背景:正在开发越来越多的移动健康(mHealth)技术来支持HIV暴露前预防(PrEP)的依从性和持久性;然而,大多数工具都集中在与男性发生性关系的男性(MSM)上,很少有西班牙语可用。最大限度地发挥这些工具在减少性别和种族/族裔差异以及促进卫生公平方面的潜在影响,非常需要为讲西班牙语的人和变性妇女量身定制的mHealth工具。
目的:这项研究的目的是适应和定制2种健康技术,PrEPmate和DOT日记,支持讲西班牙语的MSM和讲英语和西班牙语的变性人妇女的日常PrEP依从性和持久性,并评估这些工具的可行性和可接受性。
方法:PrEPmate,一个互动的,双向,短信干预,促进PrEP用户和提供商之间的个性化沟通,还有DOT日记,一个移动应用程序,通过集成的电子药丸服用和性活动日记促进PrEP使用和性健康的自我管理,以前是为讲英语的MSM开发的。我们在旧金山和迈阿密与15名讲英语和西班牙语的变性人妇女和MSM进行了3个焦点小组,以在文化上为这些优先人群定制这些工具。然后,我们在21名参与者中进行了为期1个月的技术试点,以评估适应性干预措施的可用性和可接受性,并优化这些工具的功能。
结果:焦点小组的参与者喜欢PrEPmate中短信的“人情味”,并认为这对安排约会和提问很有帮助。他们喜欢每日提醒信息,尤其是有趣的事实,性别肯定,和变性人历史主题。与会者建议进行更改,以适应讲西班牙语和变性者的语言和信息。对于DOT日记,参与者喜欢依从性跟踪和保护水平反馈,并认为日历功能易于使用。根据参与者的建议,我们在应用程序中为讲西班牙语的MSM和变性女性量身定制语言,简化了性日记,并增加了激励徽章。在精炼工具的技术试点中,PrEPmate的平均系统可用性量表评分为81.2/100,DOT日记为76.4/100(P=.48),落在“好”到“优秀”范围内,PrEPmate和DOT日记的平均客户满意度问卷得分分别为28.6和28.3,分别(最大可能得分=32)。在为期1个月的试点中,这两种工具的使用率很高(从PrEPmate的每个参与者收到的平均10.5条消息;访问DOT日记应用程序的平均17.6次),表明这两种工具都具有良好的可行性。
结论:使用以用户为中心的设计方法,我们在文化上量身定制PrEPmate和DOT日记,以支持讲西班牙语的MSM和讲英语和西班牙语的变性女性的日常PrEP使用。我们在技术试点中的积极发现支持在即将进行的比较有效性试验中进一步测试这些mHealth干预措施。
BACKGROUND: A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed.
OBJECTIVE: The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools.
METHODS: PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools.
RESULTS: Participants in focus groups liked the \"human touch\" of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the \"good\" to \"excellent\" range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools.
CONCLUSIONS: Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial.