PROJECT SUMMARY
Young men who have sex with men (YMSM) are experiencing an ongoing HIV epidemic in Vietnam, with an
HIV prevalence of 12%. However, HIV testing and pre-exposure prophylaxis (PrEP) use among YMSM remain
low. To improve HIV testing and PrEP use, mobile health (mHealth) interventions hold great promise to reach
YMSM in low- and middle-income countries (LMIC). HealthMindr, an evidence-based mHealth intervention
developed in the United States for men who have sex with men, is an ideal option for adaptation for YMSM in
Vietnam. I propose to adapt this app and explore barriers and facilitators of implementing the app among
YMSM in Vietnam. The specific aims are to (1) Adapt the HealthMindr app to improve HIV testing and PrEP
uptake among YMSM in Vietnam; (2) Examine acceptability, feasibility and preliminary effectiveness of the
adapted app among YMSM in Vietnam and (3) Explore barriers and facilitators of implementing the adapted
app among YMSM in Vietnam. In Aim 1, theater testing will be conducted through focus group discussions with
YMSM and key other stakeholders, including health officials, clinic staff and community-based organizations.
Theater testing data will be used to refine the app for beta testing. During beta testing, a small group of YMSM
will use the app for 30 days, then complete an online survey and an exit interview to rate the app’s usability,
provide their perspectives of the app and report any other areas for improvement. App analytics will also be
collected to understand whether and how the app is used. In Aim 2, the adapted app with be tested among
YMSM through a randomized controlled design. YMSM will be randomized into the intervention or control arm
(1:1 ratio). The intervention arm will have full access to the app for 3 months, while the control group will
receive standard-of-care HIV services. Key app features include HIV test planning, risk and PrEP eligibility
assessment, ordering of free condoms and HIV test kits, information about PrEP, and PrEP provider and HIV
testing locations. HIV testing and PrEP use will be assessed at baseline and 3 months and compared between
groups. A mixed methods approach will be used to evaluate app acceptability and feasibility. Quantitative data
on acceptability and feasibility will be collected through the 3-month online survey, while qualitative data will be
collected through in-depth interviews with a subset of YMSM in the intervention arm and other key
stakeholders. In Aim 3, through the same qualitative study as Aim 2, factors that influence the implementation
of the app will be explored. Determinants from seven domains will be identified: condition, technology, value
proposition, adopter system, health organization, wider system and embedding/adaption over time. Only when
mHealth interventions are both effective and adopted can they maximize their potential to reduce HIV
incidence among target populations. This proposal will generate data for designing a full-scale hybrid type 1
effectiveness-implementation trial to test the adapted app and identify implementation strategies to address the
barriers of app implementation in LMICs.
