@Article{info:doi/10.2196/63111,
author="Huang, Wenting
and Stegmueller, Daniel
and Ong, J. Jason
and Wirtz, Schlueter Susan
and Ning, Kunru
and Wang, Yuqing
and Mi, Guodong
and Yu, Fei
and Hong, Chenglin
and Sales, M. Jessica
and Liu, Yufen
and Baral, D. Stefan
and Sullivan, S. Patrick
and Siegler, J. Aaron",
title="Technology-Based HIV Prevention Interventions for Men Who Have Sex With Men: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="28",
volume="27",
pages="e63111",
keywords="HIV",
keywords="men who have sex with men",
keywords="telemedicine",
keywords="systematic review",
keywords="Bayesian",
keywords="meta-analysis",
abstract="Background: There remain unmet HIV prevention needs in China, particularly among gay, bisexual, and other men who have sex with men. Technology-based interventions are increasingly used in HIV prevention worldwide. Objective: We aimed to conduct a systematic review and meta-analysis of studies to assess the effectiveness of technology-based HIV prevention interventions to improve HIV testing and consistent condom use in China. Methods: We searched English-language (PubMed and MEDLINE, Embase, and Web of Science) and Chinese-language (Wanfang, WEIPU, and China National Knowledge Infrastructure) databases for technology-based HIV prevention intervention studies published between January 1, 2004, and September 30, 2021. Eligible studies were technology-based HIV prevention intervention studies with outcomes of HIV testing or condom use among men who have sex with men or transgender women using randomized controlled or nonrandomized pretest-posttest designs in China. The intervention technologies identified were apps, web pages, and other types of electronic communications (eg, email, SMS text messages, and video messages). A Bayesian meta-analysis was conducted to estimate the pooled effect size and 95\% credible interval (CrI). We added study and intervention features as covariates to explore their associations with the study effects. Study quality was assessed using the integrated quality criteria for review of multiple study designs. Publication bias was assessed using funnel plots and robust Bayesian meta-analyses. Results: We identified 1214 and 1691 records from English-language and Chinese-language databases, respectively. A total of 141 records entered full-text screening, and 24 (17\%) studies were eligible for the review. Approximately half (14/24, 58\%) of the interventions were delivered through social media platforms, predominantly using message-based communication. The remaining studies used email and web-based platforms. The pooled effect sizes estimated were an absolute increase of 20\% (95\% CrI 10\%-30\%) in HIV testing uptake and an absolute increase of 15\% (95\% CrI 5\%-26\%) in consistent condom use. The pooled point estimate of the effect of randomized controlled trials was smaller than that of nonrandomized studies for HIV testing uptake (16\% vs 23\%) and consistent condom use (10\% vs 19\%), but their CrIs largely overlapped. Interventions lasting >6 months were associated with a 35\% greater uptake of HIV testing (95\% CrI 19\%-51\%) compared to those lasting 6 months. Conclusions: Technology-based HIV prevention interventions are promising strategies to improve HIV testing uptake and consistent condom use among men who have sex with men in China, with significant effects found across a broad array of studies and study designs. However, many studies in this review did not include randomized designs or a control group. More rigorous study designs, such as randomized controlled trials, are needed, with outcome measurements that address the limitation of self-report outcomes to inform the development and implementation of future intervention programs. Trial Registration: PROSPERO CRD42021270856; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021270856 ",
doi="10.2196/63111",
url="https://www.jmir.org/2025/1/e63111"
}


@Article{info:doi/10.2196/65674,
author="Huaju, Tian
and Rendie, Xie
and Lu, Xiao
and Mei, Li
and Yue, Luo
and Daiying, Zhang
and Yanhua, Chen
and Jianlan, Ren",
title="The Effect of a Brief Video-Based Intervention to Improve AIDS Prevention in Older Men: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="18",
volume="11",
pages="e65674",
keywords="older men",
keywords="AIDS prevention",
keywords="video",
keywords="video-based intervention",
keywords="HIV",
keywords="AIDS",
abstract="Background: The AIDS epidemic among older people is becoming more serious. Evidence-based, acceptable, and effective preventive interventions are urgently needed. Video-based interventions have become an innovative way to change behaviors, and we have developed a brief video-based intervention named Sunset Without AIDS. Objective: In this study, we tested the effectiveness of a brief video-based intervention targeting older men's understanding of AIDS prevention. Methods: A randomized controlled trial was conducted from June 20 to July 3, 2023. In total, 100 older men were randomly divided into the intervention group (n=50) and the control group (n=50) using the envelope extraction method. The intervention group was shown the Sunset Without AIDS video; the control group viewed a standard AIDS education video. A questionnaire was used to measure the effect of Sunset Without AIDS after 2 interventions. AIDS-related high-risk behaviors were followed up 1 and 3 months after the intervention. The difference was statistically significant at P?.05. Results: After 2 interventions, the total awareness rates (\%) of AIDS-related knowledge in the intervention and control groups were 84\% (42/50) and 66\% (33/50), respectively (P=.04). The mean stigma attitude scores of the 2 groups were 2.53 (SD 0.45) and 2.58 (SD 0.49), respectively (P=.55), but there was a statistically significant difference in the first dimension (fear of infection) between the 2 groups (P<.001). The mean positive scores of attitudes of AIDS-related high-risk behaviors of the 2 groups were 83.33 (SD 21.56) and 75.67 (SD 26.77), respectively (P=.58). In addition, 82\% reported that they were satisfied with the educational content within the Sunset Without AIDS video. At 1- and 3-month follow-ups conducted after the intervention, participants in the 2 groups did not report AIDS-related high-risk behaviors. After watching the 2 videos, more people accepted and were satisfied with Sunset Without AIDS. Conclusions: Sunset Without AIDS could improve the ability of older men in China to follow best practices for AIDS prevention and provide a certain basis for the innovation of AIDS education in the older adult population. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2100045708; https://www.chictr.org.cn/showproj.html?proj=125478 ",
doi="10.2196/65674",
url="https://publichealth.jmir.org/2025/1/e65674"
}


@Article{info:doi/10.2196/67445,
author="Santos, dos Lorruan Alves
and Deus, de Luiz F{\'a}bio Alves
and Unsain, Fernandez Ramiro
and Leal, Fachel Andrea
and Grangeiro, Alexandre
and Couto, Thereza Marcia",
title="Agreements and Disagreements Between Professionals and Users About the Experience of a Telehealth Service for HIV Pre-Exposure Prophylaxis (TelePrEP): Qualitative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="2",
volume="27",
pages="e67445",
keywords="pre-exposure prophylaxis",
keywords="HIV",
keywords="telemedicine",
keywords="men who have sex with men",
keywords="health personnel",
abstract="Background: Men who have sex with men have a disproportionately high prevalence of HIV worldwide. In Brazil, men who have sex with men account for over 15\% of HIV cases, substantially higher than the general population prevalence of 0.6\%. Pre-exposure prophylaxis (PrEP) is a critical biomedical strategy for reducing HIV transmission, yet adherence remains challenging due to stigma, logistical barriers, and the need for regular clinical follow-ups. TelePrEP, a telehealth-based approach to PrEP follow-up, has emerged as a potential solution to improve accessibility and reduce stigma. However, the perspectives of users and health care providers on this intervention remain understudied in low- and middle-income countries, such as Brazil. Objective: This study aims to examine the experiences and perceptions of users and health care professionals regarding TelePrEP, an asynchronous remote consultation model, in 5 PrEP services across 3 Brazilian regions (southeast, south, and northeast). Methods: We conducted 19 in-depth interviews with PrEP users (aged between 23 and 58 years) and 6 interviews with health care professionals (aged between 35 and 61 years). Users were recruited from 5 public health care services, including outpatient HIV clinics and testing centers. The interviews explored motivations for PrEP use, experiences with in-person and remote consultations, perceived advantages and disadvantages of TelePrEP, and overall satisfaction. Thematic analysis was conducted using NVivo software. Results: Users reported greater convenience, increased autonomy, and reduced stigma, highlighting that the remote consultations eliminated the discomfort of discussing personal topics in person and minimized the need for frequent visits to health care facilities. Many felt that TelePrEP simplified HIV prevention, normalized PrEP use, and contributed to more sustainable adherence while also expressing confidence that periodic laboratory testing was sufficient for monitoring their health. Conversely, health care professionals raised concerns about the loss of personal connection with users, which they perceived as essential for detecting health issues and ensuring PrEP adherence. They also noted that TelePrEP could hinder the identification of sexually transmitted infections due to the absence of direct clinical assessments, and some questioned whether TelePrEP compromised the quality of care, fearing that users might delay reporting symptoms or other health concerns. Conclusions: To effectively address the needs of both groups, the successful implementation of telehealth PrEP services must consider these differing perceptions. Further research is essential to explore implementation in diverse settings and enhance the training of health care professionals to address the specific requirements of PrEP care. ",
doi="10.2196/67445",
url="https://www.jmir.org/2025/1/e67445"
}


@Article{info:doi/10.2196/67367,
author="Hill, J. Mandy
and Mangum, Laurenia
and Coker, J. Sandra
and Sutton, Tristen
and Santa Maria, M. Diane",
title="Dissemination and Implementation Approach to Increasing Access to Local Pre-Exposure Prophylaxis (PrEP) Resources With Black Cisgender Women: Intervention Study With Vlogs Shared on Social Media",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="28",
volume="11",
pages="e67367",
keywords="PrEP",
keywords="cisgender Black women",
keywords="social media campaign",
keywords="PrEP access",
keywords="HIV prevention",
keywords="vlogging",
keywords="dissemination and implementation",
keywords="pre-exposure prophylaxis",
keywords="dissemination",
keywords="implementation",
keywords="HIV",
keywords="prevention",
keywords="human immunodeficiency virus",
keywords="cisgender",
keywords="social media",
keywords="marketing",
keywords="campaign",
keywords="education",
keywords="sexually transmitted diseases",
keywords="STDs",
keywords="vlog",
abstract="Background: Black cisgender women account for only 2\% of pre-exposure prophylaxis (PrEP)-eligible people in the United States who use PrEP to prevent HIV. Owing to the low PrEP use, Black cisgender women continue to contract HIV more frequently than women from every other racial group. Intervention efforts that can bridge the link between knowing that PrEP prevents HIV and support with access to PrEP are necessary for Black cisgender women. Objective: The purposes of the vlogs through the campaign were to share information about ways to prevent HIV using PrEP and fact-based education and provide access to PrEP resources with active links to local PrEP providers at local community health centers. Methods: In Phase 1, the study team formerly piloted full-length video blog posts (ie, vlogs; 10?12 min each) with 26 women during an emergency department visit. Using the findings from Phase 1, Phase 2 involved a prospective 6-month social media marketing campaign. The study team led a Texas-Development CFAR-funded pilot grant to disseminate brief vlog snippets (30 s) of excerpts from full-length vlogs with a larger group of Black women in Harris County. Community members, who were aged 18?55 years, usually consume content that is often viewed by Black cisgender women (ie, health and beauty) and reside in neighborhoods (based on zip code) in Harris County where most residents are Black or African American. They were shown a series of brief vlog snippets on their social media pages, along with a brief message about PrEP and an active hyperlink to local PrEP resources. The study team assessed implementation outcomes, including the feasibility and acceptability, appropriateness of vlogs, access to PrEP resources at local clinics, and clinical outcomes such as increased PrEP awareness among Black cisgender women. Results: Within 6 months, the campaign reached 110.8k unique individuals (the number of unique accounts that have seen your content at least once) who identified as women. When stratified by age, video plays (the number of times a video starts playing) at 50\% of the vlogs (n=30,877) were most common among women aged 18?24 years (n=12,017) and least common among women aged 45?54 years (n=658). Key performance indicators showed that 1,098,629 impressions (the number of times a user saw the vlog) and 1,002,244 total video plays resulted in 15,952 link clicks to local PrEP resources. Conclusions: The campaign demonstrated the feasibility and acceptability of this approach with Black cisgender women and illustrated preliminary effectiveness at supporting access to local PrEP resources with Black cisgender women. Further dissemination and implementation of this approach is necessary to fully assess whether vlog viewership and clicks on links to PrEP resources can meaningfully empower Black cisgender women to access PrEP and help them to assess whether PrEP is personally a useful HIV prevention option. ",
doi="10.2196/67367",
url="https://publichealth.jmir.org/2025/1/e67367"
}


@Article{info:doi/10.2196/52121,
author="Daniels, Joseph
and van der Merwe, Leigh-Ann Leonashia
and Portle, Sarah
and Bongo, Cikizwa
and Nadkarni, Shiv
and Petrus Peters, Remco",
title="Tailoring a Skills-Based Serostatus Disclosure Intervention for Transgender Women in South Africa: Protocol for a Usability and Feasibility Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="26",
volume="14",
pages="e52121",
keywords="transgender women",
keywords="intervention development",
keywords="relationships",
keywords="HIV treatment",
keywords="South Africa",
keywords="mobile phones, smartphones",
keywords="skills-based",
keywords="serostatus disclosure",
keywords="HIV",
keywords="HIV prevention",
keywords="transgender",
keywords="treatment outcomes",
keywords="transmission",
keywords="HIV-discordant partnerships",
keywords="behavioral intervention",
keywords="safe sex",
keywords="human-centered design",
keywords="viral suppression",
keywords="Speaking Out and Allying Relationships",
keywords="LGBTQ2S",
keywords="LGBTQ",
keywords="2SILGBTQ",
abstract="Background: Transgender women have few interventions to support their HIV prevention and treatment outcomes in South Africa. Further, increased focus should be on intervention development that will reduce HIV transmission within HIV-discordant partnerships, especially for transgender women who navigate gender, sexuality, and relationship stigma. The Speaking Out and Allying Relationships (SOAR) intervention has been developed for sexual minority men to address these outcomes in South Africa. It is a behavioral intervention that is delivered in groups via videoconference to develop coping skills to manage HIV-related stress, assist with disclosure to partners, and establish and maintain safer sex practices with partners. Tailoring SOAR may be feasible for transgender women to support their HIV care while reducing transmission within their relationships. Objective: This study aims to (1) adapt SOAR for transgender women and test its usability, then (2) assess its feasibility. Methods: To achieve aim 1, we will use a human-centered design approach to tailor the existing SOAR intervention for transgender women. Interviews and a survey will be administered to transgender women (N=15) to assess intervention preferences. Findings will be used to tailor content like roleplays, scenarios, and media to align with transgender women's lived experiences navigating HIV and relationships. Afterward, we will conduct a usability test with 7 (47\%) of the 15 participants to determine intervention understanding and satisfaction. Participants will be transgender women living with HIV and in a relationship with a man who has unknown HIV status or is HIV-negative. All participants will be recruited using community-based approaches. In aim 2, we will examine SOAR feasibility using a 1-arm pilot study. Transgender women (N=20) will be recruited using aim 1 methods and eligibility criteria, with participants completing feasibility surveys and interviews, as well as behavioral and biomedical assessments. Results: Intervention adaptation began in May 2023 with interviews. Feasibility pilot testing was conducted with 14 transgender women, with study completion in January 2025. Conclusions: Transgender women need more intervention options that engage their relationships since these can present barriers to HIV treatment outcomes like hindering viral suppression in South Africa. Delivering an existing yet tailored intervention via videoconference expands its reach to transgender women and allows them to engage with others and learn new skills in a secure setting like their homes. SOAR has the potential to improve relationship dynamics and reduce violence, which will in turn enhance HIV treatment and prevention engagement. International Registered Report Identifier (IRRID): PRR1-10.2196/52121 ",
doi="10.2196/52121",
url="https://www.researchprotocols.org/2025/1/e52121"
}


@Article{info:doi/10.2196/59780,
author="Dos Santos, Cristina Fabiana
and Brin, Maeve
and Tanner, R. Mary
and Galindo, A. Carla
and Schnall, Rebecca",
title="The mChoice App, an mHealth Tool for the Monitoring of Preexposure Prophylaxis Adherence and Sexual Behaviors in Young Men Who Have Sex With Men: Usability Evaluation",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="28",
volume="12",
pages="e59780",
keywords="HIV prevention",
keywords="data visualization",
keywords="patient-reported health information",
keywords="mHealth",
keywords="digital health",
keywords="usability",
keywords="human immunodeficiency virus",
keywords="preexposure prophylaxis",
keywords="men who have sex with men",
keywords="apps",
keywords="HIV",
keywords="PrEP",
abstract="Background: Mobile health (mHealth) apps provide easy and quick access for end users to monitor their health-related activities. Features such as medication reminders help end users adhere to their medication schedules and automatically record these actions, thereby helping manage their overall health. Due to insufficient mHealth tools tailored for HIV preventive care in young men who have sex with men (MSM), our study evaluated the usability of the mChoice app, a tool designed to enhance preexposure prophylaxis (PrEP) adherence and promote sexual health (eg, encouraging the use of condoms and being aware of the partner's HIV status and PrEP use). Objective: This study aimed to apply systematic usability evaluations to test the mChoice app and to refine the visualizations to better capture and display patient-reported health information. Methods: Usability testing involved heuristic evaluations conducted with 5 experts in informatics and user testing with 20 young MSM who were taking or were eligible to take PrEP. Results: End users demonstrated satisfaction with the appearance of the mChoice app, reporting that the app has an intuitive interface to track PrEP adherence. However, participants highlighted areas needing improvement, including chart titles and the inclusion of ``undo'' and ``edit'' buttons to improve user control when recording PrEP use. Conclusions: Usability evaluations involving heuristic experts and end users provided valuable insights into the mChoice app's design. Areas for improvement were identified, such as enhancing chart readability and providing additional user controls. These findings will guide iterative refinements, ensuring that future versions of the app better address the needs of its target audience and effectively support HIV prevention. ",
doi="10.2196/59780",
url="https://humanfactors.jmir.org/2025/1/e59780"
}


@Article{info:doi/10.2196/59101,
author="Lin, Bing
and Liu, Jiaxiu
and Li, Kangjie
and Zhong, Xiaoni",
title="Predicting the Risk of HIV Infection and Sexually Transmitted Diseases Among Men Who Have Sex With Men: Cross-Sectional Study Using Multiple Machine Learning Approaches",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="20",
volume="27",
pages="e59101",
keywords="HIV",
keywords="sexually transmitted diseases",
keywords="men who have sex with men",
keywords="machine learning",
keywords="web application",
keywords="risk stratification",
abstract="Background: Men who have sex with men (MSM) are at high risk for HIV infection and sexually transmitted diseases (STDs). However, there is a lack of accurate and convenient tools to assess this risk. Objective: This study aimed to develop machine learning models and tools to predict and assess the risk of HIV infection and STDs among MSM. Methods: We conducted a cross-sectional study that collected individual characteristics of 1999 MSM with negative or unknown HIV serostatus in Western China from 2013 to 2023. MSM self-reported their STD history and were tested for HIV. We compared the accuracy of 6 machine learning methods in predicting the risk of HIV infection and STDs using 7 parameters for a comprehensive assessment, ranking the methods according to their performance in each parameter. We selected data from the Sichuan MSM for external validation. Results: Of the 1999 MSM, 72 (3.6\%) tested positive for HIV and 146 (7.3\%) self-reported a history of previous STD infection. After taking the results of the intersection of the 3 feature screening methods, a total of 7 and 5 predictors were screened for predicting HIV infection and STDs, respectively, and multiple machine learning prediction models were constructed. Extreme gradient boost models performed optimally in predicting the risk of HIV infection and STDs, with area under the curve values of 0.777 (95\% CI 0.639-0.915) and 0.637 (95\% CI 0.541-0.732), respectively, demonstrating stable performance in both internal and external validation. The highest combined predictive performance scores of HIV and STD models were 33 and 39, respectively. Interpretability analysis showed that nonadherence to condom use, low HIV knowledge, multiple male partners, and internet dating were risk factors for HIV infection. Low degree of education, internet dating, and multiple male and female partners were risk factors for STDs. The risk stratification analysis showed that the optimal model effectively distinguished between high- and low-risk MSM. MSM were classified into HIV (predicted risk score <0.506 and ?0.506) and STD (predicted risk score <0.479 and ?0.479) risk groups. In total, 22.8\% (114/500) were in the HIV high-risk group, and 43\% (215/500) were in the STD high-risk group. HIV infection and STDs were significantly higher in the high-risk groups (P<.001 and P=.05, respectively), with higher predicted probabilities (P<.001 for both). The prediction results of the optimal model were displayed in web applications for probability estimation and interactive computation. Conclusions: Machine learning methods have demonstrated strengths in predicting the risk of HIV infection and STDs among MSM. Risk stratification models and web applications can facilitate clinicians in accurately assessing the risk of infection in individuals with high risk, especially MSM with concealed behaviors, and help them to self-monitor their risk for targeted, timely diagnosis and interventions to reduce new infections. ",
doi="10.2196/59101",
url="https://www.jmir.org/2025/1/e59101"
}


