title: Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study.
abstract: BACKGROUND
  Men who have sex with men (MSM) are the group most impacted by the human immunodeficiency virus (HIV) epidemic and the only subgroup in the United States among which new HIV diagnoses are not decreasing. To achieve the US National HIV/AIDS (acquired immunodeficiency syndrome) Strategy goals of reducing new diagnoses by 25%, high (eg, 30-50%) coverage of multiple HIV prevention interventions is needed in both urban and rural areas. Mobile phone "apps" are an important channel through which prevention services could be provided at scale and at low marginal cost.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention.
  
  
  METHODS
  The app included self-assessment tools; prevention recommendations; commodity (condoms, HIV self-tests) ordering; reminders to MSM for basic HIV prevention services, HIV testing, condom use, screening for preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP); and prevention and treatment provider locators. The study recruited HIV-negative, Android-using MSM in Atlanta and Seattle who were asked to use the app for 4 months and complete a post-use survey. We measured the use of the app and its features, ordering of commodities, self-report of establishing an HIV testing plan, being HIV tested in the community, and starting PrEP or using nPEP. Usability was assessed using the system usability scale (SUS).
  
  
  RESULTS
  A total of 121 MSM were enrolled (59.5%, 72/121 from Atlanta; 40.5%, 49/121 from Seattle). Median age was 28. Nearly half (48.8%, 59/121) were nonwhite, and most (85.9%, 104/121) were gay-identified. Most had tested for HIV in the past (85.1%, 103/121), and 52 (43.0%, 52/121) had a plan to test for HIV regularly. Men used the app for an average of 17.7 minutes over the first 4 months. Over the 4-month period, over half ordered condoms (63.6%, 77/121) and HIV test kits (52.8%, 64/121) on the app. Eight of 86 (9%) PrEP-eligible MSM started PrEP during the 4-month period; of those, 6 of the 8 reported that the app influenced their decision to start PrEP. The mean SUS was 73 (above average).
  
  
  CONCLUSIONS
  A theory-based mobile phone app was acceptable to MSM and was rated as having above-average usability. Most men used the commodity-ordering features of the app during the 4-month evaluation period, and nearly 1 in 10 PrEP-eligible men started PrEP, with most attributing their decision to start PrEP in part to the app. A broader, randomized controlled study of the impact of the app on uptake of prevention behaviors for MSM is warranted.
authors.affiliation: Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
authors.forename: Patrick S
authors.identifier: http://orcid.org/0000-0002-7728-0587
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-2073-4242
authors.initials: R
authors.lastname: Driggers
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, United States.
authors.forename: Joanne D
authors.identifier: http://orcid.org/0000-0001-8064-3011
authors.initials: JD
authors.lastname: Stekler
authors.affiliation: Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
authors.forename: Aaron
authors.identifier: http://orcid.org/0000-0001-5553-7540
authors.initials: A
authors.lastname: Siegler
authors.affiliation: Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Tamar
authors.identifier: http://orcid.org/0000-0003-3998-2913
authors.initials: T
authors.lastname: Goldenberg
authors.affiliation: Department of Medicine, Department of Medicine, University of Washington, Seattle, WA, United States.
authors.forename: Sarah J
authors.identifier: http://orcid.org/0000-0001-7690-7002
authors.initials: SJ
authors.lastname: McDougal
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, United States.
authors.forename: Jason
authors.identifier: http://orcid.org/0000-0001-6590-9248
authors.initials: J
authors.lastname: Caucutt
authors.affiliation: Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States.
authors.forename: Jeb
authors.identifier: http://orcid.org/0000-0001-9165-1658
authors.initials: J
authors.lastname: Jones
authors.affiliation: Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Rob
authors.identifier: http://orcid.org/0000-0002-9239-2640
authors.initials: R
authors.lastname: Stephenson
keywords: condoms; homosexuality, male; mobile applications; pilot projects; pre-exposure prophylaxis; sexual minorities