Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment

Abstract

Background HIV disproportionally impacts Latino sexual minority men (SMM). Uptake of pre-exposure prophylaxis (PrEP), an effective biomedical intervention to prevent HIV, is low in this group compared with White SMM. Mobile health technology represents an innovative strategy to increase PrEP uptake among Latino SMM. Objective We aimed to describe the qualitative process leading to the development of SaludFindr, a comprehensive HIV prevention mobile app aiming to increase PrEP uptake, HIV testing, and condom use by Latino SMM. Methods We conducted 13 in-depth interviews with Latino SMM living in the Atlanta area to explore their main barriers and facilitators to PrEP uptake and to analyze their opinions of potential SaludFindr app functionalities. To explore potential app functions, we used HealthMindr, an existing HIV prevention app, as a template and added new proposed features intended to address the specific community needs. Results We identified general PrEP uptake barriers that, although common among non-Latino groups, had added complexities such as the influence of religion and family on stigma. Low perceived PrEP eligibility, intersectional stigma, lack of insurance, cost concerns, and misconceptions about PrEP side effects were described as general barriers. We also identified Latino-specific barriers that predominantly hinder access to existing services, including a scarcity of PrEP clinics that are prepared to provide culturally concordant services, limited availability of Spanish language information related to PrEP access, distrust of peers as credible sources of information, perceived ineligibility for low-cost services owing to undocumented status, fear of immigration authorities, and competing work obligations that prevent PrEP clinic attendance. Health care providers represented a trusted source of information, and 3 provider characteristics were identified as PrEP facilitators: familiarity with prescribing PrEP; being Latino; and being part of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) group or ally. The proposed app was very well accepted, with a particularly high interest in features that facilitate PrEP access, including a tailored list of clinics that meet the community needs and a private platform to seek PrEP information. Spanish language availability and free or low-cost PrEP care represented the 2 main clinic criteria that would facilitate PrEP uptake. Latino representation in clinic staff and providers; clinic perception as a safe space for undocumented patients; and LGBTQIA+ representation was listed as additional criteria. Only 8 of 47 clinics listed on the Centers for Diseases Control and Prevention PrEP locator website for the Atlanta area fulfilled at least 2 main criteria. Conclusions This study provides further evidence of the substantial PrEP uptake barriers that Latino SMM face; exposes the urgent need to increase the number of accessible PrEP-providing clinics for Latino SMM; and proposes an innovative, community-driven, and mobile technology–based tool as a future intervention to overcome some of these barriers.

Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial

“…Regarding message timing, in both PrEPmate and DOT Diary, the timing of messages can be customized and are set to be delivered at the same time each day. Cantos and colleagues [ 48 ] used the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) framework to develop an HIV prevention mobile app to increase uptake of PrEP among Latino sexual minority men called SaludFindr. Through in-depth interviews, they found both general barriers that were common to non-Latino groups, as well as Latino-specific barriers, including lack of available clinics to provide culturally concordant care and limited availability of Spanish language information on PrEP.…”

Adolescent Youth Survey on HIV Prevention in Alabama: Protocol for Community and Online Survey with Bot Detection and Fraud Screening. (Preprint)

“…However, their content is typically delivered inconsistently, is reliant on the availability of funding, While increasing PrEP uptake among young SGM is urgently warranted [12], and federal and local agencies are supporting behavioral interventions to reach this group [13], adolescent SGM will not engage in HIV biomedical prevention if they do not know about PrEP, PrEP options are not acceptable for their developmental period, or understand their risk [14][15][16]. There is an unmet need to deliver tailored HIV prevention for diverse SGM youth, built upon adolescents' existing knowledge and preferences [17,18]. To understand existing knowledge gaps, specifically to address them via intervention, we conducted the Alabama Youth Survey to evaluate 14-17 year old SGMs' preferences and knowledge related to HIV prevention, PrEP, and STIs.…”