, Hefei City

Email: info@benthamscience.net

Xiaoyan Lu

Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University

Email: info@benthamscience.net

Don Operario

Rollins School of Public Health, Emory University

Author for correspondence.
Email: info@benthamscience.net

References

  1. Zheng S. The growing threat of China’s HIV epidemic. Lancet Public Health 2018; 3(7): e311. doi: 10.1016/S2468-2667(18)30098-7 PMID: 29976325
  2. Bai X, Xu J, Yang J, et al. HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: Implications for HIV prevention. J Int AIDS Soc 2014; 17(1): 18848. doi: 10.7448/IAS.17.1.18848 PMID: 24993457
  3. Yu M, Song D, Zhang T, et al. High risks of HIV transmission for men sex worker - a comparison of profile and risk factors of HIV infection between MSM and MSW in China. BMC Public Health 2022; 22(1): 858. doi: 10.1186/s12889-022-13264-z PMID: 35488262
  4. Bureau for Disease Control and Prevention. My country's AIDS prevention and control work made new progress in 2019. 2019. Available from: http://www.nhc.gov.cn/jkj/s3586/201911/c2388ce70bdd404ea6dfcd886591784d.shtml
  5. World Wide Web. National Health Commission: There are 1.14 million surviving HIV-infected cases in China. 2021. Available from: https://baijiahao.baidu.com/s?id=1717897709779696114&wfr=spider&for=pc
  6. CCTV. The AIDS epidemic in China remains at a low epidemic level. 2019. Available from: http://tv.cctv.com/2019/12/01/VIDEqJgg0pbQJn6ctyQAIKkP191201.shtml
  7. National Health Commission of the People’s Republic of China. Special interview on World AIDS Day. 2021. Available from: https://www.nhc.gov.cn
  8. UNAIDS. Global AIDS strategy 2021-2026 End inequalities. End AIDS. Available from: https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf
  9. Furegato M, Mitchell H, Ogaz D, et al. The role of frequent HIV testing in diagnosing HIV in men who have sex with men. HIV Med 2018; 19(2): 118-22. doi: 10.1111/hiv.12558 PMID: 28984407
  10. Liu Y, Qian HZ, Ruan Y, et al. Frequent HIV testing: Impact on HIV risk among Chinese men who have sex with men. J Acquir Immune Defic Syndr 2016; 72(4): 452-61.
  11. Choy CY, Wong CS, Kumar PA, et al. National HIV programme testing recommendations. Singapore Med J 2023. PMID: 37338488
  12. Boesecke C, Schellberg S, Schneider J, Schuettfort G, Stocker H. Prevalence, characteristics and challenges of late HIV diagnosis in Germany: An expert narrative review. Infection 2023; 51(5): 1223-39. doi: 10.1007/s15010-023-02064-1 PMID: 37470977
  13. He XX, Jiang Y, Xing WG. Introduction to the AIDS self-testing guidance manual (Chinese). J Chin AIDS STDs 2020; 26(6): 653-5.
  14. Wu Z, Tang Z, Mao Y, et al. Testing and linkage to HIV care in China: A cluster-randomised trial. Lancet HIV 2017; 4(12): e555-65. doi: 10.1016/S2352-3018(17)30131-5 PMID: 28867267
  15. Wong NS, Kwan TH, Chan DPC, Lui GCY, Lee SS. Regular testing of HIV and sexually transmitted infections with self-collected samples from multiple anatomic sites to monitor sexual health in men who have sex with men: Longitudinal study. JMIR Form Res 2022; 6(11): e40996. doi: 10.2196/40996 PMID: 36399372
  16. Zhang BC, Chu QS. MSM and HIV/AIDS in China. Cell Res 2005; 15(11-12): 858-64. doi: 10.1038/sj.cr.7290359 PMID: 16354560
  17. Steward WT, Miège P, Choi KH. Charting a moral life: the influence of stigma and filial duties on marital decisions among Chinese men who have sex with men. PLoS One 2013; 8(8): e71778. doi: 10.1371/journal.pone.0071778 PMID: 23951245
  18. Wang Y, Wilson A, Chen R, Hu Z, Peng K, Xu S. Behind the rainbow, "Tongqi" wives of men who have sex with men in China: A systematic review. Front Psychol 2020; 10: 2929. doi: 10.3389/fpsyg.2019.02929 PMID: 31993006
  19. Liu Y, Jiang C, Li S, et al. Association of recent gay-related stressful events with depressive symptoms in Chinese men who have sex with men. BMC Psychiatry 2018; 18(1): 217. doi: 10.1186/s12888-018-1787-7 PMID: 29973174
  20. Feng Y, Wu Z, Detels R. Evolution of men who have sex with men community and experienced stigma among men who have sex with men in Chengdu, China. J Acquir Immune Defic Syndr 2010; 53(S1): S98-S103.
