Efficacy of MyPEEPS Mobile, an HIV Prevention Intervention Using Mobile Technology, on Reducing Sexual Risk Among Same-Sex Attracted Adolescent Males: A Randomized Clinical Trial.

Importance: HIV transmission rates in the United States have increased among men who have sex with men. However, there are no published randomized trials examining interventions to reduce sexual risk for HIV acquisition in males younger than 18 years. Objective: To determine the efficacy of MyPEEPS Mobile, a mobile-delivered HIV prevention intervention, to reduce sexual risk behavior in same-sex attracted young males. Design, Setting, and Participants: This was a national randomized clinical trial of the efficacy MyPEEPS Mobile vs a delayed intervention among males aged 13 to 18 years to prevent or reduce sexual risk for HIV acquisition. Study activities were completed through 4 study sites in Birmingham, Alabama; New York, New York; Seattle, Washington; and Chicago, Illinois. Study staff at each site met with participants in person or via video conferencing. Data were collected from June 1, 2018, to April 7, 2020, and analyzed from July to October 2021. Interventions: The MyPEEPS Mobile intervention contains 21 online psychoeducational and skill-building modules, which participants completed over a 3-month period. Participants randomized to the intervention group received access to MyPEEPS Mobile for the first 3 months, while those randomized to the delayed intervention group received access at their 9-month visit after data for the primary efficacy analysis had been collected. Main Outcomes and Measures: The self-reported primary outcome was change in the number of condomless anal sex acts between study conditions. Secondary outcomes were change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing. Results: In the analytic sample of 763 racially and ethnically diverse study participants, the mean (SD) age was 16.2 (1.4) years; 736 participants (97%) were male, 13 (2%) nonbinary; and 6 (1%) genderqueer; 158 (21%) were Black or African American, 311 (41%) were Hispanic or Latino, and 284 (37%) were White. Overall, 382 were randomized to the intervention group and 381 to the delayed intervention group. At 3-month follow-up, there was a significant reduction in the number of condomless anal sex acts in the intervention group compared with the delayed intervention group (incidence rate ratio [IRR], 0.56; 95% CI, 0.32-0.99); however, there was no significant difference between groups at 6 or 9 months. In subgroup analyses, the intervention effect was pronounced among Black non-Hispanic participants at 3-month follow-up (IRR, 0.19; 95% CI, 0.04-0.94) and 6-month follow-up (IRR, 0.15; 95% CI, 0.03-0.78) compared with the delayed intervention group. There were no significant differences in the change in the number of sex partners, number of condomless anal sex partners, the number of sex acts while under the influence of substances, preexposure prophylactic uptake, nonoccupational postexposure prophylaxis use, and HIV and sexually transmitted infection testing between the intervention and delayed intervention groups. Conclusions and Relevance: In this study, the MyPEEPS Mobile intervention demonstrated a 44% overall reduction in condomless anal sex at 3-month follow-up compared with the delayed intervention group, but not at 6 or 9 months. To our knowledge, MyPEEPS Mobile is the first intervention to demonstrate evidence of short-term efficacy for reducing sexual risk among same-sex attracted young males. Trial Registration: ClinicalTrials.gov Identifier: NCT03167606.

A Qualitative Study to Inform Adaptation of MyPEEPS Mobile for Transmasculine Youth.

Our team developed MyPEEPS (Male youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile-a health application for young cisgender men who have sex with men to promote health and reduce sexual risk. The current study sought to better understand approaches for adapting MyPEEPS for transmasculine youth. METHODS: Transmasculine youth, ages 13-18 years, who reported attraction to or sex with cisgender men were recruited to participate in focus groups in four major cities in the United States. RESULTS: Overall, participants found MyPEEPS Mobile to be a useful educational platform for sexual health education. Participants discussed expansions of the MyPEEPS Mobile App to address interpersonal concerns and provision of a holistic approach to health promotion for transmasculine youth. Detailed suggestions for improvement included personalization; transmasculine inclusivity and relatability; expansion of population-specific educational components; and improvements to functionality, images, and graphics. CONCLUSIONS: While MyPEEPS Mobile has educational components, adaptations are needed to address specific needs of TMY and optimize user-centered design for feasibility and efficacy. If tailored to the lives of transmasculine youth, MyPEEPS has the potential to promote HIV preventive behavior.

