mHealth Platform Cuts Risky Behavior, But Only in Short Term

Lisa Hightow-Weidman, MD, MPH

A mobile-optimized health education tool led to a reduction in high-risk behaviors among black men who have sex with men (BMSM), according to a new study, though the impact was limited in its duration.

The study is the latest attempt to use personal devices as a key facet of a public health strategy. Young BMSM face a particularly high risk of acquiring HIV infection. A 2016 report from the US Centers for Disease Control and Prevention, found that if then-current diagnosis rates held steady, about 1 out of every 2 BMSM would be diagnosed with HIV in their lifetimes.

Hoping to change those numbers, researchers at the University of North Carolina and Duke University examined the impact of an mHealth platform called HealthMpowerment.org on high-risk behavior among BMSM.

Lisa B. Hightow-Weidman, MD, MPH, of the University of North Carolina, said mobile is a must for online interventions today.

“If you’re gonna deliver an intervention that’s using online intervention it needs to be accessible via mobile phone,” she said. “Studies really clearly show that most folks access the internet more often on smartphones or tablet devices than desktop computers.”

The investigators enrolled 474 BMSM, some HIV-positive and others HIV-negative, and randomly assigned them to 1 of 2 groups. One group was given access to HealthMpowerment.org (HMP), which includes information and resources, but also social support functions and a game component. The other group was given access to a website with information about HIV prevention, but which did not include the social or gamified elements of HMP.

After 3 months, the rate of condomless anal intercourse among the HMP group was 32% lower than among the control (non-HMP) group. Those rates were based on self-reports by study enrollees.

However, the authors said the gap between the 2 groups had dissipated by the 12-month mark.

Hightow-Weidman said the closing of the gap points to one significant challenge with this type of HIV prevention intervention—keeping engagement over the long term.

“What we don’t know‑and I think this is where the research needs to go‑is what engagement factors really worked for each individual,” she said, “because I think it’s different for different people.”

For instance, one user might have stayed engaged because they enjoyed the game, but for another user, the social features of the program might have been more engaging.

The study data bore out the importance of engagement. When researchers isolated users who had spent at least 60 minutes on the HMP platform in the first 3 months (50 users), they estimated that those users had 4.85 fewer condomless sex encounters than they predicted would be seen in the non-HMP group.

“Given the stronger effect seen among those participants who complied with HMP, additional intervention engagement strategies are warranted,” Hightow-Weidman and colleagues wrote.

Notably, the impact of HMP was most pronounced among HIV-positive patients with detectable viral loads. In that group, the HMP cohort had an 82% lower rate of condomless anal sex compared to the non-HMP cohort.

This is not the first time the researchers have investigated the use of mHealth or eHealth software to curb risky behavior among groups at a high risk of contracting HIV. A review published earlier this year found that there was evidence to support the feasibility of such software as an effective public health intervention. However, as with this latest study, the review found a number of questions and opportunities remain, including questions of how to boost engagement and how to make such programs adaptable and scalable.

The new study, “A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM,” was published in AIDS and Behavior.