@Article{info:doi/10.2196/63428,
author="Biello, B. Katie
and Mayer, H. Kenneth
and Scott, Hyman
and Valente, K. Pablo
and Hill-Rorie, Jonathan
and Buchbinder, Susan
and Ackah-Toffey, Lucinda
and Sullivan, S. Patrick
and Hightow-Weidman, Lisa
and Liu, Y. Albert",
title="The Effects of MyChoices and LYNX Mobile Apps on HIV Testing and Pre-Exposure Prophylaxis Use by Young US Sexual Minority Men: Results From a National Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2025",
month="Feb",
day="5",
volume="11",
pages="e63428",
keywords="HIV testing",
keywords="adolescents",
keywords="sexual minority men",
keywords="mobile apps",
keywords="pre-exposure prophylaxis",
keywords="youths",
keywords="randomized controlled trial",
keywords="sexual minority",
keywords="United States",
keywords="efficacy",
keywords="LYNX",
keywords="MyChoices",
keywords="sociodemographic",
keywords="behavioral health",
keywords="HIV prevention",
keywords="HIV infection",
keywords="HIV care",
keywords="transmission",
keywords="public health",
keywords="mHealth",
keywords="mobile phones",
abstract="Background: Young sexual minority men have among the highest rates of HIV in the United States; yet, the use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among young sexual minority men. Objective: This study aims to assess the efficacy of 2 theory- and community-informed mobile apps---LYNX (APT Mobility) and MyChoices (Keymind)---to improve HIV testing and PrEP initiation among young sexual minority men. Methods: Between October 2019 and May 2022, we implemented a 3-arm, parallel randomized controlled trial in 9 US cities to test the efficacy of the LYNX and MyChoices apps against standard of care (SOC) among young sexual minority men (aged 15-29 years) reporting anal sex with cisgender male or transgender female in the last 12 months. Randomization was 1:1:1 and was stratified by site and participant age; there was no masking. The co-primary outcomes were self-reported HIV testing and PrEP initiation over 6 months of follow-up. Results: A total of 381 young sexual minority men were randomized. The mean age was 22 (SD 3.2) years. Nearly one-fifth were Black, non-Hispanic (n=67, 18\%), Hispanic or Latino men (n=67, 18\%), and 60\% identified as gay (n=228). In total, 200 (53\%) participants resided in the Southern United States. At baseline, participants self-reported the following: 29\% (n=110) had never had an HIV test and 85\% (n=324) had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (n=72, 59\%), participants randomized to MyChoices (n=87, 74\%; P=.01) were more likely to have received at least 1 HIV test over 6 months of follow-up; those randomized to LYNX also had a higher proportion of testing (n=80, 70\%) but it did not reach the a priori threshold for statistical significance (P=.08). Participants in both MyChoices (n=23, 21\%) and LYNX (n=21, 20\%) arms had higher rates of starting PrEP compared to SOC (n=19, 16\%), yet these differences were not statistically significant (P=.52). Conclusions: In addition to facilitating earlier treatment among those who become aware of their HIV status, given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25\% relative increase in HIV testing among young sexual minority men, as seen in this study, could meaningfully reduce HIV incidence in the United States. Trial Registration: ClinicalTrials.gov NCT03965221; https://clinicaltrials.gov/study/NCT03965221 ",
doi="10.2196/63428",
url="https://publichealth.jmir.org/2025/1/e63428"
}


@Article{info:doi/10.2196/58912,
author="Rubio, Claudio
and Besoain, Felipe",
title="Pervasive Games for Sexual Health Promotion: Scoping Literature Review",
journal="JMIR Serious Games",
year="2025",
month="Jan",
day="15",
volume="13",
pages="e58912",
keywords="serious games",
keywords="promotion",
keywords="ubiquitous technologies",
keywords="healthy behaviors",
keywords="HIV",
keywords="sexually transmitted infection",
keywords="STI",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change. Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded. Results: We screened 521 of 612 articles (85.1\%) after removing duplicates. After the title and abstract review, 51 (9.8\%) articles were assessed for eligibility, and 30 (5.8\%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored. Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game--based studies to ensure the reproducibility of experiments. ",
doi="10.2196/58912",
url="https://games.jmir.org/2025/1/e58912"
}


@Article{info:doi/10.2196/65713,
author="Yang, Xue
and Kang, Wenting
and Zhang, Zhuoer
and Tang, Houlin
and Zhang, Dapeng
and Sun, Lijun
and Li, Zaicun
and Liu, An",
title="HIV Pre-Exposure Prophylaxis Cascade Stages Among Men Who Have Sex With Men With Sexually Transmitted Infections in China: Multicenter Cross-Sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="30",
volume="10",
pages="e65713",
keywords="HIV",
keywords="men who have sex with men",
keywords="MSM",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="sexually transmitted infection",
keywords="STI",
abstract="Background: There is limited literature available regarding the knowledge and use of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) with sexually transmitted infections (STIs). Objective: This study's objective was to explore the HIV PrEP cascade stages (knowledge, willingness to use, and use) among MSM with STIs in China, in order to promote the implementation of PrEP in this population. Methods: A cross-sectional study was conducted using a respondent-driven sampling method in 19 cities in China, from January to August 2022. The study collected data on demographics, behaviors, and PrEP cascade stages from participants who were not infected with HIV and who self-reported being recently infected with STIs. After using chi-square tests or Fisher exact tests to analyze differences in the knowledge of PrEP, willingness to use PrEP, and PrEP use across different variables, multivariate logistic regression was used to analyze the influences of the different variables on PrEP cascade stages. Results: By August 2022, following screening and exclusion, a total of 1329 MSM were included in the study. Among them, 85.55\% (n=1137) had heard of PrEP, 81.57\% (n=1084) expressed their willingness to use PrEP if engaging in high-risk HIV behaviors, 70.58\% (n=938) had consulted a health care professional about PrEP, 62.98\% (n=837) reported having used PrEP, and 46.35\% (n=616) possessed a basic understanding of PrEP. The results of multivariate logistic regression analyses showed that the same factors significantly influenced both knowledge of PrEP and willingness to take PrEP, including age, education, marital status, income, condom usage, participation in group sex, HIV status of the most recent male sexual partner, and postexposure prophylaxis (PEP) usage. The factors significantly related to the PrEP use included income, engagement in commercial sex, participation in group sex, HIV status of the most recent male sexual partner, new drug usage, and PEP usage. Conclusions: MSM with STIs were engaged with the PrEP cascade stages at a relatively high rate, but they lacked an understanding of PrEP and underestimated HIV risk. The prevalence of having a basic understanding of PrEP was lower than PrEP usage, and this suboptimal awareness could impede PrEP efficacy and lead to risk compensation. ",
doi="10.2196/65713",
url="https://publichealth.jmir.org/2024/1/e65713"
}


@Article{info:doi/10.2196/56788,
author="Parker, N. Jayelin
and Rager, L. Theresa
and Burns, Jade
and Mmeje, Okeoma",
title="Data Verification and Respondent Validity for a Web-Based Sexual Health Survey: Tutorial",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="9",
volume="8",
pages="e56788",
keywords="sexually transmitted infections",
keywords="adolescent and young adults",
keywords="sexual health",
keywords="recruitment",
keywords="survey design",
keywords="social media",
keywords="data verification",
keywords="web-based surveys",
keywords="data integrity",
keywords="social media advertisements",
keywords="online advertisements",
keywords="STI",
keywords="STD",
keywords="sexual health survey",
keywords="sexually transmitted disease",
abstract="Background: As technology continues to shape the landscape of health research, the utilization of web-based surveys for collecting sexual health information among adolescents and young adults has become increasingly prevalent. However, this shift toward digital platforms brings forth a new set of challenges, particularly the infiltration of automated bots that can compromise data integrity and the reliability of survey results. Objective: We aimed to outline the data verification process used in our study design, which employed survey programming and data cleaning protocols. Methods: A 26-item survey was developed and programmed with several data integrity functions, including reCAPTCHA scores, RelevantID fraud and duplicate scores, verification of IP addresses, and honeypot questions. Participants aged 15?24 years were recruited via social media advertisements over 7 weeks and received a US \$15 incentive after survey completion. Data verification occurred through a 2-part cleaning process, which removed responses that were incomplete, flagged as spam by Qualtrics, or from duplicate IP addresses, or those that did not meet the inclusion criteria. Final comparisons of reported age with date of birth and reported state with state inclusion criteria were performed. Participants who completed the study survey were linked to a second survey to receive their incentive. Responses without first and last names and full addresses were removed, as were those with duplicate IP addresses or the exact same longitude and latitude coordinates. Finally, IP addresses used to complete both surveys were compared, and consistent responses were eligible for an incentive. Results: Over 7 weeks, online advertisements for a web-based survey reached 1.4 million social media users. Of the 20,585 survey responses received, 4589 (22.3\%) were verified. Incentives were sent to 462 participants; of these, 14 responses were duplicates and 3 contained discrepancies, resulting in a final sample of 445 responses. Conclusions: Confidential web-based surveys are an appealing method for reaching populations---particularly adolescents and young adults, who may be reluctant to disclose sensitive information to family, friends, or clinical providers. Web-based surveys are a useful tool for researchers targeting hard-to-reach populations due to the difficulty in obtaining a representative sample. However, researchers face the ongoing threat of bots and fraudulent participants in a technology-driven world, necessitating the adoption of evolving bot detection software and tailored protocols for data collection in unique contexts. ",
doi="10.2196/56788",
url="https://formative.jmir.org/2024/1/e56788"
}




@Article{info:doi/10.2196/59800,
author="Johnson, K. Amy
and Devlin, A. Samantha
and Pyra, Maria
and Etshokin, Eriika
and Ducheny, Kelly
and Friedman, E. Eleanor
and Hirschhorn, R. Lisa
and Haider, Sadia
and Ridgway, P. Jessica",
title="Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="15",
volume="8",
pages="e59800",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="Consolidated Framework for Implementation Research",
keywords="CFIR",
keywords="Expert Recommendations for Implementing Change",
keywords="ERIC",
keywords="implementation science",
keywords="HIV prevention",
keywords="AIDS",
keywords="United States",
keywords="Black women",
keywords="women's health",
abstract="Background: Black cisgender women (hereafter referred to as ``women'') experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, ``POWER Up'') to improve PrEP uptake among women. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0285858 ",
doi="10.2196/59800",
url="https://formative.jmir.org/2024/1/e59800"
}


@Article{info:doi/10.2196/57244,
author="Chen, Wanjun
and Chen, Lin
and Ni, Zhikan
and He, Lin
and Pan, Xiaohong",
title="Role of HIV Serostatus Communication on Frequent HIV Testing and Self-Testing Among Men Who Have Sex With Men Who Seek Sexual Partners on the Internet in Zhejiang, China: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="14",
volume="8",
pages="e57244",
keywords="human immunodeficiency virus",
keywords="HIV",
keywords="men who have sex with men",
keywords="HIV serostatus communication",
keywords="HIV testing",
keywords="HIV self-testing",
abstract="Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM. Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing. Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing. Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9\% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9\% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95\% CI 1.76-5.52) and 2.45 (95\% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all. Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all. ",
doi="10.2196/57244",
url="https://formative.jmir.org/2024/1/e57244"
}




@Article{info:doi/10.2196/48453,
author="Metz, Gido
and Thielmann, C. Rosa R. L.
and Roosjen, Hanneke
and Crutzen, Rik",
title="Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="11",
volume="8",
pages="e48453",
keywords="web-based intervention",
keywords="eHealth",
keywords="engagement",
keywords="potential impact",
keywords="mixed methods",
keywords="evaluation",
keywords="acyclic behavior change diagram",
keywords="web analytics",
keywords="think-aloud method",
keywords="web-based",
keywords="user",
keywords="chlamydia",
keywords="behavior change",
abstract="Background: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. Objective: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. Methods: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page's aim of promoting STI testing, a relatively small percentage (n=4948, 14\%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. Results: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. Conclusions: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general. ",
doi="10.2196/48453",
url="https://formative.jmir.org/2024/1/e48453",
url="http://www.ncbi.nlm.nih.gov/pubmed/39259573"
}


@Article{info:doi/10.2196/56958,
author="Lv, Jiaqi
and Jia, Yangfan
and Yan, Chunhui
and Zhang, Xingliang
and Xu, Ke
and Xu, Junfang",
title="Drug Use Behaviors and the Risk of HIV Infection Among Drug Users in China Between 2014 and 2021: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="10",
volume="10",
pages="e56958",
keywords="drug user",
keywords="drug-using behavior",
keywords="HIV",
keywords="behaviors",
keywords="behavior",
keywords="risky",
keywords="sexual",
keywords="drug",
keywords="drugs",
keywords="substance",
keywords="STI",
keywords="STD",
keywords="sexual transmission",
keywords="sexually transmitted",
keywords="association",
keywords="associations",
keywords="correlation",
keywords="correlations",
keywords="sentinel",
keywords="surveillance",
keywords="sexually transmitted infection",
keywords="sexually transmitted disease",
abstract="Background: Drug users are a high-risk group for HIV infection and are prominent HIV carriers. Given the emergence of new drugs, we explored current drug-using behaviors, HIV infections, and the correlation between drug-using behaviors and HIV infection risk among drug users from 2014 to 2021. Objective: We aimed to identify the prevalence of HIV infection risk among drug users and explore drug use behaviors based on the updated data, which could provide evidence for the precision of HIV prevention strategies among drug users. Methods: Data were collected from sentinel surveillance of drug users in rehabilitation centers and communities in Hangzhou (2014?2021), including sociodemographic characteristics, HIV awareness, drug use, risky sexual behaviors, and HIV infection status. Multivariate logistic regression was used to identify the factors influencing HIV infection and risky sexual behaviors among drug users. Results: In total, 5623 drug users (male: n=4734, 84.19\%; age: mean 38.38, SD 9.94 years) were included. New drugs dominated among the participants (n=3674, 65.34\%). The main mode of drug use was noninjection (n=4756, 84.58\%). Overall, for 27.45\% (n=1544) of injected drugs in the last month before the investigation, the average daily injection frequency was 3.10 (SD 8.24). Meanwhile, 3.43\% of participants shared needles. The incidence of sexual behaviors after drug use was 33.13\% (n=1863), with 35.75\% (n=666) of them using a condom in the last time. Overall, 116 participants tested positive for HIV antibodies (infection rate=2.06\%). New drug users exhibited more postuse sexual behaviors than traditional drug users (odds ratio [OR] 7.771, 95\% CI 6.126?9.856; P<.001). HIV-aware drug users were more likely to engage in risky sexual behaviors (OR 1.624, 95\% CI 1.152?2.291; P=.006). New-type drug users were more likely to engage in unprotected sexual behavior (OR 1.457, 95\% CI 1.055?2.011; P=.02). Paradoxically, drug users with greater HIV awareness were more prone to engaging in unprotected sexual behavior (OR 5.820, 95\% CI 4.650?7.284; P<.001). Women engaged less in unprotected sex than men (OR 0.356, 95\% CI 0.190?0.665; P=.001). HIV rates were higher among injecting drug users (OR 2.692, 95\% CI 0.995?7.287; P=.04) and lower among drug users who used condoms during recent sex than those who did not (OR 0.202, 95\% CI 0.076?0.537; P=.001). Higher education levels were associated with higher HIV infection rates. However, there was no significant correlation between HIV cognition level and HIV infection. Conclusions: New drug types and noninjection were the main patterns in last 7 years. Using new types of drugs, rather than traditional drugs, was associated with an increased risk of HIV infection. Injection drug use was a risk factor for HIV infection. HIV awareness among drug users was high, but the incidence of risky sexual behaviors remained high. Therefore, it is important to promote the behavioral transformation of high-risk populations from cognition to attitude, and then to taking protective measures. ",
doi="10.2196/56958",
url="https://publichealth.jmir.org/2024/1/e56958"
}


@Article{info:doi/10.2196/58009,
author="Gomez, Manchikanti Anu
and Reed, Diane Reiley
and Bennett, H. Ariana
and Kavanaugh, Megan",
title="Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="20",
volume="10",
pages="e58009",
keywords="contraception",
keywords="public health objectives",
keywords="public health metrics",
keywords="person-centeredness",
keywords="sexual and reproductive health equity",
abstract="Background: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. Objective: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. Methods: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Results: Comparing the 2 approaches to measuring contraceptive access, we found that 79\% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21\% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100\% were content nonusers---individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68\% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Conclusions: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward. ",
doi="10.2196/58009",
url="https://publichealth.jmir.org/2024/1/e58009",
url="http://www.ncbi.nlm.nih.gov/pubmed/39163117"
}


@Article{info:doi/10.2196/44616,
author="Zhou, Yuyin
and Cheng, Feng
and Xu, Junfang",
title="Religion, Geography, and Risky Sexual Behaviors Among International Immigrants Living in China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="28",
volume="10",
pages="e44616",
keywords="religion",
keywords="geography",
keywords="risky sexual behaviors",
keywords="international immigrants",
keywords="China",
keywords="sexual behavior",
keywords="immigrant",
abstract="Background: Behavioral differences exist between countries, regions, and religions. With rapid development in recent decades, an increasing number of international immigrants from different regions with different religions have settled in China. The degrees to which sexual behaviors---particularly risky sexual behaviors---differ by religion and geographical areas are not known. Objective: We aim to estimate the associations of religion and geographical areas with sexual behaviors of international immigrants and provide evidence for promoting the sexual health of international immigrants. Methods: A cross-sectional study was conducted via the internet with a snowball sampling method among international immigrants in China. In our study, risky sexual behaviors included having multiple sexual partners and engaging in unprotected sex. Descriptive analysis was used to analyze the basic characteristics of international immigrants as well as their sexual behaviors, religious affiliations, and geographical regions of origin. Multivariate binary logistic regression analyses with multiplicative and additive interactions were used to identify aspects of religion and geography that were associated with risky sexual behaviors among international immigrants. Results: A total of 1433 international immigrants were included in the study. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors, and Asian and Buddhist immigrants were less likely to engage in risky sexual behaviors. The majority of the Muslims had sexually transmitted infection and HIV testing experiences; however, Muslims had a low willingness to do these tests in the future. The multivariate analysis showed that Muslim (adjusted odds ratio [AOR] 0.453, 95\% CI 0.228?0.897), Hindu (AOR 0.280, 95\% CI 0.082?0.961), and Buddhist (AOR 0.097, 95\% CI 0.012?0.811) immigrants were less likely to report engaging in unprotected sexual behaviors. Buddhist immigrants (AOR 0.292, 95\% CI 0.086?0.990) were also less likely to have multiple sexual partners. With regard to geography, compared to Asians, South Americans (AOR 2.642, 95\% CI 1.034?6.755), Europeans (AOR 2.310, 95\% CI 1.022?5.221), and North Africans (AOR 3.524, 95\% CI 1.104?11.248) had a higher probability of having multiple sexual partners. Conclusions: The rates of risky sexual behaviors among international immigrants living in China differed depending on their religions and geographical areas of origin. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors. It is necessary to promote measures, including HIV self-testing, pre-exposure prophylaxis implementation, and targeted sexual health education, among international immigrants in China. ",
doi="10.2196/44616",
url="https://publichealth.jmir.org/2024/1/e44616"
}


@Article{info:doi/10.2196/50812,
author="Karuchit, Samart
and Thiengtham, Panupit
and Tanpradech, Suvimon
and Srinor, Watcharapol
and Yingyong, Thitipong
and Naiwatanakul, Thananda
and Northbrook, Sanny
and Hladik, Wolfgang",
title="A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics",
journal="JMIR Form Res",
year="2024",
month="May",
day="20",
volume="8",
pages="e50812",
keywords="online respondent-driven sampling",
keywords="web-based respondent-driven sampling",
keywords="virtual architecture",
keywords="men who have sex with men",
keywords="Thailand",
keywords="MSM",
keywords="Asia",
keywords="Asian",
keywords="gay",
keywords="homosexual",
keywords="homosexuality",
keywords="sexual minority",
keywords="sexual minorities",
keywords="biobehavioral",
keywords="surveillance",
keywords="respondent driven sampling",
keywords="survey",
keywords="surveys",
keywords="web app",
keywords="web application",
keywords="coding",
keywords="PHP",
keywords="web based",
keywords="automation",
keywords="automated",
keywords="design",
keywords="architecture",
keywords="information system",
keywords="information systems",
keywords="online sampling",
keywords="HIV",
keywords="sexually transmitted infection",
keywords="STI",
keywords="sexually transmitted disease",
keywords="STD",
keywords="sexual transmission",
keywords="sexually transmitted",
keywords="RDS",
keywords="webRDS",
abstract="Background: Thailand's HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants' phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using ``borrowed'' phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection. ",
doi="10.2196/50812",
url="https://formative.jmir.org/2024/1/e50812",
url="http://www.ncbi.nlm.nih.gov/pubmed/38767946"
}


@Article{info:doi/10.2196/46845,
author="Phillips, R. Tiffany
and Fairley, K. Christopher
and Maddaford, Kate
and McNulty, Anna
and Donovan, Basil
and Guy, Rebecca
and McIver, Ruthy
and Wigan, Rebecca
and Varma, Rick
and Ong, J. Jason
and Callander, Denton
and Skelsey, Gabrielle
and Pony, Mish
and O'Hara, Dylan
and Bilardi, E. Jade
and Chow, PF Eric",
title="Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="20",
volume="10",
pages="e46845",
keywords="case-control",
keywords="qualitative",
keywords="oral sex",
keywords="condoms",
keywords="transactional sex",
abstract="Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30\% of sex workers (192/664, 28.9\%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95\% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5\%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention. ",
doi="10.2196/46845",
url="https://publichealth.jmir.org/2024/1/e46845",
url="http://www.ncbi.nlm.nih.gov/pubmed/38767954"
}





@Article{info:doi/10.2196/43493,
author="Dai, Zhen
and Mi, Guodong
and Yu, Fei
and Chen, Guodong
and Wang, Xiaodong
and He, Qinying",
title="Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="28",
volume="25",
pages="e43493",
keywords="geosocial networking app",
keywords="GSN app",
keywords="young men who have sex with men",
keywords="MSM",
keywords="HIV",
keywords="incidence",
keywords="risk factors",
keywords="cohort study",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. Objective: This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. Methods: An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. Results: In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95\% CI 2.89-6.61) among all MSM, 3.60 (95\% CI 1.27-5.93) among student MSM, and 5.88 (95\% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95\% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95\% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95\% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95\% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95\% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. Conclusions: The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV. ",
doi="10.2196/43493",
url="https://www.jmir.org/2023/1/e43493",
url="http://www.ncbi.nlm.nih.gov/pubmed/37505891"
}