A randomized controlled trial of an mHealth intervention for increasing access to HIV testing and care among young cisgender men and transgender women: the mLab App study protocol.

BACKGROUND: The number of youth living with HIV in the United States (US) continues to rise, and racial, ethnic, and sexual minority youth including young men who have sex with men (YMSM) and young transgender women (YTGW) bear a disproportionate burden of the HIV epidemic. Due to social and healthcare system factors, many YMSM and YTGW do not seek HIV testing services and are therefore less likely to be aware that they are infected. Mobile health technology (mHealth) has the ability to increase uptake of HIV testing among these populations. Thus, the mLab App-which combines HIV prevention information with a mobile phone imaging feature for interpreting at-home HIV test results-was developed to improve testing rates and linkage to care among Black, Latino, and other YMSM and YTGW living in New York City and Chicago and their surrounding areas. METHODS: This study is a three-arm randomized controlled trial among YMSM and YTGW aged 18-29 years. Participants are randomized to either the mLab App intervention including HIV home test kits and standard of preventive care, standard of preventive care only, or HIV home test kits and standard of preventive care only. DISCUSSION: mHealth technology used for HIV prevention is capable of delivering interventions in real-time, which creates an opportunity to remotely reach users across the country to strengthen their HIV care continuum engagement and treatment outcomes. Specifically during the COVID-19 pandemic, mHealth technology combined with at-home testing may prove to be essential in increasing HIV testing rates, especially among populations at high-risk or without regular access to HIV testing. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov ( NCT03803683 ) on January 14, 2019.

Examining the Information Systems Success (ISS) of a mobile sexual health app (MyPEEPS Mobile) from the perspective of very young men who have sex with men (YMSM).

OBJECTIVE: The widespread and frequent use of mobile technology among adolescents, including sexual minority adolescents, presents an opportunity for the development of mobile health (mHealth) technology to combat the continuing HIV epidemic among young men who have sex with men (YMSM). We analyzed perceptions of the quality and impact of an HIV prevention mobile app on sexual risk reduction among YMSM. METHODS: Participants were recruited from a larger randomized controlled trial of the MyPEEPS Mobile app among YMSM aged 13-18 years. Data were collected via semi-structured interviews to assess quality and user satisfaction with MyPEEPS Mobile app using analysis informed by the Information Systems Success framework. Interview data were transcribed verbatim and analyzed using six themes: information quality, net benefit, user satisfaction, product quality, service quality, and health care barriers. RESULTS: Interviews were conducted with 40 YMSM (45% Hispanic; 80% non-White; 88% non-rural resident; 28% aged 17 years). Participants' responses indicated that information quality was high, reporting that the app information was concise, easy to understand, useful, and relevant to their life. The net benefits were stated as improvements in their decision-making skills, health behaviors, communication skills with partner(s), and increased knowledge of HIV risk. There was general user satisfaction and enjoyment when using the app, although most of the participants did not intend to reuse the app unless new activities were added. Participants expressed that the product quality of the app was good due to its personalization, representation of the LGBTQIA + community, and user-friendly interface. Although no major technical issues were reported, participants suggested that adaption to a native app, rather than a web app, would improve service quality through faster loading speed. Participants also identified some health care barriers that were minimized by app use. CONCLUSIONS: The MyPEEPS Mobile app is a well received, functional, and entertaining mHealth HIV prevention tool that may improve HIV prevention skills and reduce HIV risk among YMSM.

A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation.

BACKGROUND: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. OBJECTIVE: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. METHODS: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. RESULTS: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. CONCLUSIONS: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group.