  21. Sun S, Pachankis JE, Li X, Operario D. Addressing minority stress and mental health among men who have sex with men (MSM) in China. Curr HIV/AIDS Rep 2020; 17(1): 35-62. doi: 10.1007/s11904-019-00479-w PMID: 31950336
  22. Cao B, Saffer AJ, Yang C, et al. MSM behavior disclosure networks and HIV testing: An egocentric network analysis among MSM in China. AIDS Behav 2019; 23(5): 1368-74. doi: 10.1007/s10461-019-02404-z PMID: 30680538
  23. Wei C, Yan L, Li J, Su X, Lippman S, Yan H. Which user errors matter during HIV self-testing? A qualitative participant observation study of men who have sex with men (MSM) in China. BMC Public Health 2018; 18(1): 1108. doi: 10.1186/s12889-018-6007-3 PMID: 30200905
  24. Han L, Wei C, Muessig KE, et al. HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations. Glob Public Health 2017; 12(1): 31-44. doi: 10.1080/17441692.2015.1134612 PMID: 26785328
  25. Liu Y, Sun X, Qian HZ, et al. Qualitative assessment of barriers and facilitators of access to HIV testing among men who have sex with men in China. AIDS Patient Care STDS 2015; 29(9): 481-9. doi: 10.1089/apc.2015.0083 PMID: 26186029
  26. Tang S, Tang W, Meyers K, Chan P, Chen Z, Tucker JD. HIV epidemiology and responses among men who have sex with men and transgender individuals in China: A scoping review. BMC Infect Dis 2016; 16(1): 588. doi: 10.1186/s12879-016-1904-5 PMID: 27765021
  27. Zhang C, Qian HZ, Chen X, et al. HIV testing and seroprevalence among couples of people diagnosed with HIV in China: A meta-analysis. PLoS One 2021; 16(3): e0247754. doi: 10.1371/journal.pone.0247754 PMID: 33739981
  28. Zhou J, Yang L, Ma J, Jiang S, Liu Y, Sun Z. Factors associated with HIV testing among MSM in Guilin, China: Results from a cross-sectional study. Int J Public Health 2022; 67: 1604612. doi: 10.3389/ijph.2022.1604612 PMID: 35936995
  29. Dong Y, Liu S, Xia D, et al. Prediction model for the risk of HIV infection among MSM in China: Validation and stability. Int J Environ Res Public Health 2022; 19(2): 1010. doi: 10.3390/ijerph19021010 PMID: 35055826
  30. Han M. Analysis of epidemic situation of AIDS in China and prospect of prevention and treatment. Chin J AIDS STD 2023; 29(03): 247-50.
  31. Lyu P, Chen FF. (National HIV/AIDS epidemic estimation and interpretation in China). Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40(10): 1191-6. PMID: 31658515
  32. Research progress on HIV testing in MSM by using HIV self-testing strategy. (Chinese). Chin J AIDS STD 2019; 25(06): 648-51.
  33. Shang XX, Sheng Y. Progress in researches on HIV self-testing among men who have sex with men. (Chinese). Chin J Public Health 2021; 37(8): 1301-4.
  34. Hong H, Shi H, Jiang H, Dong H, Shen Y. Prevalence and associated factors of HIV self-testing among men who have sex with men in Ningbo, China: A cross-sectional study. AIDS Res Ther 2021; 18(1): 14. doi: 10.1186/s12981-021-00339-x PMID: 33879191
  35. d’Elbée M, Makhetha MC, Jubilee M, et al. Using HIV self-testing to increase the affordability of community-based HIV testing services. AIDS 2020; 34(14): 2115-23. doi: 10.1097/QAD.0000000000002664 PMID: 32796213
  36. De Boni RB, Veloso VG, Fernandes NM, et al. An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis. J Med Internet Res 2019; 21(8): e14145. doi: 10.2196/14145 PMID: 31373276
  37. Johnson CC, Kennedy C, Fonner V, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: A systematic review and meta-analysis. J Int AIDS Soc 2017; 20(1): 21594. doi: 10.7448/IAS.20.1.21594 PMID: 28530049
  38. Napierala Mavedzenge S, Baggaley R, Corbett EL. A review of self-testing for HIV: Research and policy priorities in a new era of HIV prevention. Clin Infect Dis 2013; 57(1): 126-38. doi: 10.1093/cid/cit156 PMID: 23487385
  39. Tang W, Wu D. Opportunities and challenges for HIV self-testing in China. Lancet HIV 2018; 5(11): e611-2. doi: 10.1016/S2352-3018(18)30244-3 PMID: 30213725
  40. Zhao Y, Zhu X, Pérez AE, et al. MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: A qualitative description. BMC Public Health 2018; 18(1): 1146. doi: 10.1186/s12889-018-6046-9 PMID: 30261856