@Article{info:doi/10.2196/45236,
author="Jing, Zhengyue
and Li, Jie
and Wang, Yi
and Zhou, Chengchao",
title="Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="7",
volume="9",
pages="e45236",
keywords="risky sexual behaviors",
keywords="early sexual intercourse",
keywords="multiple sexual partners",
keywords="condom use",
keywords="young adolescents",
keywords="low and middle-income countries",
abstract="Background: Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90\% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs. Objective: This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017. Methods: For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ?1 round of surveys from 2003 to 2017. Results: We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5\% boys) from the 69 LMICs that had conducted ?1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1\% boys) from the 17 LMICs that had conducted ?1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9\% (95\% CI 6.2\%-7.6\%) and was higher among boys (10.0\%, 95\% CI 9.1\%-11.1\%) than girls (4.2\%, 95\% CI 3.7\%-4.7\%) and among those aged 14 years to 15 years (8.5\%, 95\% CI 7.7\%-9.3\%) than those aged 12 years to 13 years (4\%, 95\% CI 3.4\%-4.7\%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52\% (95\% CI 50.4\%-53.6\%) and was higher among boys (58\%, 95\% CI 56.1\%-59.9\%) than girls (41.4\%, 95\% CI 38.9\%-43.9\%) and among those aged 14 years to 15 years (53.5\%, 95\% CI 51.6\%-55.4\%) than those aged 12 years to 13 years (49.7\%, 95\% CI 45.9\%-53.5\%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1\% (95\% CI 56.2\%-59.9\%) and was higher among girls (59.2\%, 95\% CI 56.4\%-61.9\%) than boys (57.7\%, 95\% CI 55.7\%-59.7\%) and among those aged 14 years to 15 years (59.9\%, 95\% CI 58.0\%-61.8\%) than those aged 12 years to 13 years (51.6\%, 95\% CI 47.5\%-55.7\%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1\% decrease) and condom use (2.0\% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6\%. Conclusions: We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors. ",
doi="10.2196/45236",
url="https://publichealth.jmir.org/2023/1/e45236",
url="http://www.ncbi.nlm.nih.gov/pubmed/37285196"
}


@Article{info:doi/10.2196/46514,
author="Kwan, Ho Tsz
and Chan, Chung Denise Pui
and Wong, Yeung-shan Samuel
and Lee, Shan Shui",
title="Implementation Cascade of a Social Network--Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="26",
volume="25",
pages="e46514",
keywords="community-based testing service",
keywords="cross-sectional study",
keywords="HIV self-test",
keywords="HIV testing",
keywords="HIV",
keywords="implementation cascade",
keywords="men who have sex with men",
keywords="social network",
keywords="virus transmission",
abstract="Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network--based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network--based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95\% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95\% CI 0.45-0.99, P=.045). Almost all (434/442, 98\%) MSM who completed the questionnaire requested a self-test, of whom 82\% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95\% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95\% CI 0.22-0.56, P<.001). More than half (216/354, 61\%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93\% (200/216). They were more likely to have sought sex partners (OR 2.20, 95\% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95\% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users' individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 ",
doi="10.2196/46514",
url="https://www.jmir.org/2023/1/e46514",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099364"
}


@Article{info:doi/10.2196/45796,
author="Berry, R. Katie
and Gliske, Kate
and Schmidt, Clare
and Cray, Elliette Ley David
and Killian, Michael
and Fenkel, Caroline",
title="Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities--Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="21",
volume="7",
pages="e45796",
keywords="lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities",
keywords="LGBTQIA+",
keywords="youth",
keywords="mental health",
keywords="affirming health care",
keywords="suicidal ideation",
keywords="depression",
keywords="nonsuicidal self-harm",
keywords="NSSI",
abstract="Background: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. Objective: This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Methods: Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8\%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. Results: LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5\% reduction in depressive symptoms. Overall, 50.5\% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1\% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1\% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. Conclusions: This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically. ",
doi="10.2196/45796",
url="https://formative.jmir.org/2023/1/e45796",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083637"
}


@Article{info:doi/10.2196/43539,
author="Sallabank, Gregory
and Stephenson, Rob
and Gandhi, Monica
and Merrill, Leland
and Sharma, Akshay",
title="Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="6",
volume="7",
pages="e43539",
keywords="HIV",
keywords="sexually transmitted diseases",
keywords="preexposure prophylaxis",
keywords="self-testing",
keywords="sexual and gender minorities",
abstract="Background: Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support. Objective: Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study's implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return. Methods: Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis. Results: University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box. Conclusions: Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing. International Registered Report Identifier (IRRID): RR2-10.2196/13647 ",
doi="10.2196/43539",
url="https://formative.jmir.org/2023/1/e43539",
url="http://www.ncbi.nlm.nih.gov/pubmed/37023442"
}


@Article{info:doi/10.2196/43986,
author="Ray, E. Anne
and Mun, Eun-Young
and Lewis, A. Melissa
and Litt, M. Dana
and Stapleton, L. Jerod
and Tan, Lin
and Buller, B. David
and Zhou, Zhengyang
and Bush, M. Heather
and Himelhoch, Seth",
title="Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="20",
volume="12",
pages="e43986",
keywords="alcohol-related risky sexual behavior",
keywords="college students",
keywords="cross-tailored dynamic feedback",
keywords="effectiveness-implementation hybrid designs",
keywords="personalized feedback intervention",
keywords="underage drinking",
abstract="Background: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. Objective: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. Methods: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. Results: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. Conclusions: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. Trial Registration: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903 International Registered Report Identifier (IRRID): DERR1-10.2196/43986 ",
doi="10.2196/43986",
url="https://www.researchprotocols.org/2023/1/e43986",
url="http://www.ncbi.nlm.nih.gov/pubmed/36716301"
}


@Article{info:doi/10.2196/40503,
author="Reisner, L. Sari
and Pletta, R. David
and Pardee, J. Dana
and Deutsch, B. Madeline
and Peitzmeier, M. Sarah
and Hughto, MW Jaclyn
and Quint, Meg
and Potter, Jennifer",
title="Digital-Assisted Self-interview of HIV or Sexually Transmitted Infection Risk Behaviors in Transmasculine Adults: Development and Field Testing of the Transmasculine Sexual Health Assessment",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="17",
volume="9",
pages="e40503",
keywords="transgender",
keywords="sexual health",
keywords="HIV",
keywords="sexually transmitted infection",
keywords="STI",
keywords="epidemiology",
keywords="mobile phone",
abstract="Background: The sexual health of transmasculine (TM) people---those who identify as male, men, or nonbinary and were assigned a female sex at birth---is understudied. One barrier to conducting HIV- and sexually transmitted infection (STI)--related research with this population is how to best capture sexual risk data in an acceptable, gender-affirming, and accurate manner. Objective: This study aimed to report on the community-based process of developing, piloting, and refining a digitally deployed measure to assess self-reported sexual behaviors associated with HIV and STI transmission for research with TM adults. Methods: A multicomponent process was used to develop a digital-assisted self-interview to assess HIV and STI risk in TM people: gathering input from a Community Task Force; working with an interdisciplinary team of content experts in transgender medicine, epidemiology, and infectious diseases; conducting web-based focus groups; and iteratively refining the measure. We field-tested the measure with 141 TM people in the greater Boston, Massachusetts area to assess HIV and STI risk. Descriptive statistics characterized the distribution of sexual behaviors and HIV and STI transmission risk by the gender identity of sexual partners. Results: The Transmasculine Sexual Health Assessment (TM-SHA) measures the broad range of potential sexual behaviors TM people may engage in, including those which may confer risk for STIs and not just for HIV infection (ie, oral-genital contact); incorporates gender-affirming language (ie, genital or frontal vs vaginal); and asks sexual partnership characteristics (ie, partner gender). Among 141 individual participants (mean age 27, SD 5 years; range 21-29 years; n=21, 14.9\% multiracial), 259 sexual partnerships and 15 sexual risk behaviors were reported. Participants engaged in a wide range of sexual behaviors, including fingering or fisting (receiving: n=170, 65.6\%; performing: n=173, 66.8\%), oral-genital sex (receiving: n=182, 70.3\%; performing: n=216, 83.4\%), anal-genital sex (receptive: n=31, 11.9\%; insertive: n=9, 3.5\%), frontal-genital sex (receptive: n=105, 40.5\%; insertive: n=46, 17.8\%), and sharing toys or prosthetics during insertive sex (n=62, 23.9\%). Overall barrier use for each sexual behavior ranged from 10.9\% (20/182) to 81\% (25/31). Frontal receptive sex with genitals and no protective barrier was the highest (21/42, 50\%) with cisgender male partners. In total, 14.9\% (21/141) of participants reported a lifetime diagnosis of STI. The sexual history tool was highly acceptable to TM participants. Conclusions: The TM-SHA is one of the first digital sexual health risk measures developed specifically with and exclusively for TM people. TM-SHA successfully integrates gender-affirming language and branching logic to capture a wide array of sexual behaviors. The measure elicits sexual behavior information needed to assess HIV and STI transmission risk behaviors. A strength of the tool is that detailed partner-by-partner data can be used to model partnership-level characteristics, not just individual-level participant data, to inform HIV and STI interventions. ",
doi="10.2196/40503",
url="https://publichealth.jmir.org/2023/1/e40503",
url="http://www.ncbi.nlm.nih.gov/pubmed/36930204"
}


@Article{info:doi/10.2196/42267,
author="Sullivan, Sean Patrick
and Hall, Eric
and Bradley, Heather
and Sanchez, Travis
and Woodyatt, R. Cory
and Russell, S. Elizabeth",
title="Estimating HIV Incident Diagnoses Among Men Who Have Sex With Men Eligible for Pre-exposure Prophylaxis but Not Taking It: Protocol and Feasibility Assessment of Data Sources and Methods",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="7",
volume="12",
pages="e42267",
keywords="HIV incidence estimates",
keywords="pre-exposure prophylaxis",
keywords="commercial pharmacy data",
keywords="HIV",
keywords="HIV epidemic",
keywords="surveillance data",
keywords="public health",
keywords="men who have sex with men",
keywords="health monitoring",
keywords="clinical trial design",
abstract="Background: HIV incidence estimates are published each year for all Ending the HIV Epidemic (EHE) counties, but they are not stratified by the demographic variables highly associated with risk of infection. Regularly updated estimates of HIV incident diagnoses available at local levels are required to monitor the epidemic in the United States over time and could contribute to background incidence rate estimates for alternative clinical trial designs for new HIV prevention products. Objective: We describe methods using existing, robust data sources within areas in the United States to reliably estimate longitudinal HIV incident diagnoses stratified by race and age categories among men who have sex with other men (MSM) eligible for pre-exposure prophylaxis (PrEP) but not taking it. Methods: This is a secondary analysis of existing data sources to develop new estimates of incident HIV diagnoses in MSM. We reviewed past methods used to estimate incident diagnoses and explored opportunities to improve these estimates. We will use existing surveillance data sources and population sizes of HIV PrEP-eligible MSM estimated from population-based data sources (eg, US Census data and  pharmaceutical prescription databases) to develop metropolitan statistical area--level estimates of new HIV diagnoses among PrEP-eligible MSM. Required parameters are number of new diagnoses among MSM, estimates of MSM with an indication for PrEP, and prevalent PrEP use including median duration of use; these parameters will be stratified by jurisdiction and age group or race or ethnicity. Preliminary outputs will be available in 2023, and updated estimates will be produced annually thereafter. Results: Data to parameterize new HIV diagnoses among PrEP-eligible MSM are available with varying levels of public availability and timeliness. In early 2023, the most recent available data on new HIV diagnoses were from the 2020 HIV surveillance report, which reports 30,689 new HIV infections in 2020, and 24,724 of them occurred in an MSA with a population of ?500,000. Updated estimates for PrEP coverage based on commercial pharmacy claims data through February 2023 will be generated. The rate of new HIV diagnoses among MSM can be estimated from new diagnoses within each demographic group (numerator) and the total person-time at risk of diagnosis for each group (denominator) by metropolitan statistical area and year. To estimate time at risk, the person-time of individuals on PrEP or person-time after incident HIV infection but before diagnosis should be removed from stratified population size estimates of the total number of person-years with indications for PrEP. Conclusions: Reliable, serial, cross-sectional estimates for rates of new HIV diagnoses for MSM with PrEP indications can serve as benchmark community estimates of failures of HIV prevention and opportunities to improve services and will support public health epidemic monitoring and alternative clinical trial designs. International Registered Report Identifier (IRRID): DERR1-10.2196/42267 ",
doi="10.2196/42267",
url="https://www.researchprotocols.org/2023/1/e42267",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881450"
}


@Article{info:doi/10.2196/43772,
author="Tang, Weiming
and Xie, Yewei
and Xiong, Mingzhou
and Wu, Dan
and Ong, J. Jason
and Wi, Elvira Teodora
and Yang, Bin
and Tucker, D. Joseph
and Wang, Cheng",
title="A Pay-It-Forward Approach to Improve Chlamydia and Gonorrhea Testing Uptake Among Female Sex Workers in China: Venue-Based Superiority Cluster Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="2",
volume="9",
pages="e43772",
keywords="pay-it-forward",
keywords="chlamydia",
keywords="gonorrhea",
keywords="testing",
keywords="female sex workers",
keywords="women",
keywords="China",
keywords="cost",
keywords="stigma",
keywords="prevention",
keywords="community",
keywords="HIV",
keywords="care",
keywords="STD",
keywords="implementation",
keywords="research",
abstract="Background: Regular chlamydia and gonorrhea testing are essential for key populations, such as female sex workers (FSWs). However, testing cost, stigma, and lack of access prevent FSWs in low- and middle-income countries from receiving chlamydia and gonorrhea testing. A social innovation to address these problems is ``pay it forward,'' where an individual receives a gift (free testing) and then asks whether they would like to give a gift to another person in the community. Objective: This cluster randomized controlled trial examined the effectiveness and cost of the pay-it-forward strategy in increasing access to chlamydia and gonorrhea testing among FSWs in China. Methods: This trial integrated a pay-it-forward approach into a community-based HIV outreach service. FSWs (aged 18 years or older) were invited by an outreach team from 4 Chinese cities (clusters) to receive free HIV testing. The 4 clusters were randomized into 2 study arms in a 1:1 ratio: a pay-it-forward arm (offered chlamydia and gonorrhea testing as a gift) and a standard-of-care arm (out-of-pocket cost for testing: US \$11). The primary outcome was chlamydia and gonorrhea test uptake, as ascertained by administrative records. We conducted an economic evaluation using a microcosting approach from a health provider perspective, reporting our results in US dollars (at 2021 exchange rates). Results: Overall, 480 FSWs were recruited from 4 cities (120 per city). Most FSWs were aged ?30 years (313/480, 65.2\%), were married (283/480, 59\%), had an annual income <US \$9000 (301/480, 62.7\%), and had never been tested for chlamydia (401/480, 83.5\%) or gonorrhea (397/480, 82.7\%). Chlamydia and gonorrhea test uptake in the pay-it-forward and standard-of-care arms were 82\% (197/240) and 4\% (10/240), respectively, with an adjusted proportion difference of 76.7\% (lower bound 95\% CI 70.8\%). All those who tested positive were referred to and received treatment at local sexually transmitted infection clinics. This finding was consistent when adjusting for marital status, income, inconsistent condom use during commercial sex in the last 3 months, and HIV testing history. Among 197 women who received tests in the pay-it-forward arm, 99 (50.3\%) donated money, with a median donation of US \$1.54 (IQR 0.77-1.54). The economic cost per person tested was US \$568.71 for standard of care and US \$43.20 for pay it forward. Conclusions: The pay-it-forward strategy has the potential to enhance chlamydia and gonorrhea testing for Chinese FSWs and may be useful for scaling up preventive services. Further implementation research is needed to inform the transition of pay-it-forward research into practice. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000037653; https://www.chictr.org.cn/showprojen.aspx?proj=57233 ",
doi="10.2196/43772",
url="https://publichealth.jmir.org/2023/1/e43772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862485"
}


@Article{info:doi/10.2196/43116,
author="Pathmendra, Pranujan
and Raggatt, Michelle
and Lim, SC Megan
and Marino, L. Jennifer
and Skinner, Rachel S.",
title="Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="28",
volume="25",
pages="e43116",
keywords="adolescence",
keywords="teenager",
keywords="sexual debut",
keywords="sexual behavior",
keywords="risky behavior",
keywords="pornography use",
keywords="digital media",
abstract="Background: Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences. Objective: We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [<16 years], condomless sex, past-year multiple partners [>1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years. Methods: We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022. Results: Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes. Conclusions: More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=227390 ",
doi="10.2196/43116",
url="https://www.jmir.org/2023/1/e43116",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853749"
}


@Article{info:doi/10.2196/43019,
author="Clement, Edwards Meredith
and Lovett, Aish
and Caldwell, Sylvia
and Beckford, Jeremy
and Hilgart, Michelle
and Corneli, Amy
and Flickinger, Tabor
and Dillingham, Rebecca
and Ingersoll, Karen",
title="Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="27",
volume="7",
pages="e43019",
keywords="pre-exposure prophylaxis",
keywords="HIV",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective: In this study, we introduced an existing PrEP adherence app to new potential users---BMSM engaged in PrEP care in New Orleans---to guide app adaptation with STI prevention features and tailoring for the local context. Methods: Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results: Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep'd app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions: A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes. ",
doi="10.2196/43019",
url="https://formative.jmir.org/2023/1/e43019",
url="http://www.ncbi.nlm.nih.gov/pubmed/36848209"
}


@Article{info:doi/10.2196/43550,
author="Jackman, P. Kevon-Mark
and Tilchin, Carla
and Wagner, Jessica
and Flinn, E. Ryan
and Trent, Maria
and Latkin, Carl
and Ruhs, Sebastian
and Fields, L. Errol
and Hamill, M. Matthew
and Mahaffey, Carlos
and Greenbaum, Adena
and Jennings, M. Jacky",
title="Desires for Individual- and Interpersonal-Level Patient Portal Use for HIV Prevention Among Urban Sexual Minority Men: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="24",
volume="7",
pages="e43550",
keywords="patient portal",
keywords="HIV",
keywords="STI",
keywords="prevention",
keywords="risk factor",
keywords="communication",
keywords="disclosure",
keywords="digital technology",
keywords="men who have sex with men",
keywords="gay",
keywords="homosexual",
keywords="sexual minority",
keywords="African American",
abstract="Background: Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal. Objective: Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals. Methods: Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness. Results: Of the 245 participants, 71\% (n=174) were Black and 22\% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80\% of participants. Specifically, tools to help manage HIV (n=183, 75\%) and information about pre- and postexposure prophylaxis (both 71\%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95\% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95\% CI 1.23-1.93). Conclusions: Our findings indicate what features Black sexual minority men envision may be included in the patient portal's design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men's willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events. ",
doi="10.2196/43550",
url="https://formative.jmir.org/2023/1/e43550",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826983"
}


@Article{info:doi/10.2196/43394,
author="Chiou, Piao-Yi
and Tsao, Wei-Wen
and Lin, Kuan-Chia
and Fang, Yuan-Yuan
and Lin, Kuan-Yin
and Li, Chia-Lin",
title="Risk and Protective Profile of Men Who Have Sex With Men Using Mobile Voluntary HIV Counseling and Testing: Latent Class Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Feb",
day="16",
volume="9",
pages="e43394",
keywords="HIV testing",
keywords="latent class analysis",
keywords="men who have sex with men",
keywords="mobile health",
keywords="postexposure prophylaxis (PEP)",
keywords="preexposure prophylaxis (PrEP)",
keywords="risk-taking",
keywords="anal sex",
keywords="sexual partners",
keywords="social networking",
abstract="Background: Mobile voluntary counseling and testing (VCT) for HIV has been carried out to improve the targeting of at-risk populations and HIV case detection for men who have sex with men (MSM). However, the HIV-positive detection rate using this screening strategy has declined in recent years. This may imply unknown changes in risk-taking and protective features jointly influencing the testing results. These changing patterns in this key population remain unexplored. Objective: The aim of this study was to identify the nuanced group classification of MSM who underwent mobile VCT using latent class analysis (LCA), and to compare the difference in characteristics and testing results between subgroups. Methods: A cross-sectional research design and purposive sampling were applied between May 21, 2019, and December 31, 2019. Participants were recruited by a well-trained research assistant through social networking platforms, including the most popular instant messenger app Line, geosocial network apps dedicated to MSM, and online communities. Mobile VCT was provided to participants at an assigned time and place. Demographic characteristics and risk-taking and protective features of the MSM were collected via online questionnaires. LCA was used to identify discrete subgroups based on four risk-taking indicators---multiple sexual partners (MSP), unprotected anal intercourse (UAI), recreational drug use within the past 3 months, and history of sexually transmitted diseases---and three protective indicators---experience of postexposure prophylaxis, preexposure prophylaxis use, and regular HIV testing. Results: Overall, 1018 participants (mean age 30.17, SD 7.29 years) were included. A three-class model provided the best fit. Classes 1, 2, and 3 corresponded to the highest risk (n=175, 17.19\%), highest protection (n=121, 11.89\%), and low risk and low protection (n=722, 70.92\%), respectively. Compared to those of class 3, class 1 participants were more likely to have MSP and UAI within the past 3 months, to be ?40 years of age (odds ratio [OR] 2.197, 95\% CI 1.357-3.558; P=.001), to have HIV-positive results (OR 6.47, 95\% CI 2.272-18.482; P<.001), and a CD4 count ?349/$\mu$L (OR 17.50, 95\% CI 1.223-250.357; P=.04). Class 2 participants were more likely to adopt biomedical preventions and have marital experience (OR 2.55, 95\% CI 1.033-6.277; P=.04). Conclusions: LCA helped derive a classification of risk-taking and protection subgroups among MSM who underwent mobile VCT. These results may inform policies for simplifying the prescreening assessment and more precisely recognizing those who have higher probabilities of risk-taking features but remain undiagnosed targets, including MSM engaging in MSP and UAI within the past 3 months and those ?40 years old. These results could be applied to tailor HIV prevention and testing programs. ",
doi="10.2196/43394",
url="https://publichealth.jmir.org/2023/1/e43394",
url="http://www.ncbi.nlm.nih.gov/pubmed/36795477"
}


@Article{info:doi/10.2196/43844,
author="Cantos, D. Valeria
and Hagen, Kimberly
and Duarte, Paula Ana
and Escobar, Carolina
and Batina, Isabella
and Orozco, Humberto
and Rodriguez, Josue
and Camacho-Gonzalez, Andres
and Siegler, J. Aaron",
title="Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="8",
volume="7",
pages="e43844",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="Latino",
keywords="sexual minority men",
keywords="SMM",
keywords="mobile health",
keywords="mHealth",
keywords="HIV prevention",
keywords="HIV",
keywords="technology",
keywords="minority",
keywords="men",
keywords="development",
keywords="biomedical intervention",
keywords="mobile technology",
keywords="mobile app",
keywords="community",
keywords="app",
keywords="barrier",
keywords="mobile phone",
abstract="Background: HIV disproportionally impacts Latino sexual minority men (SMM). Uptake of pre-exposure prophylaxis (PrEP), an effective biomedical intervention to prevent HIV, is low in this group compared with White SMM. Mobile health technology represents an innovative strategy to increase PrEP uptake among Latino SMM. Objective: We aimed to describe the qualitative process leading to the development of SaludFindr, a comprehensive HIV prevention mobile app aiming to increase PrEP uptake, HIV testing, and condom use by Latino SMM. Methods: We conducted 13 in-depth interviews with Latino SMM living in the Atlanta area to explore their main barriers and facilitators to PrEP uptake and to analyze their opinions of potential SaludFindr app functionalities. To explore potential app functions, we used HealthMindr, an existing HIV prevention app, as a template and added new proposed features intended to address the specific community needs. Results: We identified general PrEP uptake barriers that, although common among non-Latino groups, had added complexities such as the influence of religion and family on stigma. Low perceived PrEP eligibility, intersectional stigma, lack of insurance, cost concerns, and misconceptions about PrEP side effects were described as general barriers. We also identified Latino-specific barriers that predominantly hinder access to existing services, including a scarcity of PrEP clinics that are prepared to provide culturally concordant services, limited availability of Spanish language information related to PrEP access, distrust of peers as credible sources of information, perceived ineligibility for low-cost services owing to undocumented status, fear of immigration authorities, and competing work obligations that prevent PrEP clinic attendance. Health care providers represented a trusted source of information, and 3 provider characteristics were identified as PrEP facilitators: familiarity with prescribing PrEP; being Latino; and being part of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) group or ally. The proposed app was very well accepted, with a particularly high interest in features that facilitate PrEP access, including a tailored list of clinics that meet the community needs and a private platform to seek PrEP information. Spanish language availability and free or low-cost PrEP care represented the 2 main clinic criteria that would facilitate PrEP uptake. Latino representation in clinic staff and providers; clinic perception as a safe space for undocumented patients; and LGBTQIA+ representation was listed as additional criteria. Only 8 of 47 clinics listed on the Centers for Diseases Control and Prevention PrEP locator website for the Atlanta area fulfilled at least 2 main criteria. Conclusions: This study provides further evidence of the substantial PrEP uptake barriers that Latino SMM face; exposes the urgent need to increase the number of accessible PrEP-providing clinics for Latino SMM; and proposes an innovative, community-driven, and mobile technology--based tool as a future intervention to overcome some of these barriers. ",
doi="10.2196/43844",
url="https://formative.jmir.org/2023/1/e43844",
url="http://www.ncbi.nlm.nih.gov/pubmed/36625855"
}


@Article{info:doi/10.2196/44157,
author="Jalil, Moreira Emilia
and Wilson, Erin
and Monteiro, Laylla
and Varggas, Thaylla
and Moura, Isabele
and Torres, S. Thiago
and Hoagland, Brenda
and Cardoso, Wagner Sandra
and Ismerio Moreira, Ronaldo
and Gon{\c{c}}alves Veloso dos Santos, Valdilea
and Grinsztejn, Beatriz
and ",
title="A Peer-Led Digital Intervention to Reduce HIV Prevention and Care Disparities Among Young Brazilian Transgender Women (The BeT Study): Protocol for an Intervention Study",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="3",
volume="12",
pages="e44157",
keywords="youth",
keywords="transgender women",
keywords="Brazil",
keywords="HIV prevention",
keywords="HIV care",
keywords="peer-led digital intervention",
abstract="Background: The HIV epidemic continues to disproportionately burden marginalized populations despite the availability of effective preventive and therapeutic interventions. Transgender women are severely affected by HIV worldwide including in Brazil and other low- and middle-income countries, with evidence of increasing new infections among young people. There is an urgent need for youth-specific HIV prevention and care interventions for young transgender women in Brazil. Objective: This study aims to (1) address stigma in the Brazilian public health system and (2) reduce barriers to HIV care and prevention with systems navigation among young transgender women aged 18-24 years in Rio de Janeiro, Brazil. Methods: The Brilhar e Transcender (BeT) study is a status-neutral, peer-led, single-arm digital intervention study enrolling 150 young transgender women in Rio de Janeiro, Brazil. The intervention was pilot tested and refined using data from a formative phase. The BeT intervention takes place over 3 months, is delivered remotely via mobile phone and in person by peers, and comprises three components: (1) BeT sessions, (2) digital interactions, and (3) automated messages. Eligibility criteria include identifying as transgender women, being aged 18-24 years, speaking in Portuguese, and living in the Rio de Janeiro metropolitan area in Brazil. The primary outcomes are HIV incidence, pre-exposure prophylaxis uptake, linkage to HIV care, and viral suppression. Primary outcomes were assessed at baseline and quarterly for 12 months. Participants respond to interviewer-based surveys and receive tests for HIV and sexually transmitted infections. Results: The study has been approved by the Brazilian and the US local institutional review boards in accordance with all applicable regulations. Study recruitment began in February 2022 and was completed in early July 2022. Plans are to complete the follow-up assessment of study participants on July 2023, analyze the study data, and disseminate intervention results by December 2023. Conclusions: Interventions to engage a new generation of transgender women in HIV prevention and care are needed to curb the epidemic. The BeT study will evaluate a digital peer-led intervention for young transgender women in Brazil, which builds on ways young people engage in systems and uses peer-led support to empower transgender youth in self-care and health promotion. A promising evaluation of the BeT intervention may lead to the availability of this rapidly scalable status-neutral HIV intervention that can be translated throughout Brazil and other low- and middle-income countries for young transgender women at high risk of or living with HIV. Trial Registration: ClinicalTrials.gov NCT05299645; https://clinicaltrials.gov/ct2/show/NCT05299645 International Registered Report Identifier (IRRID): DERR1-10.2196/44157 ",
doi="10.2196/44157",
url="https://www.researchprotocols.org/2023/1/e44157",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735296"
}


@Article{info:doi/10.2196/41162,
author="Li, Xuan
and Zhang, Hanxiyue
and Zhao, Shuangyu
and Tang, Kun",
title="Predicting Risky Sexual Behavior Among College Students Through Machine Learning Approaches: Cross-sectional Analysis of Individual Data From 1264 Universities in 31 Provinces in China",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="25",
volume="9",
pages="e41162",
keywords="risky sexual behavior",
keywords="sexually transmitted infections",
keywords="college students",
keywords="machine learning",
keywords="prediction",
keywords="students",
keywords="risk factor",
keywords="STI",
keywords="intervention",
keywords="China",
keywords="sex",
abstract="Background: Risky sexual behavior (RSB), the most direct risk factor for sexually transmitted infections (STIs), is common among college students. Thus, identifying relevant risk factors and predicting RSB are important to intervene and prevent RSB among college students. Objective: We aim to establish a predictive model for RSB among college students to facilitate timely intervention and the prevention of RSB to help limit STI contraction. Methods: We included a total of 8794 heterosexual Chinese students who self-reported engaging in sexual intercourse from November 2019 to February 2020. We identified RSB among those students and attributed it to 4 dimensions: whether contraception was used, whether the contraceptive method was safe, whether students engaged in casual sex or sex with multiple partners, and integrated RSB (which combined the first 3 dimensions). Overall, 126 predictors were included in this study, including demographic characteristics, daily habits, physical and mental health, relationship status, sexual knowledge, sexual education, sexual attitude, and previous sexual experience. For each type of RSB, we compared 8 machine learning (ML) models: multiple logistic regression (MLR), naive Bayes (BYS), linear discriminant analysis (LDA), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), deep learning (DL), and the ensemble model. The optimal model for both RSB prediction and risk factor identification was selected based on a set of validation indicators. An MLR model was applied to investigate the association between RSB and identified risk factors through ML methods. Results: In total, 5328 (60.59\%) students were found to have previously engaged in RSB. Among them, 3682 (41.87\%) did not use contraception every time they had sexual intercourse, 3602 (40.96\%) had previously used an ineffective or unsafe contraceptive method, and 1157 (13.16\%) had engaged in casual sex or sex with multiple partners. XGBoost achieved the optimal predictive performance on all 4 types of RSB, with the area under the receiver operator characteristic curve (AUROC) reaching 0.78, 0.72, 0.94, and 0.80 for contraceptive use, safe contraceptive method use, engagement in casual sex or with multiple partners, and integrated RSB, respectively. By ensuring the stability of various validation indicators, the 12 most predictive variables were then selected using XGBoost, including the participants' relationship status, sexual knowledge, sexual attitude, and previous sexual experience. Through MLR, RSB was found to be significantly associated with less sexual knowledge, more liberal sexual attitudes, single relationship status, and increased sexual experience. Conclusions: RSB is prevalent among college students. The XGBoost model is an effective approach to predict RSB and identify corresponding risk factors. This study presented an opportunity to promote sexual and reproductive health through ML models, which can help targeted interventions aimed at different subgroups and the precise surveillance and prevention of RSB among college students through risk probability prediction. ",
doi="10.2196/41162",
url="https://publichealth.jmir.org/2023/1/e41162",
url="http://www.ncbi.nlm.nih.gov/pubmed/36696166"
}


@Article{info:doi/10.2196/43532,
author="Yu, Yanqiu
and Fong, I. Vivian W.
and Ng, Hoi-Yuk Joyce
and Wang, Zixin
and Tian, Xiaobing
and Lau, F. Joseph T.",
title="The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="17",
volume="25",
pages="e43532",
keywords="men who have sex with men",
keywords="internet gaming disorder",
keywords="self-control",
keywords="loneliness",
keywords="hopelessness",
keywords="structural equation modeling",
abstract="Background: The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM. Objective: This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored. Methods: With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted. Results: The prevalence of IGD was 12.8\% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness {\textrightarrow} lower self-control {\textrightarrow} higher IGD (full mediation), (2) loneliness {\textrightarrow} lower self-control {\textrightarrow} higher IGD (partial mediation: effect size of 28\%), and (3) a direct effect from loneliness to IGD. Conclusions: IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD. ",
doi="10.2196/43532",
url="https://www.jmir.org/2023/1/e43532",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649059"
}


@Article{info:doi/10.2196/37344,
author="Song, Liping
and Yu, Xiangyuan
and Su, Bing
and Geng, Kui Wen
and Lan, Guanghua
and Zhang, Xiangjun",
title="HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="11",
volume="7",
pages="e37344",
keywords="HIV",
keywords="young men who have sex with men",
keywords="syphilis",
keywords="sexually transmitted infection",
keywords="ethnic minority",
abstract="Background: Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. Objective: This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. Methods: This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. Results: The prevalence of HIV and syphilis was 9.3\% (59/632) and 11.4\% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95\% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95\% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95\% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95\% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95\% CI 2.34-119.18, P=.005) were independently associated with HIV infection. Conclusions: There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex. ",
doi="10.2196/37344",
url="https://formative.jmir.org/2023/1/e37344",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630166"
}


@Article{info:doi/10.2196/35713,
author="Zhou, Yuyin
and Cheng, Feng
and Xu, Junfang",
title="Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="10",
volume="9",
pages="e35713",
keywords="international immigrants",
keywords="HIV",
keywords="risky sexual behavior",
keywords="China",
abstract="Background: The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors. Objective: The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system. Methods: Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV. Results: In total, 1433 international immigrants were included in the study, 61.76\% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23\% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95\% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95\% CI --1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95\% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95\% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95\% CI 1.085-1.841). Those who were married (AOR 0.577, 95\% CI 0.372-0.894), with an annual disposable income >150,000 yuan ({\textasciitilde}US \$22,000; AOR 0.661, 95\% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95\% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95\% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95\% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95\% CI 1.208-2.258). Conclusions: International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population. ",
doi="10.2196/35713",
url="https://publichealth.jmir.org/2023/1/e35713",
url="http://www.ncbi.nlm.nih.gov/pubmed/36626224"
}


@Article{info:doi/10.2196/43414,
author="Dana, Ruth
and Sullivan, Stephen
and MacGowan, J. Robin
and Chavez, R. Pollyanna
and Wall, M. Kristin
and Sanchez, H. Travis
and Stephenson, Rob
and Hightow-Weidman, Lisa
and Johnson, A. Jeffrey
and Smith, Amanda
and Sharma, Akshay
and Jones, Jeb
and Hannah, Marissa
and Trigg, Monica
and Luo, Wei
and Caldwell, Joanna
and Sullivan, Sean Patrick",
title="Engaging Black or African American and Hispanic or Latino Men Who Have Sex With Men for HIV Testing and Prevention Services Through Technology: Protocol for the iSTAMP Comparative Effectiveness Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="6",
volume="12",
pages="e43414",
keywords="HIV self-testing",
keywords="HIV self-test",
keywords="prevention",
keywords="men who have sex with men",
keywords="internet",
keywords="mobile phone",
abstract="Background: Gay, bisexual, and other men who have sex with men (MSM), particularly Black or African American MSM (BMSM) and Hispanic or Latino MSM (HLMSM), continue to be disproportionately affected by the HIV epidemic in the United States. Previous HIV self-testing programs have yielded high testing rates, although these studies predominantly enrolled White, non-Hispanic MSM. Mobile health tools can support HIV prevention, testing, and treatment. This protocol details an implementation study of mailing free HIV self-tests (HIVSTs) nested within a randomized controlled trial designed to assess the benefit of a mobile phone app for increasing the uptake of HIV prevention and other social services. Objective: This study was a comparative effectiveness trial of innovative recruitment and testing promotion strategies intended to effectively reach cisgender BMSM and HLMSM. We evaluated the use of a mobile app for increasing access to care. Methods: Study development began with individual and group consultations that elicited feedback from 3 core groups: HIV care practitioners and researchers, HIV service organization leaders from study states, and BMSM and HLMSM living in the study states. Upon completion of the formative qualitative work, participants from 11 states, based on the observed areas of highest rate of new HIV diagnoses among Black and Hispanic MSM, were recruited through social networking websites and smartphone apps. After eligibility was verified, participants consented and were randomized to the intervention arm (access to the Know@Home mobile app) or the control arm (referral to web resources). We provided all participants with HIVSTs. The evaluation of the efficacy of a mobile phone app to support linkage to posttest prevention services that included sexually transmitted infection testing, pre-exposure prophylaxis initiation, antiretroviral treatment, and acquisition of condoms and compatible lubricants has been planned. Data on these outcomes were obtained from several sources, including HIVST-reporting surveys, the 4-month follow-up survey, laboratory analyses of dried blood spot cards returned by the participant, and data obtained from the state health department surveillance systems. Where possible, relevant subgroup analyses were performed. Results: During the formative development phase, 9 consultations were conducted: 6 in-depth individual discussions and 3 group consultations. From February 2020 through February 2021, we enrolled 2093 MSM in the randomized controlled trial from 11 states, 1149 BMSM and 944 HLMSM. Conclusions: This study was designed and implemented to evaluate the effectiveness of recruitment strategies to reach BMSM and HMSM and of a mobile app with regard to linkage to HIV prevention or treatment services. Data were also obtained to allow for the analyses of cost and cost-effectiveness related to study enrollment, HIV testing uptake, identification of previously undiagnosed HIV, sexually transmitted infection testing and treatment, and linkage to HIV prevention or treatment services. Trial Registration: ClinicalTrials.gov (NCT04219878); https://clinicaltrials.gov/ct2/show/NCT04219878 International Registered Report Identifier (IRRID): DERR1-10.2196/43414 ",
doi="10.2196/43414",
url="https://www.researchprotocols.org/2023/1/e43414",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607707"
}


@Article{info:doi/10.2196/42902,
author="Choi, Hang Edmond Pui
and Choi, Ying Kitty Wai
and Wu, Chanchan
and Chau, Hing Pui
and Kwok, Yan Jojo Yan
and Wong, Wai William Chi
and Chow, Fung Eric Pui",
title="Web-Based Harm Reduction Intervention for Chemsex in Men Who Have Sex With Men: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="5",
volume="9",
pages="e42902",
keywords="chemsex",
keywords="drug abuse",
keywords="eHealth",
keywords="men who have sex with men",
keywords="trial",
keywords="prevention",
keywords="Chinese",
abstract="Background: Men who have sex with men (MSM) who practice chemsex have a higher likelihood of engaging in risky sexual behaviors and higher rates of HIV infection and other sexually transmitted infections (STIs) than those who do not. Objective: This trial aimed to evaluate the effectiveness of a web-based intervention in reducing the sexual harms of chemsex among MSM. Methods: The study was a 2-arm, assessor-blinded, randomized, parallel-group trial with a 3-month follow-up period. The study was conducted in the year 2021 in Hong Kong. Underpinned by the theory of planned behaviors and a harm reduction approach, the intervention consisted of interactive components and knowledge-based information about chemsex. Participants in the control group received brief information and content about sexual violence. The primary outcome was self-efficacy in refusing risky sexual behaviors and chemsex, as measured by the Condom Self-Efficacy Scale (CSES), Self-Efficacy for Sexual Safety (SESS) instrument, and Drug Avoidance Self-Efficacy Scale (DASES). The secondary outcomes included intentions to have chemsex, actual engagement in chemsex, HIV and other STI testing, and condom use in the last 3 months. All outcomes were self-reported. An online structured questionnaire was used to collect data. Results: In total, 316 MSM enrolled in the study. The intervention group demonstrated a significantly larger improvement in condom-use self-efficacy (as measured by CSES scores; time-by-group interaction: $\beta$=4.52, 95\% CI 2.03-7.02; P<.001), self-efficacy for sexual safety (as measured by SESS scores; time-by-group interaction: $\beta$=2.11, 95\% CI 0.66-3.56; P=.004), and drug avoidance self-efficacy (as measured by DASES scores; time-by-group interaction: $\beta$=6.98, 95\% CI 1.75-12.22; P=.009). Regarding the secondary outcomes, participants in the intervention group demonstrated a significantly larger reduction in the likelihood of having engaged in chemsex in the last 3 months (time-by-group interaction: odds ratio [OR]=0.23, 95\% CI 0.10-0.53; P=.001) and likelihood of having had the intention to engage in chemsex in the last 3 months (time-by-group interaction: OR=0.37, 95\% CI 0.18-0.78; P=.009). Participants in the intervention group also showed a significantly larger increase in the likelihood of having undergone HIV testing in the last 3 months (time-by-group interaction: OR=3.08, 95\% CI 1.72-5.54; P<.001). Conclusions: This study suggests that a web-based intervention with a harm reduction approach can enhance the self-efficacy of MSM in refusing risky sexual behaviors and chemsex and improve the uptake of HIV testing. We also provide initial evidence that such interventions can reduce both the intention of MSM to engage in chemsex and their actual engagement in chemsex. Trial Registration: ISRCTN Registry ISRCTN20134522; https://www.isrctn.com/ISRCTN20134522. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-10742-8 ",
doi="10.2196/42902",
url="https://publichealth.jmir.org/2023/1/e42902",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602853"
}


@Article{info:doi/10.2196/42939,
author="Khati, Antoine
and Wickersham, A. Jeffrey
and Rosen, O. Aviana
and Luces, B. Jeffrey Ralph
and Copenhaver, Nicholas
and Jeri-Wahrhaftig, Alma
and Ab Halim, Akbar Mohd
and Azwa, Iskandar
and Gautam, Kamal
and Ooi, Hong Kai
and Shrestha, Roman",
title="Ethical Issues in the Use of Smartphone Apps for HIV Prevention in Malaysia: Focus Group Study With Men Who Have Sex With Men",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="23",
volume="6",
number="12",
pages="e42939",
keywords="HIV",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="HIV prevention",
keywords="men who have sex with men",
keywords="privacy",
keywords="confidentiality",
keywords="Malaysia",
keywords="mobile apps",
keywords="ethics",
keywords="focus group",
keywords="implementation",
keywords="user privacy",
keywords="mobile phone",
abstract="Background: The use of smartphone apps can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, mobile health app-based strategies have the potential to open new frontiers for HIV prevention. However, little guidance is available to inform researchers about the ethical concerns that are unique to the development and implementation of app-based HIV prevention programs. Objective: This study aimed to fill this gap by characterizing the attitudes and concerns of Malaysian MSM regarding HIV prevention mobile apps, particularly regarding the ethical aspects surrounding their use. Methods: We conducted web-based focus group discussions with 23 MSM between August and September 2021. Using in-depth semistructured interviews, participants were asked about the risks and ethical issues they perceived to be associated with using mobile apps for HIV prevention. Each session was digitally recorded and transcribed. Transcripts were inductively coded using the Dedoose software (SocioCultural Research Consultants) and analyzed to identify and interpret emerging themes. Results: Although participants were highly willing to use app-based strategies for HIV prevention, they raised several ethical concerns related to their use. Prominent concerns raised by participants included privacy and confidentiality concerns, including fear of third-party access to personal health information (eg, friends or family and government agencies), issues around personal health data storage and management, equity and equitable access, informed consent, and regulation. Conclusions: The study's findings highlight the role of ethical concerns related to the use of app-based HIV prevention programs. Given the ever-growing nature of such technological platforms that are intermixed with a complex ethical-legal landscape, mobile health platforms must be safe and secure to minimize unintended harm, safeguard user privacy and confidentiality, and obtain public trust and uptake. ",
doi="10.2196/42939",
url="https://formative.jmir.org/2022/12/e42939",
url="http://www.ncbi.nlm.nih.gov/pubmed/36563046"
}


