Preliminary evaluation of a gamified smartphone intervention (O2O-PEP) for enhancing HIV post-exposure prophylaxis uptake in men who have sex with men: pilot feasibility study.

backgroundAddressing the burden of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) has become a major priority. Over the years, post-exposure prophylaxis (PEP) has proven efficacy in preventing HIV transmission. However, the widespread underutilization of PEP undermines its protective potential. To address this issue, we developed an innovative, gamified mini-app embedded in WeChat, known as O2O-PEP (online-to-offline collaborative model for HIV postexposure prophylaxis), that targets PEP uptake.

objectiveWe aimed to conduct a pilot feasibility study to assess the feasibility, acceptability, and preliminary efficacy of O2O-PEP in promoting PEP uptake among Chinese MSM.

methodsA single-arm, pre-post feasibility study combing quantitative and qualitative methods for data collection was performed in Qingdao, China. Eligible MSM were invited to use the O2O-PEP for 2 weeks. The mini-app provides an online-to-offline service model, enabling MSM to access PEP-related character-based narratives, share on moments, sexual transmitted disease picture test quizzes, e-Consultation, and referrals to offline PEP service providers. Additionally, gamification features, such as reward-based engagement and social support, are incorporated to enhance user motivation. Intervention feasibility was tested by looking at participant engagement data. The acceptability of the intervention was explored with System Usability Scale (SUS) and in-depth interviews. Preliminary efficacy was measured by assessing HIV PEP knowledge and HIV PEP uptake.

resultsA total of twenty Chinese MSM were successfully enrolled. All participants completed baseline outcome measures, and 19 (19/20, 95%) completed outcome measures at 2 weeks. Participants had a mean age of 29.65 years (SD 9.17). PEP knowledge scores increased from 7.79 (SD 1.69) at baseline to 9.68 (SD 2.86) at the two-week follow-up, reflecting a large Cohen's d effect size of 0.8. One participant successfully accessed PEP within 12 h after engaging in condomless anal sex with a stranger during the intervention period. On average, participants spent 35.84 min using the mini-app over a two-week period, though app usage declined over the study period. Acceptability ratings ranged from moderate to extreme across several dimensions, including satisfaction, usability, recommendation of the mini-app to others, and user-friendliness. Ratings for the difficulty of using O2O-PEP was somewhat lower. Regarding the SUS score, 89.5% of participants rated the mini-app within the acceptable usability range (≥ 50), indicating that the majority found the mini-app to be user-friendly. Qualitative analysis of follow-up assessments identified areas where O2O-PEP needed to be improved to enhance user engagement, including a desire to additional functions of psychological and sexual transmitted diseases counseling.

conclusionsThis study pioneers the application of gamification to PEP uptake, demonstrating the feasibility and acceptability of O2O-PEP. A further efficacy trial is currently underway.

trial registrationThis study was prospectively registered at the Chinese Clinical Trial Registry (No. ChiCTR2200062538) on 11 Augst, 2022.