  41. Tao J, Li M, Qian HZ, et al. Home-based HIV testing for men who have sex with men in China: A novel community-based partnership to complement government programs. PLoS One 2014; 9(7): e102812. doi: 10.1371/journal.pone.0102812 PMID: 25051160
  42. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: A literature review. AIDS Behav 2015; 19(11): 1949-65. doi: 10.1007/s10461-015-1097-8 PMID: 26054390
  43. Steehler K, Siegler AJ. Bringing HIV self-testing to scale in the United States: A review of challenges, potential solutions, and future opportunities. J Clin Microbiol 2019; 57(11): e00257-19. doi: 10.1128/JCM.00257-19 PMID: 31462549
  44. Ntinga X, Musiello F, Keter AK, Barnabas R, van Heerden A. The feasibility and acceptability of an mhealth conversational agent designed to support HIV self-testing in South Africa: Cross-sectional Study. J Med Internet Res 2022; 24(12): e39816. doi: 10.2196/39816 PMID: 36508248
  45. Purnomo J, Coote K, Mao L, et al. Using eHealth to engage and retain priority populations in the HIV treatment and care cascade in the Asia-Pacific region: A systematic review of literature. BMC Infect Dis 2018; 18(1): 82. doi: 10.1186/s12879-018-2972-5 PMID: 29454322
  46. Sullivan PS, Mena L, Elopre L, Siegler AJ. Implementation strategies to increase PrEP uptake in the South. Curr HIV/AIDS Rep 2019; 16(4): 259-69. doi: 10.1007/s11904-019-00447-4 PMID: 31177363
  47. Mulawa MI, LeGrand S, Hightow-Weidman LB. eHealth to enhance treatment adherence among youth living with HIV. Curr HIV/AIDS Rep 2018; 15(4): 336-49. doi: 10.1007/s11904-018-0407-y PMID: 29959649
  48. Devi BR, Syed-Abdul S, Kumar A, et al. mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones. Comput Methods Programs Biomed 2015; 122(2): 257-65. doi: 10.1016/j.cmpb.2015.08.003 PMID: 26304621
  49. Mustanski B, Parsons JT, Sullivan PS, Madkins K, Rosenberg E, Swann G. Biomedical and behavioral outcomes of keep it up!: An eHealth HIV prevention program RCT. Am J Prev Med 2018; 55(2): 151-8. doi: 10.1016/j.amepre.2018.04.026 PMID: 29937115
  50. Washington TA, Applewhite S, Glenn W. Using facebook as a platform to direct young black men who have sex with men to a video-based HIV testing intervention: A feasibility study. Urban Soc Work 2017; 1(1): 36-52. doi: 10.1891/2474-8684.1.1.36 PMID: 29276800
  51. Sullivan PS, Hightow-Weidman L. Mobile apps for HIV prevention: How do they contribute to our epidemic response for adolescents and young adults? mHealth 2021; 7: 36. doi: 10.21037/mhealth-20-71 PMID: 33898605
  52. Guo Y, Xu Z, Qiao J, et al. Development and feasibility testing of an mhealth (Text Message and WeChat) intervention to improve the medication adherence and quality of life of people living with HIV in China: Pilot randomized controlled trial. JMIR Mhealth Uhealth 2018; 6(9): e10274. doi: 10.2196/10274 PMID: 30181109
  53. Chen X, Zhou X, Li H, Li J, Jiang H. The value of WeChat application in chronic diseases management in China. Comput Methods Programs Biomed 2020; 196: 105710. doi: 10.1016/j.cmpb.2020.105710 PMID: 32858284
  54. Li Y, Cheng X, Xu W, Tan L, Gou X. A WeChat-based mobile platform for perioperative health education for gastrointestinal surgery. Emerg Med Int 2021; 2021: 1-8. doi: 10.1155/2021/6566981 PMID: 34868685
  55. Zhang X, Wen D, Liang J, Lei J. How the public uses social media wechat to obtain health information in china: A survey study. BMC Med Inform Decis Mak 2017; 17(S2): 66. doi: 10.1186/s12911-017-0470-0 PMID: 28699549
  56. Shrestha R, Lim SH, Altice FL, et al. Use of smartphone to seek sexual health information online among malaysian men who have sex with men (MSM): Implications for mHealth intervention to increase HIV testing and reduce HIV risks. J Community Health 2020; 45(1): 10-9. doi: 10.1007/s10900-019-00713-x PMID: 31375976
  57. Wang Z, Deng S, Lv H, Fan Y, Zhang L, Wang F. Effect of WeChat-based continuous care intervention on the somatic function, depression, anxiety, social function and cognitive function for cancer patients: Meta-analysis of 18 RCTs. Nurs Open 2023; 10(9): 6045-57. doi: 10.1002/nop2.1916 PMID: 37365734
  58. Pang Z, Hu B, Chai D, et al. Effect of WeChat-based health preaching combined with an enhanced recovery after surgery model on perioperative limb motor function and complications in orthopaedic patients. J Healthc Eng 2022; 2022: 1-6. doi: 10.1155/2022/9538138 PMID: 35299684
  59. Zhu X, Zhang W, Operario D, et al. Effects of a mobile health intervention to promote HIV self-testing with MSM in China: A randomized controlled trial. AIDS Behav 2019; 23(11): 3129-39. doi: 10.1007/s10461-019-02452-5 PMID: 30852728
  60. Lu X, Gao P, Wang X, et al. User preferences for an mhealth approach to support HIV self-testing and linkage to HIV prevention or care services for MSM in China. AIDS Educ Prev 2021; 33(6): 534-50.
  61. Zhang L, Chow EPF, Jing J, et al. HIV prevalence in China: Integration of surveillance data and a systematic review. Lancet Infect Dis 2013; 13(11): 955-63. doi: 10.1016/S1473-3099(13)70245-7 PMID: 24107261
  62. Wu Z, Xu J, Liu E, et al. HIV and syphilis prevalence among men who have sex with men: A cross-sectional survey of 61 cities in China. Clin Infect Dis 2013; 57(2): 298-309. doi: 10.1093/cid/cit210 PMID: 23580732
  63. You X, Gilmour S, Cao W, et al. HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: A retrospective cohort study. BMC Public Health 2021; 21(1): 802. doi: 10.1186/s12889-021-10835-4 PMID: 33902499
  64. van Rijnsoever FJ. (I Can’t Get No) saturation: A simulation and guidelines for sample sizes in qualitative research. PLoS One 2017; 12(7): e0181689. doi: 10.1371/journal.pone.0181689 PMID: 28746358
  65. Coyne IT. Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs 1997; 26(3): 623-30. doi: 10.1046/j.1365-2648.1997.t01-25-00999.x PMID: 9378886
  66. Helms YB, Hamdiui N, Kretzschmar MEE, et al. Applications and recruitment performance of web-based respondent-driven sampling: Scoping review. J Med Internet Res 2021; 23(1): e17564. doi: 10.2196/17564 PMID: 33448935
  67. CDC National Clinical Quality Assessment of HIV Antibody Diagnostic Reagents. National HIV antibody diagnostic reagents in 2019 clinical quality assessment report. 2019. Available from: https://www.chinacdc.cn/zxdt/201912/W020191218527929912835.pdf
  68. Zhao DH, Wang ZQ, Zheng Y, et al. Application of mobile Internet data technology in AIDS prevention and control (Chinese). Zhongguo Yufang Yixue Zazhi 2021; 22(07): 551-4.
  69. Pan JC. A powerful personal synchronous web disk: NutStore. (Chinese). China Inf Sci Tech 2018; (20): 71-2.
  70. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach 2020; 42(8): 846-54. doi: 10.1080/0142159X.2020.1755030 PMID: 32356468
  71. Dunbar W, Alcide Jean-Pierre MC, Pétion JS, Labat A, Maulet N, Coppieters Y. A realist evaluation of the continuum of HIV services for men who have sex with men. AIDS Res Ther 2021; 18(1): 67. doi: 10.1186/s12981-021-00396-2 PMID: 34627315
  72. Muessig KE, Pike EC, LeGrand S, Hightow-Weidman LB. Mobile phone applications for the care and prevention of HIV and other sexually transmitted diseases: A review. J Med Internet Res 2013; 15(1): e1. doi: 10.2196/jmir.2301 PMID: 23291245
  73. Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a mobile HIV prevention app for men who have sex with men. JMIR Mhealth Uhealth 2014; 2(4): e47. doi: 10.2196/mhealth.3745 PMID: 25355249
  74. Muessig KE, Pike EC, Fowler B, et al. Putting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men. AIDS Patient Care STDS 2013; 27(4): 211-22. doi: 10.1089/apc.2012.0404 PMID: 23565925
  75. Schnall R, Rojas M, Bakken S, et al. A user-centered model for designing consumer mobile health (mHealth) applications (apps). J Biomed Inform 2016; 60: 243-51. doi: 10.1016/j.jbi.2016.02.002 PMID: 26903153
  76. Yan J, Zhang A, Zhou L, Huang Z, Zhang P, Yang G. Development and effectiveness of a mobile phone application conducting health behavioral intervention among men who have sex with men, a randomized controlled trial: Study protocol. BMC Public Health 2017; 17(1): 355. doi: 10.1186/s12889-017-4235-6 PMID: 28438144

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