@Article{info:doi/10.2196/40150,
author="Yeh, Teresa Ping
and Kennedy, Elizabeth Caitlin
and Minamitani, Ayako
and Baggaley, Rachel
and Shah, Purvi
and Verster, Annette
and Luhmann, Niklas
and de Mello, Brito Maeve
and Macdonald, Virginia",
title="Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="22",
volume="24",
number="12",
pages="e40150",
keywords="online service delivery",
keywords="digital health interventions",
keywords="HIV",
keywords="viral hepatitis",
keywords="sexually transmitted infections",
keywords="key populations",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported. Objective: This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings). Methods: We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively. Results: Of 2711 records identified, we included 13 (0.48\%) articles in the effectiveness review (3/13, 23\% for web-based outreach; 7/13, 54\% for web-based case management; and 3/13, 23\% for targeted web-based health information), 15 (0.55\%) articles in the values and preferences review, and 1 (0.04\%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95\% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms. Conclusions: Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs). ",
doi="10.2196/40150",
url="https://www.jmir.org/2022/12/e40150",
url="http://www.ncbi.nlm.nih.gov/pubmed/36548036"
}


@Article{info:doi/10.2196/39678,
author="Herrijgers, Corinne
and Platteau, Tom
and Vandebosch, Heidi
and Poels, Karolien
and Florence, Eric",
title="Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="21",
volume="11",
number="12",
pages="e39678",
keywords="mobile health",
keywords="chemsex",
keywords="intervention mapping",
keywords="harm reduction",
keywords="men who have sex with men",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex. Objective: The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation. Methods: The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022. Results: Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy). Conclusions: The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions. International Registered Report Identifier (IRRID): RR1-10.2196/39678 ",
doi="10.2196/39678",
url="https://www.researchprotocols.org/2022/12/e39678",
url="http://www.ncbi.nlm.nih.gov/pubmed/36542451"
}


@Article{info:doi/10.2196/37395,
author="Rutstein, E. Sarah
and Matoga, Mitch
and Chen, S. Jane
and Mathiya, Esther
and Ndalama, Beatrice
and Nyirenda, Naomi
and Bonongwe, Naomi
and Chithambo, Shyreen
and Chagomerana, Maganizo
and Tegha, Gerald
and Hosseinipour, C. Mina
and Herce, E. Michael
and Jere, Edward
and Krysiak, G. Robert
and Hoffman, F. Irving",
title="Integrating Enhanced HIV Pre-exposure Prophylaxis Into a Sexually Transmitted Infection Clinic in Lilongwe: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="5",
volume="11",
number="12",
pages="e37395",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="sexually transmitted infections",
keywords="STI",
keywords="sub-Saharan Africa",
keywords="partner notification",
abstract="Background: Pre-exposure prophylaxis (PrEP) reduces HIV acquisition risk by >90\% and is a critical lever to reduce HIV incidence. Identifying individuals most likely to benefit from PrEP and retaining them on PrEP throughout HIV risk is critical to realize PrEP's prevention potential. Individuals with sexually transmitted infections (STIs) are an obvious priority PrEP population, but there are no data from sub-Saharan Africa (SSA) confirming the effectiveness of integrating PrEP into STI clinics. Assisted partner notification may further enhance STI clinic--based PrEP programming by recruiting PrEP users from the pool of named sexual partners of individuals presenting with an incident STI. However, the acceptability, feasibility, and effectiveness of these integrated and enhanced strategies are unknown. Objective: This study aims to describe the implementation outcomes of acceptability, feasibility, and effectiveness (regarding PrEP uptake and persistence) of integrating an enhanced PrEP implementation strategy into an STI clinic in Malawi. Methods: The enhanced PrEP STI study is a prospective cohort study enrolling patients who are eligible for PrEP (aged ?15 years) who are seeking STI services at a Lilongwe-based STI clinic. Data collection relies on a combination of in-depth interviews, patient and clinic staff surveys, and clinic record review. All enrolled PrEP users will be screened for acute HIV infection and receive quarterly testing for Neisseria gonorrhea, Chlamydia trachomatis, and syphilis. Participants will be asked to name recent sexual partners for assisted notification; returning partners will be screened for PrEP eligibility and, if interested, enrolled into the cohort of PrEP initiators. We will also enroll patients who are eligible for PrEP but choose not to initiate it, from the STI clinic. Patient participants will be followed for 6 months; we will assess self-reported PrEP use, PrEP refills, sexual behaviors, perceived HIV risk, and incident STIs. Clinic staff participants will be interviewed at baseline and at approximately 6 months and will complete surveys examining the perceived acceptability and feasibility of the integrated and enhanced PrEP strategy. Results: Enrollment began in March 2022 and is projected to continue until February 2023, with patient participant follow-up through August 2023. The results of this study are expected to be reported in 2024. Conclusions: This study will generate important evidence regarding the potential integration of PrEP services into STI clinics in SSA and preliminary data regarding the effectiveness of an enhanced intervention that includes assisted partner notification as a strategy to identify potential PrEP users. Furthermore, this trial will provide some of the first insights into STI incidence among PrEP users recruited from an STI clinic in SSA---critical data to inform the use of etiologic STI testing where syndromic management is the current standard. These findings will help to design future PrEP implementation strategies in SSA. Trial Registration: ClinicalTrials.gov NCT05307991; https://clinicaltrials.gov/ct2/show/NCT05307991 International Registered Report Identifier (IRRID): DERR1-10.2196/37395 ",
doi="10.2196/37395",
url="https://www.researchprotocols.org/2022/12/e37395",
url="http://www.ncbi.nlm.nih.gov/pubmed/36469400"
}


@Article{info:doi/10.2196/38398,
author="Liu, Miao
and Zhu, Yi
and Gao, Haiqing
and Li, Jialing",
title="Examining Chinese Users' Feedback Comments on HIV Self-testing Kits From e-Commerce Platforms: Thematic and Content Analysis",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="30",
volume="24",
number="11",
pages="e38398",
keywords="HIV self-testing",
keywords="Chinese",
keywords="feedback comments",
keywords="e-commerce platforms",
abstract="Background: HIV self-testing is preferred by many Chinese people for its convenience and confidentiality. However, most studies on HIV self-testing (HIVST) uptake in China overfocused on men who have sex with men and overrelied on obtrusive methods such as surveys and interviews to collect data. Objective: We aimed to explore Chinese HIVST kit users' authentic experience via their feedback comments posted on e-commerce platforms using an unobtrusive approach. Methods: In total, 21,018 feedback comments about buying and using HIVST kits posted on Chinese e-commerce platforms (Tmall and Pinduoduo) were collected. An inductive thematic analysis based on a random sample of 367 comments yielded several thematic features. These thematic features were developed into coding categories for a quantitative content analysis of another random sample of 1857 comments. Results: Four themes were identified in the first study, including the expression of positive and negative emotions after and before getting the test, respectively, calling for living a clean and moral life in the future, comments on the sellers and HIVST kits, and the reasons for buying HIVST kits. The results from the second study suggested that there were significant associations between different platforms and several thematic features. Nearly 50\% of the comments were related to the product itself and the disclosures of HIV-negative test results. More than 25\% of the comments showed users' feelings of gratefulness after receiving negative test results such as ``thank heavens for sparing my life.'' Conclusions: The results suggested that Chinese users relied on HIVST kits to reduce and prevent HIV infection, while they also considered HIV infection a punishment related to moral violation such as being sexually promiscuous. The traditional Chinese health belief that health is influenced by one's morality still persists among some Chinese users. Many users also lacked appropriate knowledge about HIV transmission and self-testing kits. ",
doi="10.2196/38398",
url="https://www.jmir.org/2022/11/e38398",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449327"
}


@Article{info:doi/10.2196/41453,
author="Storholm, D. Erik
and Siconolfi, E. Dan
and Wagner, J. Glenn
and Huang, Wenjing
and Nacht, L. Carrie
and Sallabank, Greg
and Felner, K. Jennifer
and Wolf, Joshua
and Lee, D. Sarita
and Stephenson, Rob",
title="Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="15",
volume="11",
number="11",
pages="e41453",
keywords="intimate partner violence",
keywords="cohort study",
keywords="sexual minority men",
keywords="HIV",
keywords="sexually transmitted infections",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
abstract="Background: Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. Objective: This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. Methods: This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention--identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months.  Results: Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. Conclusions: This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. International Registered Report Identifier (IRRID): DERR1-10.2196/41453 ",
doi="10.2196/41453",
url="https://www.researchprotocols.org/2022/11/e41453",
url="http://www.ncbi.nlm.nih.gov/pubmed/36378519"
}


@Article{info:doi/10.2196/40095,
author="Copen, E. Casey
and Rushmore, Julie
and De Voux, Alex
and Kirkcaldy, D. Robert
and Fakile, F. Yetunde
and Tilchin, Carla
and Duchen, Jessica
and Jennings, M. Jacky
and Spahnie, Morgan
and Norris Turner, Abigail
and Miller, C. William
and Novak, M. Richard
and Schneider, A. John
and Trotter, B. Andrew
and Bernstein, T. Kyle",
title="Factors Associated With Syphilis Transmission and Acquisition Among Men Who Have Sex With Men: Protocol for a Multisite Egocentric Network Study",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="4",
volume="11",
number="11",
pages="e40095",
keywords="sexually transmitted infection",
keywords="HIV risk",
keywords="men who have sex with men",
keywords="sexual network",
keywords="syphilis",
keywords="mobile phone",
abstract="Background: In the United States, the rates of primary and secondary syphilis have increased more rapidly among men who have sex with men (MSM) than among any other subpopulation. Rising syphilis rates among MSM reflect changes in both individual behaviors and the role of sexual networks (eg, persons linked directly or indirectly by sexual contact) in the spread of the infection. Decades of research examined how sexual networks influence sexually transmitted infections (STIs) among MSM; however, few longitudinal data sources focusing on syphilis have collected network characteristics. The Centers for Disease Control and Prevention, in collaboration with 3 sites, enrolled a prospective cohort of MSM in 3 US cities to longitudinally study sexual behaviors and STIs, including HIV, for up to 24 months. Objective: The Network Epidemiology of Syphilis Transmission (NEST) study aimed to collect data on the factors related to syphilis transmission and acquisition among MSM. Methods: The NEST study was a prospective cohort study that enrolled 748 MSM in Baltimore, Maryland; Chicago, Illinois; and Columbus, Ohio. NEST recruitment used a combination of convenience sampling, venue-based recruitment, and respondent-driven sampling approaches. At quarterly visits, participants completed a behavioral questionnaire and were tested for syphilis, HIV, gonorrhea, and chlamydia. The participants also provided a list of their sexual partners and described their 3 most recent partners in greater detail. Results: The NEST participants were enrolled in the study from July 2018 to December 2021. At baseline, the mean age of the participants was 31.5 (SD 9.1) years. More than half (396/727. 54.5\%) of the participants were non-Hispanic Black, 29.8\% (217/727) were non-Hispanic White, and 8.8\% (64/727) were Hispanic or Latino. Multiple recruitment strategies across the 3 study locations, including respondent-driven sampling, clinic referrals, flyers, and social media advertisements, strengthened NEST participation. Upon the completion of follow-up visits in March 2022, the mean number of visits per participant was 5.1 (SD 3.2; range 1-9) in Baltimore, 2.2 (SD 1.6; range 1-8) in Chicago, and 7.2 (SD 2.9; range 1-9) in Columbus. Using a community-based participatory research approach, site-specific staff were able to draw upon collaborations with local communities to address stigma concerning STIs, particularly syphilis, among potential NEST participants. Community-led efforts also provided a forum for staff to describe the NEST study objectives and plans for research dissemination to the target audience. Strategies to bolster data collection during the COVID-19 pandemic included telehealth visits (all sites) and adaptation to self-collection of STI specimens (Baltimore only). Conclusions: Data from NEST will be used to address important questions regarding individual and partnership-based sexual risk behaviors among MSM, with the goal of informing interventions to prevent syphilis in high-burden areas. International Registered Report Identifier (IRRID): RR1-10.2196/40095 ",
doi="10.2196/40095",
url="https://www.researchprotocols.org/2022/11/e40095",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331528"
}


@Article{info:doi/10.2196/30372,
author="Kuringe, Evodius
and Christensen, Alice
and Materu, Jacqueline
and Drake, Mary
and Majani, Esther
and Casalini, Caterina
and Mjungu, Deusdedit
and Mbita, Gaspar
and Kalage, Esther
and Komba, Albert
and Nyato, Daniel
and Nnko, Soori
and Shao, Amani
and Changalucha, John
and Wambura, Mwita",
title="Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Sep",
day="19",
volume="8",
number="9",
pages="e30372",
keywords="adolescent",
keywords="female",
keywords="HIV infections/epidemiology",
keywords="HIV infections/prevention and control",
keywords="herpes simplex virus type 2",
keywords="incidence",
keywords="motivation",
keywords="Tanzania",
abstract="Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95\% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95\% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243 ",
doi="10.2196/30372",
url="https://publichealth.jmir.org/2022/9/e30372",
url="http://www.ncbi.nlm.nih.gov/pubmed/36121686"
}


@Article{info:doi/10.2196/34150,
author="Yang, Zijie
and Wei, Lan
and Xie, Wei
and Chen, Lin
and Yang, Zhengrong
and Zhang, Yan
and Liu, Shaochu
and Tan, Wei
and Zheng, Chenli
and Gan, Yongxia
and Li, Dongmin
and Zou, Huachun
and Chen, Wanying
and Ma, Ling
and Ju, Niu
and Sun, Yinghui
and Lv, Fan
and Zhao, Jin",
title="Estimating Changes in Population Size and Behavioral Characteristics in Men Who Have Sex With Men Between 2014 and 2019: Longitudinal Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="16",
volume="8",
number="8",
pages="e34150",
keywords="men who have sex with men",
keywords="population size",
keywords="HIV/AIDS",
keywords="behavioral characteristics",
abstract="Background: Men who have sex with men (MSM) are at high risk for HIV infection. Accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM is of great importance to develop targeted HIV prevention and interventions. Objective: The goal of the research was accurate estimation of the population size and monitoring the risk sexual behavioral change of MSM. Methods: Street interception investigation methods were conducted among males aged 16 years and older in selected sites in Shenzhen in 2014 and 2019. A population survey was used to estimate the population size of MSM. Logistic regression analysis was applied to evaluate the difference in behavioral characteristics in MSM from 2014 to 2019. Results: In this study, we surveyed 10,170 participants in 2014, of whom 448 (4.41\%, 95\% CI 4.01\%-4.80\%) participants were men who have ever had sex with another man (MSMe) and 229 (2.25\%, 95\% CI 1.96\%-2.54\%) were men who had sex with another man in the previous 6 months (MSMa). A total of 10,226 participants were surveyed in 2019, of which 500 (4.90\%, 95\% CI 4.47\%-5.31\%) and 208 (2.03\%, 95\% CI 1.76\%-2.31\%) participants were MSMe and MSMa, respectively. The results showed that the population size of MSM who are active (MSMa) in Shenzhen was 155,469 (2.29\%, 95\% CI 2.28\%-2.30\%) in 2014 and 167,337 (2.05\%, 95\% CI 2.04\%-2.06\%) in 2019. It was estimated that there were about 12,005,445 (2.04\%, 95\% CI 2.04\%-2.04\%) MSMa in China in 2019. Compared with 2014, the MSMa in 2019 were more likely to seek sex partners through mobile phone apps and less likely to have male and female sex partners in addition to having inconsistent condom use and more than 6 sex partners in the previous 6 months. Conclusions: In Shenzhen, the proportion of MSMa among the general male population was lower in 2019 than in 2014, and the prevalence of HIV risk behavior was reduced in 2019. Although the preferred platform to find male sex partners among MSM has changed, intervention with high--HIV risk MSM could still help to reduce HIV risk behaviors among the whole MSM group. Because MSM prefer to seek sex partners through mobile phone apps, further study is needed to strengthen internet interventions with high--HIV risk MSM to curb the spread of HIV. ",
doi="10.2196/34150",
url="https://publichealth.jmir.org/2022/8/e34150",
url="http://www.ncbi.nlm.nih.gov/pubmed/35972779"
}


@Article{info:doi/10.2196/34181,
author="Dangerfield II, T. Derek
and Anderson, N. Janeane
and Wylie, Charleen
and Arrington-Sanders, Renata
and Bluthenthal, N. Ricky
and Beyrer, Christopher
and Farley, E. Jason",
title="Refining a Multicomponent Intervention to Increase Perceived HIV Risk and PrEP Initiation: Focus Group Study Among Black Sexual Minority Men",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="10",
volume="6",
number="8",
pages="e34181",
keywords="sexual health",
keywords="life course theory",
keywords="health belief",
keywords="possible",
keywords="HIV",
keywords="preexposure prophylaxis",
keywords="mHealth",
keywords="smartphone",
keywords="health app",
keywords="digital health",
abstract="Background: Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited. Objective: The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach. Methods: Data were obtained guided by life course theory and the health belief model using 12 focus groups and 1 in-depth interview among HIV-negative BSMM from Baltimore, MD, between October 2019 and May 2020 (n=39). Groups were stratified by the following ages: 18 to 24 years, 25 to 34 years, and 35 years and older. Participants were provided details regarding an existing mobile app diary to self-monitor sexual behaviors and a hypothetical PCA with whom to review the app. Facilitators posed questions regarding perceived HIV risk, attitudes toward the app, working with a PCA, and preferences for PCA characteristics and approaches. Results: Most participants identified as homosexual, gay, or same gender-loving (26/38, 68\%), were employed (26/38, 69\%), single (25/38, 66\%), and interested in self-monitoring sexual behaviors (28/38, 68\%). However, themes suggested that participants had low perceived HIV risk, that self-monitoring sexual behaviors using a mobile app diary was feasible but could trigger internalized stigma, and that an acceptable PCA should be a possible self for BSMM to aspire to but they still wanted clinicians to ``do their job.'' Conclusions: HIV-negative BSMM have dissonant attitudes regarding perceived HIV risk and the utility of a mobile app and PCA to increase perceived HIV risk and PrEP initiation. Future research will explore the feasibility, acceptability, and preliminary impact of implementing the multicomponent intervention on perceived HIV risk and PrEP initiation among BSMM in a pilot study. ",
doi="10.2196/34181",
url="https://formative.jmir.org/2022/8/e34181",
url="http://www.ncbi.nlm.nih.gov/pubmed/35947442"
}


@Article{info:doi/10.2196/35729,
author="Stone, Nicole
and Bedford, Rowena
and Newby, Katie
and Brown, Katherine
and Jackson, Louise
and Bremner, Stephen
and Morrison, Leanne
and McGrath, Nuala
and Nadarzynski, Tom
and Bayley, Jake
and Perry, Nicky
and Graham, Cynthia",
title="Reducing New Chlamydia Infection Among Young Men by Promoting Correct and Consistent Condom Use: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="10",
volume="11",
number="8",
pages="e35729",
keywords="condom fit and feel",
keywords="condom use",
keywords="pleasure",
keywords="digital intervention",
keywords="sexual behavior",
keywords="health psychology",
keywords="behavior intervention",
keywords="chlamydia",
keywords="sexual health",
keywords="randomized controlled trial",
abstract="Background: The health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence shows that brief behavior change interventions that focus on skills, communication, and motivation to acquire safe sex practices should be adopted into routine care to reduce STIs. Funding for sexual health services in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The home-based intervention strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms they like and feel more confident when using condoms. Objective: The aim of this study is to determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care among young men. Methods: The 3 trial arms consisting of ``e-HIS'' (HIS-UK delivered digitally), ``ProHIS'' (HIS-UK delivered face-to-face), and control condition (usual National Health Service [NHS] care) will be compared against the following 3 primary outcomes: the extent to which correct and consistent condom use is increased; improvement of condom use experiences (pleasure as well as fit and feel); and decrease in chlamydia test positivity. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (ie, breakage or slippage) or condomless penile-vaginal or penile-anal intercourse with casual or new sexual partners during the previous 3 months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and university-associated health centers and general practitioner practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to 1 of 3 trial arms. A repeated measures design will assess the parallel arms with baseline and 12 monthly follow-up questionnaires after intervention and 3 chlamydia screening points (baseline, 6, and 12 months). Results: Recruitment commenced in March 2020. Due to the COVID-19 pandemic, the study was halted and has since reopened for recruitment in Summer 2021. A 30-month recruitment period is planned. Conclusions: If effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage sexual health services to adopt digital technologies, allowing for them to become more widely available to young people while decreasing health inequalities and fear of stigmatization. Trial Registration: ISRCTN Registry ISRCTN11400820; https://www.isrctn.com/ISRCTN11400820 ",
doi="10.2196/35729",
url="https://www.researchprotocols.org/2022/8/e35729",
url="http://www.ncbi.nlm.nih.gov/pubmed/35947422"
}


@Article{info:doi/10.2196/32286,
author="Chabata, T. Sungai
and Makandwa, Rumbidzo
and Hensen, Bernadette
and Mushati, Phillis
and Chiyaka, Tarisai
and Musemburi, Sithembile
and Busza, Joanna
and Floyd, Sian
and Birdthistle, Isolde
and Hargreaves, R. James
and Cowan, M. Frances",
title="Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="27",
volume="8",
number="7",
pages="e32286",
keywords="respondent-driven sampling",
keywords="peer outreach",
keywords="female sex worker",
keywords="young women who sell sex",
keywords="HIV prevention",
keywords="Zimbabwe",
keywords="sub-Saharan Africa",
abstract="Background: Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. Objective: We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. Methods: We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 ``seed'' participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. Results: Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6\% vs 930/5386, 17.3\%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3\% vs 243/930, 26.1\%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8\% vs 396/930, 42.6\%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US \$7.46 for peer outreach and US \$52.81 for RDS. Conclusions: Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5085-6 ",
doi="10.2196/32286",
url="https://publichealth.jmir.org/2022/7/e32286",
url="http://www.ncbi.nlm.nih.gov/pubmed/35896024"
}


@Article{info:doi/10.2196/23823,
author="Gilmore, K. Amanda
and Leone, M. Ruschelle
and Oesterle, W. Daniel
and Davis, Cue Kelly
and Orchowski, M. Lindsay
and Ramakrishnan, Viswanathan
and Kaysen, Debra",
title="Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change)",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="22",
volume="6",
number="7",
pages="e23823",
keywords="sexual assault prevention",
keywords="alcohol",
keywords="college students",
keywords="sexual and gender minorities",
abstract="Background: Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation. Objective: We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women. Methods: Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change. Results: Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change. Conclusions: Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation. Trial Registration: ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137 ",
doi="10.2196/23823",
url="https://formative.jmir.org/2022/7/e23823",
url="http://www.ncbi.nlm.nih.gov/pubmed/35867393"
}


@Article{info:doi/10.2196/30944,
author="Parker, N. Jayelin
and Choi, Ki Seul
and Bauermeister, A. Jose
and Bonar, E. Erin
and Carrico, W. Adam
and Stephenson, Rob",
title="HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="1",
volume="8",
number="7",
pages="e30944",
keywords="testing",
keywords="substance use",
keywords="sexual minority",
keywords="social determinants",
abstract="Background: Gay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education. Objective: We explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan. Methods: We analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors. Results: Our findings showed that 35.5\% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6\%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs. Conclusions: This study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 ",
doi="10.2196/30944",
url="https://publichealth.jmir.org/2022/7/e30944",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776441"
}


@Article{info:doi/10.2196/33867,
author="Choi, Ki Seul
and Golinkoff, Jesse
and Michna, Mark
and Connochie, Daniel
and Bauermeister, Jos{\'e}",
title="Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="27",
volume="8",
number="6",
pages="e33867",
keywords="paradata",
keywords="mobile health",
keywords="mHealth",
keywords="digital health intervention",
keywords="risk reduction",
keywords="HIV prevention",
keywords="public health",
keywords="digital health",
keywords="sexual health",
keywords="sexual risks",
abstract="Background: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users' engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. Objective: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM's online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants' engagement (ie, the number of log-ins and the number of sessions viewed). Methods: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM's baseline characteristics on their DHI engagement. We then examined the association between the participants' engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. Results: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [$\beta$]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM ($\beta$=.27; P=.002), higher education attainment ($\beta$=.22; P=.003), higher perceived usefulness of online dating for hookups ($\beta$=.13; P=.002) and perceived loneliness ($\beta$=.06; P=.004), as well as lower experienced online discrimination ($\beta$=--.01; P=.007) and limerence ($\beta$=--.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia ($\beta$=--.06; P<.001) and with changes in perceived usefulness of online dating for hookups ($\beta$=--.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants' behaviors at the 90-day follow-up. Conclusions: DHI engagement is linked to participants' sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention's effectiveness, DHIs with personalized intervention components that consider the individuals' differences could increase the overall engagement and efficacy of DHIs. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060. ",
doi="10.2196/33867",
url="https://publichealth.jmir.org/2022/6/e33867",
url="http://www.ncbi.nlm.nih.gov/pubmed/35759333"
}


@Article{info:doi/10.2196/32718,
author="Oh, Jimin
and Bonett, Stephen
and Kranzler, C. Elissa
and Saconi, Bruno
and Stevens, Robin",
title="User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="17",
volume="8",
number="6",
pages="e32718",
keywords="HIV prevention",
keywords="social media",
keywords="public health",
keywords="young adults",
keywords="LASSO",
keywords="HIV",
keywords="Twitter",
keywords="digital health",
abstract="Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95\% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95\% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95\% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. ",
doi="10.2196/32718",
url="https://publichealth.jmir.org/2022/6/e32718",
url="http://www.ncbi.nlm.nih.gov/pubmed/35713945"
}


@Article{info:doi/10.2196/35548,
author="Gibson, P. Laurel
and Kramer, B. Emily
and Bryan, D. Angela",
title="Geosocial Networking App Use Associated With Sexual Risk Behavior and Pre-exposure Prophylaxis Use Among Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-sectional Web-Based Survey",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="13",
volume="6",
number="6",
pages="e35548",
keywords="dating app",
keywords="mobile dating",
keywords="hookup",
keywords="gay",
keywords="pre-exposure prophylaxis",
keywords="sexual risk",
keywords="HIV",
keywords="STI",
keywords="mobile phone",
abstract="Background: In the United States, geosocial networking (GSN) apps (ie, mobile dating apps) have become central to dating and sexual interactions in recent years. Among gay, bisexual, and other men who have sex with men (GBM), these apps play an important role in reducing barriers and facilitating partner seeking. However, despite these benefits, there are concerns that these apps may facilitate risky sexual behavior and transmission of sexually transmitted infections (STIs) among GBM. Objective: This study aimed to examine the association between GSN app use and sexual risk in a US sample of GBM. Methods: Using a cross-sectional design, respondents (N=223) completed a web-based survey assessing their use of GSN apps, sexual risk and protective behaviors, HIV serostatus, and previous STI diagnoses. Results: Respondents were aged 21-78 (mean 31.90, SD 10.06) years and 69.5\% (155/223) were non-Hispanic White. The sample included respondents from 40 states and the District of Columbia. Nearly half (104/223, 47\%) of the participants reported using GSN apps. GSN users were more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P<.001), and a previous STI diagnosis (P=.001) than nonusers. GSN users also reported more frequent use of recreational drugs before sex (P=.001), alcohol use before sex (P<.001), and cannabis use before sex (P=.01). Interestingly, GSN users were also more likely to report having ever taken an HIV test (P<.001) and using pre-exposure prophylaxis (P=.03). The rates of HIV seropositivity did not differ significantly between GSN users and nonusers (P=.53). Among the subset of GSN users, 38 participants reported using only GBM-specific GSN apps (eg, Grindr), whereas 27 participants reported using only sexuality nonspecific GSN apps (eg, Tinder). Exclusive users of GBM--specific apps reported more frequent recreational drug use before sex (P=.01) and were also more likely to report past-year condomless anal intercourse (P<.001), 3 or more sexual partners in the previous year (P=.004), a previous STI diagnosis (P=.002), and HIV testing (P=.003). Alcohol use before sex, cannabis use before sex, pre-exposure prophylaxis use, and HIV rates were similar between both groups (P>.11). Conclusions: The findings suggest that GSN apps may be a useful pathway for interventions aimed at reducing STI risk in GBM. Future prospective studies should examine how risk levels change after the initiation of GSN app use. ",
doi="10.2196/35548",
url="https://formative.jmir.org/2022/6/e35548",
url="http://www.ncbi.nlm.nih.gov/pubmed/35699992"
}


@Article{info:doi/10.2196/32416,
author="Lightfoot, Marguerita
and Jackson-Morgan, Joi
and Pollack, Lance
and Bennett, Ayanna",
title="Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="9",
volume="6",
number="6",
pages="e32416",
keywords="HIV prevention",
keywords="STI prevention",
keywords="adolescents",
keywords="youth",
keywords="text messaging",
keywords="SMS",
keywords="peer-to-peer intervention",
keywords="HIV",
keywords="STI",
keywords="HIV testing",
abstract="Background: Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective: We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods: The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic's service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results: Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55\%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions: Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services. ",
doi="10.2196/32416",
url="https://formative.jmir.org/2022/6/e32416",
url="http://www.ncbi.nlm.nih.gov/pubmed/35686737"
}


@Article{info:doi/10.2196/37356,
author="Phoo, Nge Nang Nge
and Lobo, Roanna
and Vujcich, Daniel
and Reid, Alison",
title="Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review",
journal="J Med Internet Res",
year="2022",
month="May",
day="31",
volume="24",
number="5",
pages="e37356",
keywords="ACASI",
keywords="survey mode",
keywords="sexual behaviors",
keywords="HIV",
keywords="STI",
keywords="hepatitis",
keywords="blood-borne virus",
keywords="Asia",
keywords="sub-Saharan Africa",
keywords="review",
abstract="Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are  regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as ``forced sex,'' ``multiple partners,'' ``transactional sex,'' and ``ever had sex,'' as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. ",
doi="10.2196/37356",
url="https://www.jmir.org/2022/5/e37356",
url="http://www.ncbi.nlm.nih.gov/pubmed/35639465"
}


@Article{info:doi/10.2196/33207,
author="Franco Vega, Ignacio
and Eleftheriou, Anastasia
and Graham, Cynthia",
title="Using Video Games to Improve the Sexual Health of Young People Aged 15 to 25 Years: Rapid Review",
journal="JMIR Serious Games",
year="2022",
month="May",
day="19",
volume="10",
number="2",
pages="e33207",
keywords="sex education",
keywords="serious games",
keywords="sexually transmitted infections",
keywords="rapid review",
keywords="mobile phone",
abstract="Background: Sexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies. Objective: This study aims to assess the effects of video game--based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years. Methods: A rapid review of randomized controlled trials and quasi--randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50\% (35/70) of the retrieved articles during the full-text screening phase. Results: From a total of 459 identified citations, after removing duplicates, 327 (71.2\%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4\%) full texts were screened, from which 10 (3.1\%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game--based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed. Conclusions: Although game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game--based interventions to improve sexual health in young people. ",
doi="10.2196/33207",
url="https://games.jmir.org/2022/2/e33207",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587873"
}


@Article{info:doi/10.2196/38348,
author="Ramos, Raquel S.
and Johnson, Constance
and Melkus, Gail
and Kershaw, Trace
and Gwadz, Marya
and Reynolds, Harmony
and Vorderstrasse, Allison",
title="Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="17",
volume="11",
number="5",
pages="e38348",
keywords="virtual environment",
keywords="behavioral intervention",
keywords="consumer health informatics",
keywords="HIV",
keywords="cardiovascular disease",
keywords="sexual minority men",
keywords="prevention education",
keywords="gamification",
keywords="health communication",
abstract="Background: It is estimated that 70\% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78\% of persons with HIV will be diagnosed with CVD. Objective: We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. Methods: This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. Results: The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87\% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. Conclusions: This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. Trial Registration: ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952 International Registered Report Identifier (IRRID): PRR1-10.2196/38348 ",
doi="10.2196/38348",
url="https://www.researchprotocols.org/2022/5/e38348",
url="http://www.ncbi.nlm.nih.gov/pubmed/35579928"
}


@Article{info:doi/10.2196/36845,
author="Daniels, Joseph
and Peters, H. Remco P.
and Medina-Marino, Andrew
and Bongo, Cikizwa
and Stephenson, Rob",
title="A Skills-Based HIV Serostatus Disclosure Intervention for Sexual Minority Men in South Africa: Protocol for Intervention Adaptation and a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="16",
volume="11",
number="5",
pages="e36845",
keywords="gay",
keywords="bisexual",
keywords="men who have sex with men",
keywords="HIV intervention adaptation",
keywords="videoconference delivery",
keywords="HIV",
keywords="public health",
keywords="mobile phone",
abstract="Background: Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is a high HIV transmission risk within HIV-discordant partnerships, but an existing intervention may address these outcomes, if adapted effectively. Healthy Relationships (HR) is a behavioral intervention that was originally delivered in groups and in person over 5 sessions to develop coping skills for managing HIV-related stress and sexually risky situations, enhance decision-making skills for HIV disclosure to partners, and establish and maintain safer sex practices with partners. HR effectively improves prevention behaviors but has yet to be tailored to a non-US context. Objective: We aim to adapt HR into a new culturally grounded intervention entitled Speaking Out \& Allying Relationships for GBMSM and then assess its feasibility in Eastern Cape, South Africa. Methods: The study will have 2 aims. For aim 1---adaptation---we will use a human-centered design approach. Initial intervention tailoring will involve integrating Undetectable=Untransmittable and pre-exposure prophylaxis education, developing intervention content for a videoconference format, and designing role-plays and movies for skill building based on preliminary data. Afterward, interviews and surveys will be administered to GBMSM to assess intervention preferences, and a focus group will be conducted with health care providers and information technology experts to assess the intervention's design. Finally, a usability test will be performed to determine functionality and content understanding. Participants will be GBMSM living with HIV (n=15) who are in a relationship and health care providers and information technology (n=7) experts working in HIV care and programming with this population. For aim 2, we will examine the feasibility of the adapted intervention by using a pilot randomized control design. There will be 60 individuals per arm. Feasibility surveys and interviews will be conducted with the intervention arm, and behavioral and biomedical assessments for relationship and treatment adherence outcomes will be collected for both arms. All participants will be GBMSM living with HIV who are in a relationship with an HIV-negative or unknown status partner. Results: Intervention adaptation began in August 2021. Initial tailoring and the refining of GBMSM intervention preferences were completed in December 2021. Usability and feasibility assessments are due to be completed by March 2022 and February 2024, respectively. Conclusions: GBMSM need efficacious interventions that tackle partnership dynamics, HIV prevention, and treatment outcomes for antiretroviral treatment adherence and viral suppression in South Africa. Harnessing everyday technology use for social networking (eg, videoconferences), Undetectable=Untransmittable education, and pre-exposure prophylaxis to update an existing intervention for South African GBMSM has the potential to strengthen relationship communication about HIV treatment and prevention and, in turn, improve outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/36845 ",
doi="10.2196/36845",
url="https://www.researchprotocols.org/2022/5/e36845",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576574"
}


@Article{info:doi/10.2196/31847,
author="Xu, Junfang
and Luo, Yan
and Dong, Hengjin
and Zhao, Gang",
title="The Effects of Internet Exposure on Sexual Risk Behavior Among Sexually Experienced Male College Students in China: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="2",
volume="8",
number="5",
pages="e31847",
keywords="college males",
keywords="internet exposure",
keywords="sexual partners",
keywords="risk behavior",
keywords="HIV",
keywords="MSM",
keywords="social networks",
keywords="students",
keywords="sexually transmitted infections",
keywords="public health",
abstract="Background: As a young subgroup, college students have become the main users of mobile social networks. Considering that people can indiscriminately access explicit sexual content on the internet, coupled with the increase of HIV infections in male college students, the role of the internet in meeting sexual partners and its correlation to risky sexual behavior has become an important topic. Objective: The aim of this study is to explore the effects of internet exposure on sexual partners and sexual risk behavior among sexually experienced male college students. Methods: An institution-based cross-sectional study design was used to collect data through a paper-based questionnaire administered to male college students recruited from colleges and gay organizations in Hangzhou, Zhejiang Province, China. A total of 1045 sexually experienced male students were incorporated in our analysis, with the following information collected: sociodemographic characteristics, sexual intercourse--related behaviors, and sexually transmitted disease (STD) knowledge. Mann-Whitney U and Kruskal-Wallis tests were used to examine differences regarding basic characteristics and sexual risk behaviors between male college students who meet sexual partners via the internet and those who do not. Sequential logistic regression models were employed to examine the influence of meeting sexual partners via the internet on risky sexual behaviors after controlling for other factors. Results: The mean age of the sexually experienced male students was 21.6 (SD 2.0) years. The likelihood of risky sexual behavior was varied, yet it was the highest for those who aim to meet paid sexual partners (145/192, 75.5\% to 19/22, 86.4\%), followed by those seeking partners for love or romance (258/435, 59.3\%). Compared to non-internet partner seekers, internet partner seekers tended to have more casual intercourse (292/542, 53.9\% versus 51/503, 10.1\%), paid intercourse (32/542, 5.9\% versus 12/503, 2.4\%), and intercourse with same-sex partners (349/542, 64.4\% versus 41/503, 8.2\%); they were also more likely to use psychoactive drugs (125/349, 35.8\% versus 5/41, 12.2\%) and have more than 2 partners. With the increase of HIV and STD knowledge, the probability of having unprotected intercourse decreased for non-internet partner seekers. However, it increased for internet partner seekers with a rising HIV knowledge score. Sequential logistic regression showed that meeting sexual partners on the internet was statistically associated with sexual risk behaviors with multiple sexual partners (odds ratio 4.434; P<.001). Conclusions: Meeting sexual partners via the internet is a common behavior among sexually experienced male college students, and those who meet partners on the internet exhibited higher levels of risky sexual behaviors although they had sufficient HIV and STD knowledge; this is especially true for students who aimed to find partners for sexual intercourse. Thus, more attention should be paid to young adults to address the risky sexual behaviors that may contribute to STD spread among this population. ",
doi="10.2196/31847",
url="https://publichealth.jmir.org/2022/5/e31847",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499864"
}


@Article{info:doi/10.2196/27792,
author="Okumu, Moses
and Logie, H. Carmen
and Ansong, David
and Mwima, Simon
and Hakiza, Robert
and Newman, A. Peter",
title="Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e27792",
keywords="condom negotiation",
keywords="sexting",
keywords="refugee and displaced adolescents",
keywords="digital sexual communication",
keywords="HIV prevention",
keywords="gender",
abstract="Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents' confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective: This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods: Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala's slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants' support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results: The one-factor CuNET with the validation sample was valid ($\chi$24=5.3; P=.26; root mean square error of approximation=0.05, 90\% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach $\alpha$=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95\% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95\% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95\% CI 0.64-1.26). Conclusions: The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. ",
doi="10.2196/27792",
url="https://publichealth.jmir.org/2022/4/e27792",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384852"
}


@Article{info:doi/10.2196/27061,
author="Melendez-Torres, GJ
and Meiksin, Rebecca
and Witzel, Charles T.
and Weatherburn, Peter
and Falconer, Jane
and Bonell, Chris",
title="eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e27061",
keywords="men who have sex with men",
keywords="HIV and sexually transmitted infections",
keywords="mental health",
keywords="substance use",
keywords="mobile apps",
keywords="HIV",
keywords="eHealth",
keywords="electronic media",
keywords="mobile phone apps",
keywords="sexual risk",
abstract="Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95\% CI --0.18 to 0.52; I2=0\%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=--0.14, 95\% CI --0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=--0.12, 95\% CI --0.19 to --0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. ",
doi="10.2196/27061",
url="https://publichealth.jmir.org/2022/4/e27061",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384845"
}


@Article{info:doi/10.2196/31033,
author="Fan, Song
and Li, Peiyang
and Hu, Yuqing
and Gong, Hui
and Yu, Maohe
and Ding, Yi
and Luo, Zhenzhou
and Wu, Guohui
and Ouyang, Lin
and Zou, Huachun",
title="Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="28",
volume="8",
number="3",
pages="e31033",
keywords="gay app",
keywords="men who have sex with men",
keywords="student",
keywords="China",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Gay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM. Objective: We conducted this study to understand gay app use and its influencing factors among MSM attending university in China. Methods: From January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps. Results: A total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2\%) reported gay app use at some point in their life, and 240/439 (53.7\%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5\%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners' HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95\% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95\% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95\% CI 1.46-2.01; P<.001). Conclusions: Seeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741 ",
doi="10.2196/31033",
url="https://publichealth.jmir.org/2022/3/e31033",
url="http://www.ncbi.nlm.nih.gov/pubmed/35343911"
}


@Article{info:doi/10.2196/29196,
author="Wilbourn, Brittany
and Howard-Howell, Tyriesa
and Castel, Amanda
and D'Angelo, Lawrence
and Trexler, Constance
and Carr, Rashida
and Greenberg, Daniel",
title="Barriers and Facilitators to HIV Testing Among Adolescents and Young Adults in Washington, District of Columbia: Formative Research to Inform the Development of an mHealth Intervention",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="11",
volume="6",
number="3",
pages="e29196",
keywords="youth",
keywords="HIV",
keywords="knowledge",
keywords="testing",
abstract="Background: Adolescents and young adults (AYA) in the United States, and in Washington, District of Columbia (DC), specifically, are disproportionately affected by HIV. Both the national Ending the HIV Epidemic initiative and DC-specific plans emphasize HIV testing, and innovative strategies to encourage testing among AYA are needed. Objective: The purpose of this study is to identify sexual behaviors, HIV knowledge, HIV perceptions (eg, susceptibility and severity), and perceived barriers and facilitators to HIV testing among AYA at risk for HIV in DC. Methods: This study was part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA. Focus groups and surveys stratified by self-reported sexual orientation were conducted among, and administered to, AYA aged 13-24 years in DC. HIV knowledge was explored during focus groups and measured using an adapted version of the Brief HIV Knowledge Questionnaire. Survey data were summarized using descriptive statistics and compared by self-reported sexual orientation. Transcripts were thematically analyzed. Results: Of the 46 AYA who participated in the focus groups, 30 (65\%) identified as heterosexual and 16 (35\%) as lesbian, gay, bisexual, transgender, or queer. A higher proportion of lesbian, gay, bisexual, transgender, or queer AYA reported sexual activity (12/16, 75\%, vs 18/30, 60\%), condomless sex (11/12, 92\%, vs 15/18, 83\%), and HIV testing (13/16, 81\%, vs 17/29, 58\%) than heterosexual AYA. HIV prevention (``condoms'' and ``...PrEP'') and transmission (``exchange of fluids'') knowledge was high, and most (34/44, 77\%) of the AYA perceived HIV testing as beneficial. However, the AYA also demonstrated some misinformation concerning HIV: an average of 67\% (31/46; SD 0.474) of the participants believed that an HIV test could deliver accurate results 1 week after a potential exposure and an average of 72\% (33/46; SD 0.455) believed that an HIV vaccine exists. The AYA also identified individual (``...people...are scared''), interpersonal (``it's an awkward conversation''), and structural (``...people don't...know where they can go'') barriers to testing. Most of the AYA indicated that they were very likely to use the demonstrated game prototype to help with getting tested for HIV (median 3.0, IQR 2.0-3.0, using a scale ranging from 0 to 3, with 3 indicating high likelihood) and strongly agreed that the game was interesting (median 5.0, IQR 5.0-5.0), fun (median 5.0, IQR 4.0-5.0), and easy to learn (median 5.0, IQR 5.0-5.0, using a scale ranging from 1 to 5, with 5 indicating strong agreement). Conclusions: These results suggest a need for multilevel HIV testing interventions and informed the development of a mobile health intervention aiming to increase HIV knowledge and risk perception among AYA, while reducing barriers to testing at the individual and structural levels, supporting efforts to end the domestic HIV epidemic. ",
doi="10.2196/29196",
url="https://formative.jmir.org/2022/3/e29196",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275083"
}


@Article{info:doi/10.2196/34574,
author="Sullivan, Sean Patrick
and Stephenson, Rob
and Hirshfield, Sabina
and Mehta, Christina Cyra
and Zahn, Ryan
and Bauermeister, A. Jose
and Horvath, Keith
and Chiasson, Ann Mary
and Gelaude, Deborah
and Mullin, Shelby
and Downing Jr, J. Martin
and Olansky, Jolene Evelyn
and Wiatrek, Sarah
and Rogers, Q. Erin
and Rosenberg, Eli
and Siegler, J. Aaron
and Mansergh, Gordon",
title="Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e34574",
keywords="HIV prevention",
keywords="mHealth",
keywords="tool",
keywords="video",
keywords="randomized clinical trial",
keywords="app",
keywords="prevention",
keywords="HIV",
keywords="PrEP",
keywords="STI",
keywords="testing",
keywords="behavior",
keywords="efficacy",
keywords="men who have sex with men",
keywords="MSM",
keywords="sexuality",
keywords="gay",
keywords="bisexual",
keywords="United States",
abstract="Background: Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. Objective: This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. Methods: We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. Results: In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84\%) were assigned to the intervention group and 608 (99.51\%) were analyzed, while 615 (50.16\%) were assigned to the control group and 612 (99.51\%) were analyzed.  For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95\% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95\% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. Conclusions: Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. Trial Registration: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID): RR2-10.2196/16439 ",
doi="10.2196/34574",
url="https://www.jmir.org/2022/2/e34574",
url="http://www.ncbi.nlm.nih.gov/pubmed/35025755"
}


@Article{info:doi/10.2196/30526,
author="Ilskens, Karina
and Wrona, J. Kamil
and Dockweiler, Christoph
and Fischer, Florian",
title="An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="2",
volume="10",
number="1",
pages="e30526",
keywords="serious games",
keywords="entertainment education",
keywords="STI",
keywords="STD",
keywords="sexual health",
keywords="effect",
keywords="impact",
keywords="sexually transmitted infections",
keywords="adolescents",
keywords="adolescent sexual health",
abstract="Background: Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective: The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods: A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results: Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions: This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents' sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior. ",
doi="10.2196/30526",
url="https://games.jmir.org/2022/1/e30526",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107438"
}


@Article{info:doi/10.2196/32400,
author="Tang, Jian
and Zheng, Yu
and Zhang, Daiying
and Yu, Xingli
and Ren, Jianlan
and Li, Mei
and Luo, Yue
and Tian, Min
and Chen, Yanhua",
title="Evaluation of an AIDS Educational Mobile Game (AIDS Fighter {\textperiodcentered} Health Defense) for Young Students to Improve AIDS-Related Knowledge, Stigma, and Attitude Linked to High-Risk Behaviors in China: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Jan",
day="24",
volume="10",
number="1",
pages="e32400",
keywords="young students",
keywords="AIDS education",
keywords="educational game",
keywords="game-based intervention",
keywords="serious games",
keywords="public health",
keywords="HIV",
keywords="AIDS epidemic",
keywords="stigma",
keywords="health defense",
keywords="health knowledge",
keywords="digital health",
keywords="digital health intervention",
abstract="Background: The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter {\textperiodcentered} Health Defense. Objective: In this study, we tested the effect of AIDS Fighter {\textperiodcentered} Health Defense on young students in improving AIDS-related knowledge, stigma, and attitude related to high-risk behaviors in Southwest China. Methods: A randomized controlled trial was conducted from September 14 to 27, 2020. In total, 96 students from 2 classes in a middle school were selected by stratified cluster sampling in Luzhou City, Southwest China. The students were randomly divided into the intervention group (n=50, 52\%) and the control group (n=46, 48\%). The intervention group played the AIDS educational game AIDS Fighter {\textperiodcentered} Health Defense; the control group learned AIDS-related knowledge through independent learning on the QQ chat group. An AIDS-related knowledge questionnaire, a stigma scale, and an attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of the AIDS educational game via face-to-face interviews. The user experience of the game was assessed using the Educational Game User Experience Evaluation Scale. The difference was statistically significant at P?.05. Results: After the intervention, the AIDS knowledge awareness rate (X? [SD], \%) of the intervention and control groups were 70.09 (SD 11.58) and 57.49 (SD 16.58), with t=4.282 and P<.001. The stigma scores of the 2 groups were 2.44 (SD 0.57) and 2.48 (SD 0.47), with t=0.373 and P=0.71. The positive rate (X? [SD], \%) of attitudes of high-risk AIDS behaviors of the 2 groups were 82.00 (SD 23.44) and 79.62 (SD 17.94), with t=0.555 and P=0.58. The mean percentage of the game evaluation was 54.73\% as excellent, 31.45\% as good, 13.09\% as medium, and 0.73\% as poor. Conclusions: AIDS Fighter {\textperiodcentered} Health Defense could increase AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors was not seen. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038230; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2000038230 ",
doi="10.2196/32400",
url="https://games.jmir.org/2022/1/e32400",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870603"
}


@Article{info:doi/10.2196/34885,
author="Torres, Silva Thiago
and Jalil, Moreira Emilia
and Coelho, Esteves Lara
and Bezerra, Barros Daniel Rodrigues
and Jalil, Moreira Cristina
and Hoagland, Brenda
and Cardoso, Wagner Sandra
and Arayasirikul, Sean
and Veloso, Gon{\c{c}}alves Valdilea
and Wilson, C. Erin
and McFarland, Willi
and Grinsztejn, Beatriz",
title="A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="13",
volume="11",
number="1",
pages="e34885",
keywords="sexual and gender minorities",
keywords="young MSM",
keywords="Brazil",
keywords="HIV prevention",
keywords="technology-based adherence intervention",
keywords="HIV",
abstract="Background: In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. Objective: We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. Methods: A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. Results: The Conectad@s project has been approved by our local institutional review board (\#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. Conclusions: The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. International Registered Report Identifier (IRRID): DERR1-10.2196/34885 ",
doi="10.2196/34885",
url="https://www.researchprotocols.org/2022/1/e34885",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023848"
}


@Article{info:doi/10.2196/31381,
author="Decker, J. Martha
and Harrison, Salish
and Price, Melisa
and Gutmann-Gonzalez, Abigail
and Yarger, Jennifer
and Tenney, Rachel",
title="Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="12",
volume="9",
number="1",
pages="e31381",
keywords="adolescent",
keywords="sex education",
keywords="technology",
keywords="mobile app",
keywords="implementation",
keywords="California",
keywords="health educator",
abstract="Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths' sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators' experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators' experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87\% of the time in the first year, which decreased to 47\% in the third year as health educators' familiarity with the app increased and functionality improved. Technology issues were also more common in non--school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents' use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 ",
doi="10.2196/31381",
url="https://humanfactors.jmir.org/2022/1/e31381",
url="http://www.ncbi.nlm.nih.gov/pubmed/35019842"
}


@Article{info:doi/10.2196/30408,
author="Wray, B. Tyler
and Chan, A. Philip
and Guigayoma, P. John
and Kahler, W. Christopher",
title="Game Plan---a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="5",
volume="6",
number="1",
pages="e30408",
keywords="HIV",
keywords="pre-exposure prophylaxis",
keywords="alcohol use",
keywords="mHealth",
keywords="eHealth",
keywords="intervention",
keywords="mobile phone",
abstract="Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP's effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective: We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods: Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results: In addition to Game Plan's pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions: Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult. ",
doi="10.2196/30408",
url="https://formative.jmir.org/2022/1/e30408",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989679"
}


@Article{info:doi/10.2196/27696,
author="Brody, Carinne
and Chhoun, Pheak
and Tuot, Sovannary
and Fehrenbacher, E. Anne
and Moran, Alexander
and Swendeman, Dallas
and Yi, Siyan",
title="A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="4",
volume="24",
number="1",
pages="e27696",
keywords="mHealth",
keywords="female sex workers",
keywords="HIV",
keywords="sexually transmitted infection",
keywords="linkage to services",
keywords="sexual and reproductive health",
keywords="gender-based violence",
keywords="low- and middle-income countries",
abstract="Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95\% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95\% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95\% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95\% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs' health outcomes in the future. Trial Registration: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2614-7  ",
doi="10.2196/27696",
url="https://www.jmir.org/2022/1/e27696",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982716"
}


@Article{info:doi/10.2196/33877,
author="Yu, Yi-Fang
and Wu, Huei-Jiuan
and Ku, Wen-Wei Stephane
and Huang, Po-Hsien
and Li, Chia-Wen
and Huang, Poyao
and Strong, Carol",
title="Condomless Anal Sex Associated With Heterogeneous Profiles Of HIV Pre-Exposure Prophylaxis Use and Sexual Activities Among Men Who Have Sex With Men: A Latent Class Analysis Using Sex Diary Data on a Mobile App",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e33877",
keywords="mobile apps",
keywords="pre-exposure prophylaxis",
keywords="PrEP",
keywords="latent class analysis",
keywords="men who have sex with men",
keywords="MSM",
keywords="condom",
keywords="sex diaries",
keywords="adherence",
keywords="app",
keywords="sex",
keywords="diary",
keywords="sexual health",
keywords="HIV",
keywords="Taiwan",
keywords="risk",
keywords="prevention",
abstract="Background: New innovative technologies, such as mobile apps, have been developed to increase pre-exposure prophylaxis (PrEP) adherence and the use of log sex diaries. The contiguity of mobile apps reduces the recall bias that generally affects reported condom and PrEP use. However, none of the currently used mobile apps were designed for event-driven PrEP users, and few studies have demonstrated the potential usage of sex diary data to facilitate the understanding of the different HIV risks among heterogeneous profiles of sex diaries and PrEP use. Objective: We aim to discriminate the heterogeneous profiles of sex events and PrEP use and examine the risk of condomless anal sex among different types of sex events. Methods: We recruited 35 adult men who have sex with men from two medical centers in Taiwan since May 2020 and followed up for four months. Participants were on PrEP or willing to take PrEP. They were asked to log their sex events, PrEP use, and dosing regimens on a mobile app to improve their PrEP adherence. Latent class analysis was used to distinguish profiles of sex events and PrEP use. Indicators included correct intake of PrEP for each sex event, participants' sexual positioning, partner's HIV status, and age. Results: A total of 551 sex events were classified into three classes by latent class analysis: PrEP nonadherent flip-flopping (234/551, 42\%), PrEP imperfect-adherent power bottoming (284/551, 52\%), and PrEP adherent serodiscordant topping (33/551, 6\%). ``PrEP nonadherent flip-flopping'' sex events were more likely to involve condomless anal sex than ``PrEP imperfect-adherent power bottoming'' (OR 1.83, 95\% CI 1.03-3.25) after considering random intercepts for individuals, and this class needed to increase their PrEP adherence and use of condoms. ``PrEP imperfect-adherent power bottoming'' realized their own risk and packaged PrEP with condoms to protect themselves. Up to 99\% (32/33) of sex events in ``PrEP adherent serodiscordant topping'' were protected by PrEP, but all of the sex events in this group were condomless. Conclusions: Using the sex diary data could advance the capacity to identify high-risk groups. HIV prevention strategy should be more flexible and combine PrEP with condom use for future HIV prevention. ",
doi="10.2196/33877",
url="https://www.jmir.org/2021/12/e33877",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941560"
}


@Article{info:doi/10.2196/27385,
author="Card, G. Kiffer
and Lachowsky, J. Nathan
and Hogg, S. Robert",
title="Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="29",
volume="7",
number="11",
pages="e27385",
keywords="gay, bisexual, and other men who have sex with men",
keywords="spatial distribution",
keywords="population size estimation",
keywords="pornography",
keywords="technology-aided surveillance",
abstract="Background: We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited. Objective: We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM). Methods: We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term ``gay porn'' with that of the search term ``porn.'' Results: Our results suggested that most cities have a gbMSM population size between 2\% and 4\% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1\% and 2\% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation. Conclusions: We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach. ",
doi="10.2196/27385",
url="https://publichealth.jmir.org/2021/11/e27385",
url="http://www.ncbi.nlm.nih.gov/pubmed/34618679"
}


@Article{info:doi/10.2196/26480,
author="Marley, Gifty
and Fu, Gengfeng
and Zhang, Ye
and Li, Jianjun
and Tucker, D. Joseph
and Tang, Weiming
and Yu, Rongbin",
title="Willingness of Chinese Men Who Have Sex With Men to Use Smartphone-Based Electronic Readers for HIV Self-testing: Web-Based Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="19",
volume="23",
number="11",
pages="e26480",
keywords="smartphone-based electronic reader",
keywords="electronic readers",
keywords="HIV self-testing",
keywords="HIVST",
keywords="self-testing",
keywords="cellular phone--based readers",
keywords="mHealth",
abstract="Background: The need for strategies to encourage user-initiated reporting of results after HIV self-testing (HIVST) persists. Smartphone-based electronic readers (SERs) have been shown capable of reading diagnostics results accurately in point-of-care diagnostics and could bridge the current gaps between HIVST and linkage to care. Objective: Our study aimed to assess the willingness of Chinese men who have sex with men (MSM) in the Jiangsu province to use an SER for HIVST through a web-based cross-sectional study. Methods: From February to April 2020, we conducted a convenience web-based survey among Chinese MSM by using a pretested structured questionnaire. Survey items were adapted from previous HIVST feasibility studies and modified as required. Prior to answering reader-related questions, participants watched a video showcasing a prototype SER. Statistical analysis included descriptive analysis, chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant. Results: Of 692 participants, 369 (53.3\%) were aged 26-40 years, 456 (65.9\%) had ever self-tested for HIV, and 493 (71.2\%) were willing to use an SER for HIVST. Approximately 98\% (483/493) of the willing participants, 85.3\% (459/538) of ever self-tested and never self-tested, and 40\% (46/115) of unwilling participants reported that SERs would increase their HIVST frequency. Engaging in unprotected anal intercourse with regular partners compared to consistently using condoms (adjusted odds ratio [AOR] 3.04, 95\% CI 1.19-7.74) increased the odds of willingness to use an SER for HIVST. Participants who had ever considered HIVST at home with a partner right before sex compared to those who had not (AOR 2.99, 95\% CI 1.13-7.90) were also more willing to use an SER for HIVST. Playing receptive roles during anal intercourse compared to playing insertive roles (AOR 0.05, 95\% CI 0.02-0.14) was associated with decreased odds of being willing to use an SER for HIVST. The majority of the participants (447/608, 73.5\%) preferred to purchase readers from local Centers of Disease Control and Prevention offices and 51.2\% (311/608) of the participants were willing to pay less than US \$4.70 for a reader device. Conclusions: The majority of the Chinese MSM, especially those with high sexual risk behaviors, were willing to use an SER for HIVST. Many MSM were also willing to self-test more frequently for HIV with an SER. Further research is needed to ascertain the diagnostic and real-time data-capturing capacity of prototype SERs during HIVST. ",
doi="10.2196/26480",
url="https://www.jmir.org/2021/11/e26480",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806988"
}


@Article{info:doi/10.2196/31843,
author="Wray, B. Tyler
and Chan, A. Philip
and Kahler, W. Christopher",
title="Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="16",
volume="5",
number="11",
pages="e31843",
keywords="pre-exposure prophylaxis",
keywords="HIV",
keywords="HIV prevention",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site's content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website's esthetics to the participants' engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. ",
doi="10.2196/31843",
url="https://formative.jmir.org/2021/11/e31843",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783662"
}


@Article{info:doi/10.2196/23874,
author="Chukwu, Emeka
and Gilroy, Sonia
and Addaquay, Kojo
and Jones, Nafisa Nki
and Karimu, Gbadia Victor
and Garg, Lalit
and Dickson, Eva Kim",
title="Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="12",
volume="5",
number="11",
pages="e23874",
keywords="young people",
keywords="short message service",
keywords="SMS",
keywords="chatbot",
keywords="text message",
keywords="interactive voice response",
keywords="IVR",
keywords="WhatsApp",
keywords="Facebook",
keywords="family planning",
keywords="contraceptives",
keywords="Sierra Leone",
abstract="Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media--only internet bundle, with the cost ranging from 1000 leones (US \$0.11) to 1500 leones (US \$0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US \$0.11) and 5000 leones (US \$0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. ",
doi="10.2196/23874",
url="https://formative.jmir.org/2021/11/e23874",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766908"
}


@Article{info:doi/10.2196/30125,
author="Mulgund, Pavankumar
and Sharman, Raj
and Purao, Sandeep
and Thimmanayakanapalya, Suresh Sagarika
and Winkelstein, Peter",
title="Mapping Information Needs of Patients With Sexually Transmitted Infections Using Web-Based Data Sources: Grounded Theory Investigation",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="10",
volume="23",
number="11",
pages="e30125",
keywords="information needs",
keywords="sexually transmitted diseases",
keywords="patient journey maps",
keywords="health information seeking",
keywords="stigmatizing disorders",
keywords="online forum",
keywords="sexually transmitted infection",
keywords="American Sexual Health Association",
keywords="grounded theory",
keywords="stigma",
abstract="Background: According to the World health organization (WHO), more than 1 million sexually transmitted infections (STIs) are acquired each day across the world. The incidence rates of STIs in the United States are at a record high for the fourth consecutive year. Owing to the stigma associated with the incidence of STI, there is a general reluctance to seek information in person. Instead, web-based information sources remain the primary avenues of information-seeking. However, these sources are designed without a comprehensive understanding of the information needs of individuals who have contracted STIs. Objective: This study aimed to investigate the information needs of individuals who have or suspect they have contracted an STI. A better understanding of their information needs can drive the design of more effective digital interventions. Methods: This is a qualitative and analytical study of 549 transcripts (consisting of queries posted over the last 10 years) from web-based forums of the American Sexual Health Association (ASHA), which allows patients, volunteers, and health care providers connect anonymously. The analysis follows a grounded theory (GT) approach with multiple coding stages to uncover categories and themes. Results: Three categories of information needs emerged. The first two, clinical and logistical, are similar to other contexts. However, our analysis shows that there is a significant need for the last category---psychosocial information. Approximately 59\% of instances are linked to concerns such as confusion, discretion, remorse, and others. These needs vary across the stages of a patient's journey from symptom manifestation to treatment maintenance. Conclusions: Responding to the needs of individuals who have or suspect they have contracted an STI requires compassionate and personalized responses (beyond factual clinical and logistical information). Web-based forums provide anonymity but do not adequately incorporate mechanisms, practices, or incentives to respond to diverse psychosocial concerns. Innovative approaches to add such support can make the digital interventions more effective for this group of individuals. ",
doi="10.2196/30125",
url="https://www.jmir.org/2021/11/e30125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757326"
}


@Article{info:doi/10.2196/25099,
author="Muwanguzi, A. Patience
and Ngabirano, Denis Tom
and Kiwanuka, Noah
and Nelson, E. LaRon
and Nasuuna, M. Esther
and Osingada, Peter Charles
and Nabunya, Racheal
and Nakanjako, Damalie
and Sewankambo, K. Nelson",
title="The Effects of Workplace-Based HIV Self-testing on Uptake of Testing and Linkage to HIV Care or Prevention by Men in Uganda (WISe-Men): Protocol for a Cluster Randomized Trial",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="1",
volume="10",
number="11",
pages="e25099",
keywords="Africa",
keywords="workplace HIV testing",
keywords="HIV self-testing",
keywords="linkage to care",
keywords="linkage to prevention",
abstract="Background: HIV testing uptake remains low among men in sub-Saharan Africa. HIV self-testing (HIVST) at the workplace is a novel approach to increase the availability of, and access to, testing among men. However, both access and linkage to posttest services remain a challenge. Objective: The aim of this protocol is to describe a cluster randomized trial (CRT)---Workplace-Based HIV Self-testing Among Men (WISe-Men)---to evaluate the effect of HIVST in workplace settings on the uptake of HIV testing services (HTS) and linkage to treatment and prevention services among men employed in private security services in Uganda. Methods: This is a two-arm CRT involving men employed in private security services in two Ugandan districts. The participants in the intervention clusters will undergo workplace-based HIVST using OraQuick test kits. Those in the control clusters will receive routine HTS at their work premises. In addition to HTS, participants in both the intervention and control arms will undergo other tests and assessments, which include blood pressure assessment, blood glucose and BMI measurement, and rapid diagnostic testing for syphilis. The primary outcome is the uptake of HIV testing. The secondary outcomes include HIV status reporting, linkage into HIV care and confirmatory testing following HIVST, initiation of antiretroviral therapy following a confirmatory HIV test, the uptake of voluntary medical male circumcision, consistent condom use, and the uptake of pre-exposure prophylaxis by the most at-risk populations. Results: Participant enrollment commenced in February 2020, and the trial is still recruiting study participants. Follow-up for currently enrolled participants is ongoing. Data collection and analysis is expected to be completed in December 2021. Conclusions: The WISe-Men trial will provide information regarding whether self-testing at worksites increases the uptake of HIV testing as well as the linkage to care and prevention services at male-dominated workplaces in Uganda. Additionally, the findings will help us propose strategies for improving men's engagement in HTS and ways to improve linkage to further care following a reactive or nonreactive HIVST result. Trial Registration: ClinicalTrials.gov NCT04164433; https://clinicaltrials.gov/ct2/show/NCT04164433 International Registered Report Identifier (IRRID): DERR1-10.2196/25099 ",
doi="10.2196/25099",
url="https://www.researchprotocols.org/2021/11/e25099",
url="http://www.ncbi.nlm.nih.gov/pubmed/34723826"
}


@Article{info:doi/10.2196/26177,
author="Mpunga, Elizabeth
and Persaud, Navindra
and Akolo, Christopher
and Boyee, Dorica
and Kamanga, Gift
and Trapence, Gift
and Chilongozi, David
and Ruberintwari, Melchiade
and Masankha Banda, Louis",
title="Readiness for Use of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in Malawi: Qualitative Focus Group and Interview Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Oct",
day="27",
volume="7",
number="10",
pages="e26177",
keywords="MSM",
keywords="readiness to use",
keywords="PrEP",
keywords="HIV prevention",
keywords="qualitative assessment",
keywords="HIV",
keywords="men who have sex with men",
keywords="Malawi",
keywords="prophylaxis",
abstract="Background: Men who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5\% compared to 8.4\% among men in the general population). The use of oral preexposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi. Objective: The 3 main objectives of this assessment were to determine: (1) awareness of PrEP, (2) factors that influence willingness to use PrEP, and (3) potential barriers to PrEP use and adherence among MSM in order to guide the design and implementation of a PrEP program in Malawi. Methods: Ahead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from 4 MSM-friendly drop-in centers where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP, their willingness to use PrEP, their barriers to PrEP use, and their preferences for service delivery. The data were analyzed using a thematic content analysis framework that was predetermined in line with objectives. Results: A total of 109 MSM were interviewed---13 through IDIs and 96 through FGDs. Most participants were aware of PrEP as a new HIV intervention but had limited knowledge related to its use. However, the majority were willing to use it and were looking forward to having access to it. IDI participants indicated that they will be more willing to take PrEP if the dosing frequency were appropriate and MSM were involved in information giving and distribution of the drug. FGD participants emphasized that places of distribution and characteristics of the service provider are the key factors that will affect use. Knowing the benefits of PrEP emerged as a key theme in both the IDIs and FGDs. Participants highlighted barriers that would hinder them from taking PrEP such as side effects which were cited in IDIs and FGDs. Key factors from FGDs include cost, fear of being outed, drug stockouts, fear of being known as MSMs by wives, and lack of relevant information. FGDs cited stigma from health care workers, forgetfulness, and community associated factors. Conclusions: Despite having inadequate knowledge about PrEP, study participants were largely willing to use PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites. ",
doi="10.2196/26177",
url="https://publichealth.jmir.org/2021/10/e26177",
url="http://www.ncbi.nlm.nih.gov/pubmed/34228627"
}


@Article{info:doi/10.2196/28508,
author="Li, Shangcao
and Zhang, Jing
and Mao, Xiang
and Lu, Tianyi
and Gao, Yangyang
and Zhang, Wenran
and Wang, Hongyi
and Chu, Zhenxing
and Hu, Qinghai
and Jiang, Yongjun
and Geng, Wenqing
and Shang, Hong
and Xu, Junjie",
title="Feasibility of Indirect Secondary Distribution of HIV Self-test Kits via WeChat Among Men Who Have Sex With Men: National Cross-sectional Study in China",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="26",
volume="23",
number="10",
pages="e28508",
keywords="secondary distribution",
keywords="HIV",
keywords="men who have sex with men",
keywords="WeChat",
keywords="HIV self-testing",
abstract="Background: HIV self-testing (HIVST) kits are common in key sexually active populations. Direct secondary distribution of HIVST kits (DSDHK) is effective in improving the uptake of HIVST. However, there are concerns about the various limitations of DSDHK, including limited geographic reach, payment problems, and need for face-to-face interactions. Objective: In this study, we aim to evaluate the feasibility and characteristics of indirect secondary distribution of HIVST kits (ISDHK) via WeChat (distributing HIVST application links and follow-up HIVST kits to partners) among men who have sex with men (MSM). Methods: From October 2017 to September 2019, an HIVST recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for the HIVST kits (referred to as index participants [IPs]). All MSM participants were encouraged to distribute the HIVST application link to their friends and sexual partners (referred to as alters) through their social networks. All the alters were further encouraged to continue distributing the HIVST application link. All participants paid a deposit (US \$7), which was refundable upon completion of the questionnaire, and uploaded the test results via a web-based survey system. Results: A total of 2263 MSM met the criteria and successfully applied for HIVST. Of these, 1816 participants returned their HIVST results, including 1422 (88.3\%) IPs and 394 (21.7\%) alters. More alters had condomless anal intercourse, a higher proportion of them had never previously tested for HIV, and they showed a greater willingness to distribute HIVST kits to their sexual partners (P=.002) than the IPs. After controlling for age, education, and income, the alters had a greater proportion of MSM who had never tested for HIV before (adjusted odds ratio [aOR] 1.29, 95\% CI 1.00-1.68), were more willing to distribute the HIVST application link (aOR 1.71, 95\% CI 1.21-2.40), had a lower number of sexual partners (aOR 0.71, 95\% CI 0.57-0.90), and were less likely to search for sexual partners on the web (aOR 0.78, 95\% CI 0.60-1.02) than IPs. In comparison, the rates of reactive HIVST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy were similar for IPs and alters. Conclusions: The ISDHK model of distributing HIVST application links among the MSM population via social media is feasible. The ISDHK model should be used to supplement the DSDHK model to enable a greater proportion of the MSM population to know their HIV infection status. ",
doi="10.2196/28508",
url="https://www.jmir.org/2021/10/e28508",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698651"
}


@Article{info:doi/10.2196/19614,
author="Haruna, Hussein
and Okoye, Kingsley
and Zainuddin, Zamzami
and Hu, Xiao
and Chu, Samuel
and Hosseini, Samira",
title="Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study",
journal="JMIR Serious Games",
year="2021",
month="Oct",
day="12",
volume="9",
number="4",
pages="e19614",
keywords="gamified instruction",
keywords="serious gaming",
keywords="gamification",
keywords="educational innovation",
keywords="teenage students",
keywords="digital generation",
keywords="e-learning",
keywords="low-tech setting",
abstract="Background: Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education. Objective: The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting. Methods: A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods. Results: The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t119=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches. Conclusions: Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education. ",
doi="10.2196/19614",
url="https://games.jmir.org/2021/4/e19614",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636739"
}


@Article{info:doi/10.2196/23204,
author="Mauka, Wilhellmuss
and Mbotwa, Christopher
and Moen, K{\aa}re
and Lichtwarck, Ochieng Hanne
and Haaland, Inga
and Kazaura, Method
and Leyna, H. Germana
and Leshabari, T. Melkizedeck
and Mmbaga, J. Elia",
title="Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="7",
volume="5",
number="10",
pages="e23204",
keywords="mHealth application",
keywords="participatory design",
keywords="HIV",
keywords="pre-exposure prophylaxis",
keywords="Africa",
keywords="female sex workers",
keywords="sex and gender minorities",
abstract="Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app's design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 ",
doi="10.2196/23204",
url="https://formative.jmir.org/2021/10/e23204",
url="http://www.ncbi.nlm.nih.gov/pubmed/34617904"
}


@Article{info:doi/10.2196/31185,
author="Snow-Hill, L. Nyssa
and Donenberg, Geri
and Feil, G. Edward
and Smith, R. David
and Floyd, R. Brenikki
and Leve, Craig",
title="A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="30",
volume="5",
number="9",
pages="e31185",
keywords="health education",
keywords="sexual behavior",
keywords="juvenile delinquency",
keywords="feasibility studies",
keywords="evidence-based practice",
keywords="adolescent health services",
keywords="inservice training",
keywords="implementation science",
keywords="organizational innovation",
keywords="technology",
keywords="risk reduction behavior",
keywords="mobile phone",
keywords="health technology",
keywords="health promotion",
keywords="sexual health",
abstract="Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth---PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. ",
doi="10.2196/31185",
url="https://formative.jmir.org/2021/9/e31185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591028"
}


@Article{info:doi/10.2196/22312,
author="Xin, Meiqi
and Coulson, S. Neil
and Jiang, Li Crystal
and Sillence, Elizabeth
and Chidgey, Andrew
and Kwan, Man Norman Nok
and Mak, S. Winnie W.
and Goggins, William
and Lau, Fai Joseph Tak
and Mo, Han Phoenix Kit",
title="Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e22312",
keywords="narrative persuasion",
keywords="firsthand experiential stories",
keywords="online intervention",
keywords="HIV prevention",
keywords="sexual behavior",
keywords="men who have sex with men",
abstract="Background: In the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention. Objective: In this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness. Methods: Persuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery. Results: A series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online. Conclusions: We systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future. ",
doi="10.2196/22312",
url="https://www.jmir.org/2021/9/e22312",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528889"
}


@Article{info:doi/10.2196/30367,
author="Tzilos Wernette, Golfo
and Countryman, Kristina
and Mmeje, Okeoma
and Ngo, M. Quyen
and Zlotnick, Caron",
title="Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="10",
volume="10",
number="9",
pages="e30367",
keywords="COVID-19",
keywords="pregnancy",
keywords="COVID-19 pandemic",
keywords="alcohol use",
keywords="drug use",
keywords="sexually transmitted infections",
keywords="technology-delivered interventions",
abstract="Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0\% vs 43/52, 83\%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 ",
doi="10.2196/30367",
url="https://www.researchprotocols.org/2021/9/e30367",
url="http://www.ncbi.nlm.nih.gov/pubmed/34351867"
}


@Article{info:doi/10.2196/30237,
author="Crawford, D. Natalie
and Josma, Dorie
and Harrington, V. Kristin R.
and Morris, Joseph
and Quamina, Alvan
and Birkett, Michelle
and Phillips II, Gregory",
title="Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="9",
volume="5",
number="9",
pages="e30237",
keywords="think-aloud",
keywords="egocentric networks",
keywords="sociogram",
keywords="social networks",
keywords="MSM",
keywords="transgender",
keywords="network canvas",
keywords="black MSM",
keywords="infectious disease transmission",
keywords="stigma",
abstract="Background: Characteristics of an individual's social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as ``easy to use,'' with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals' social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. ",
doi="10.2196/30237",
url="https://formative.jmir.org/2021/9/e30237",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499040"
}


@Article{info:doi/10.2196/25360,
author="Chen, Lin
and Chen, Wanjun
and Jiang, Tingting
and Ni, Zhikan
and Ma, Qiaoqin
and Pan, Xiaohong",
title="The Characteristics and Risk Factors of Web-Based Sexual Behaviors Among Men Who Have Sex With Men in Eastern China: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="2",
volume="7",
number="9",
pages="e25360",
keywords="HIV",
keywords="men who have sex with men",
keywords="casual sexual partners",
keywords="internet",
keywords="cross-sectional study",
abstract="Background: Finding casual sex partners on the internet has been considered a huge challenge for HIV transmission among men who have sex with men (MSM) in China. Objective: This study aimed to identify the characteristics and risk factors of finding causal sex partners on the internet among MSM in Zhejiang Province, China. Methods: This was a cross-sectional study. Participants were enrolled by 4 community-based organizations (CBOs) and 10 Voluntary Counselling and Testing (VCT) clinics through advertisements in bathrooms, bars, and gay hook-up apps from June to December 2018. A CBO- or physician-assisted survey was conducted to collected information on finding casual sex partners, perceived HIV infection, and HIV risk behaviors. Results: Among 767 participants, 310 (40.4\%) reported finding causal sex partners on the internet. Factors associated with finding casual sex partners on the internet included watching pornographic videos on the internet more than once a week (adjusted odds ratio [aOR]=1.881, 95\% CI 1.201-2.948), discussing ``hooking-up online'' with friends (aOR=4.018, 95\% CI 2.910-5.548), and perceiving that the likelihood of HIV infection among casual sex partners sought on the internet was ``medium'' (aOR=2.034, 95\% CI 1.441-2.873) or ``low'' (aOR=2.548, 95\% CI 1.524-4.259). Among the participants who reported finding casual sex partners on the internet, 30.2\% (91/310) reported having unprotected sex with casual sex partners encountered on the internet in the past 6 months. On multivariate logistic regression analyses, knowing the HIV infection status of casual sex partners sought on the internet was significantly associated with performing inserted intercourse (aOR=1.907, 95\% CI 1.100-3.306) and a decreased risk of inconsistent condom use (aOR=0.327, 95\% CI 0.167-0.642). Conclusions: Web-based casual sexual behavior is becoming more prevalent, and the rate of unprotected sex among MSM in Zhejiang Province is high. Future HIV prevention approaches should emphasize the importance for MSM to proactively determine the HIV infection status of potential casual sex partners sought on the internet. ",
doi="10.2196/25360",
url="https://publichealth.jmir.org/2021/9/e25360",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473066"
}


@Article{info:doi/10.2196/30499,
author="Anderson, Pamela
and Coyle, Karin
and Guinosso, Stephanie
and Ferrand, L. John
and Owora, Arthur
and Houghton, F. Rebecca
and Walsh-Buhi, Eric",
title="Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="1",
volume="10",
number="9",
pages="e30499",
keywords="adolescents",
keywords="youth",
keywords="teens",
keywords="healthy relationships",
keywords="unintended pregnancy",
keywords="teen pregnancy",
keywords="sexually transmitted infections",
keywords="sexually transmitted diseases",
keywords="sexual health education",
keywords="school-based health center",
keywords="randomized controlled trial",
abstract="Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study---the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov \#NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID): DERR1-10.2196/30499 ",
doi="10.2196/30499",
url="https://www.researchprotocols.org/2021/9/e30499",
url="http://www.ncbi.nlm.nih.gov/pubmed/34468330"
}


@Article{info:doi/10.2196/27168,
author="Yunus, Olivia Jessie
and Sawitri, Sagung Anak Agung
and Wirawan, Nyoman Dewa
and Mahendra, Agus I. Gusti Agung
and Susanti, Dewi
and Utami Ds, Dwi Ni Kadek Ayu
and Asanab, Dedison
and Narayani, Ayu Ida
and Mukuan, Sherli Oldri
and Widihastuti, Asti
and Magnani, Robert
and Januraga, Putu Pande",
title="Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="21",
volume="10",
number="7",
pages="e27168",
keywords="HIV",
keywords="self-testing",
keywords="oral fluid test",
keywords="community-based screening",
keywords="female sex worker",
keywords="Indonesia",
abstract="Background: New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. Objective: This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. Methods: We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. Results: Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1\%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. Conclusions: The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. Trial Registration: ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145 International Registered Report Identifier (IRRID): RR1-10.2196/27168 ",
doi="10.2196/27168",
url="https://www.researchprotocols.org/2021/7/e27168",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287217"
}


@Article{info:doi/10.2196/26202,
author="Constantinou, Heidi
and Fairley, K. Christopher
and Hocking, S. Jane
and Bradshaw, S. Catriona
and Choi, H. Edmond P.
and Maddaford, Kate
and Phillips, R. Tiffany
and Chow, F. Eric P.",
title="Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="20",
volume="5",
number="7",
pages="e26202",
keywords="internet",
keywords="dating apps",
keywords="mobile phone",
keywords="sexually transmitted infections",
keywords="health risk behaviors",
abstract="Background: The association between meeting partners on the web and sexual practices has been understudied in heterosexuals. Objective: This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. Methods: We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants' HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants' sexual practices, IVDU, and STI status. Results: A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3\% men; 245/373, 65.7\% women; P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party; 126/325, 38.8\%), whereas the women met partners most commonly through friends or family (178/373, 47.7\%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95\% CI 26.13-808.51) and on the internet (AOR 10.00, 95\% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95\% CI 1.94-5.71) and women (AOR 2.58, 95\% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95\% CI 1.24-7.48) and women (AOR 3.75, 95\% CI 1.58-8.89). Conclusions: Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a public setting. ",
doi="10.2196/26202",
url="https://formative.jmir.org/2021/7/e26202",
url="http://www.ncbi.nlm.nih.gov/pubmed/34283024"
}


@Article{info:doi/10.2196/22693,
author="Beres, K. Laura
and Mbabali, Ismail
and Anok, Aggrey
and Katabalwa, Charles
and Mulamba, Jeremiah
and Thomas, G. Alvin
and Bugos, Eva
and Nakigozi, Gertrude
and Grabowski, K. Mary
and Chang, W. Larry",
title="Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="20",
volume="5",
number="7",
pages="e22693",
keywords="ecological momentary assessment",
keywords="ecological momentary intervention",
keywords="mHealth",
keywords="digital health",
keywords="smartphone",
keywords="mobile phone",
keywords="randomized trial",
keywords="Uganda",
keywords="Africa",
abstract="Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual's natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non--long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48\% women; median age 31 years). EMA data collection was feasible, with 85.5\% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6\% of days to P2, 4.3\% of days; intervention: P1, 7.2\% of days to P3, 2.4\% of days). Decreases in sex with a non--long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9\% of days to 1\% of days; intervention: 6.6\% of days to 1.3\% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6\% of days to 76.6\% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8\% decrease in the mean proportion of days vegetables consumed; intervention: 11.1\% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 ",
doi="10.2196/22693",
url="https://formative.jmir.org/2021/7/e22693",
url="http://www.ncbi.nlm.nih.gov/pubmed/34283027"
}


@Article{info:doi/10.2196/26704,
author="Santa Maria, Diane
and Padhye, Nikhil
and Businelle, Michael
and Yang, Yijiong
and Jones, Jennifer
and Sims, Alexis
and Lightfoot, Marguerita",
title="Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="6",
volume="23",
number="7",
pages="e26704",
keywords="youth",
keywords="homelessness",
keywords="HIV",
keywords="prevention",
keywords="just-in-time adaptive interventions",
keywords="mHealth",
keywords="ecological momentary assessments",
keywords="drug use",
keywords="stress",
keywords="intervention",
keywords="smartphone",
keywords="mobile phone",
keywords="drug",
keywords="efficacy",
keywords="pilot",
keywords="feasibility",
keywords="predictor",
keywords="risk",
keywords="behavior",
abstract="Background: People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. Objective: This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. Methods: A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. Results: Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52\%), male (n=56, 57\%), and African American (n=56, 57\%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). Conclusions: Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. Trial Registration: ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024 ",
doi="10.2196/26704",
url="https://www.jmir.org/2021/7/e26704",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255679"
}


@Article{info:doi/10.2196/26085,
author="Bernier, Th{\'e}r{\`e}se
and Shah, Amika
and Ross, E. Lori
and Logie, H. Carmen
and Seto, Emily",
title="The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="24",
volume="23",
number="6",
pages="e26085",
keywords="sex work",
keywords="smartphone",
keywords="mobile phone",
keywords="occupational health and safety",
keywords="online",
keywords="internet",
keywords="website",
abstract="Background: In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks. Objective: This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers' use of ICTs in the delivery of occupational health and safety strategies? Methods: A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review. Results: Of the 2477 articles initially identified, 41 (1.66\%) met the inclusion criteria. Of these studies, 71\% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58\%), followed by text messaging (10/41, 24\%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17\%; eg, voice mail). In 56\% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24\% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20\% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged. Conclusions: Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety. ",
doi="10.2196/26085",
url="https://www.jmir.org/2021/6/e26085/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185001"
}


@Article{info:doi/10.2196/28864,
author="Ocasio, A. Manuel
and Fernandez, Isabel Maria
and Joseph, M. Ja'Lon
and Rezai, Roxana
and ",
title="Engaging Sexual and Gender Minority Youth in HIV Interventions Through Gay Dating Apps: Recruitment Protocol",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="22",
volume="10",
number="6",
pages="e28864",
keywords="HIV/AIDS",
keywords="adolescents",
keywords="recruitment",
keywords="dating apps",
keywords="msm",
keywords="mHealth",
keywords="gender",
keywords="gay",
keywords="behavior interventions",
keywords="mobile phone",
abstract="Background: HIV continues to disproportionately impact sexual and gender minority youth (SGMY) in the United States. Public health efforts have increasingly focused on developing efficacious interventions to curb the spread of HIV among SGMY and help those living with HIV achieve and sustain viral suppression. However, recruiting and engaging SGMY in prevention and care interventions is challenging. Objective: During the past decade, gay dating apps have quickly emerged as popular web-based spaces in which SGMY congregate. Although the recruitment of SGMY through these apps has been commonly reported, advertisement is the typical modality used, and direct recruitment approaches are not adequately described. This study aims to describe the process for developing a direct recruitment protocol for use in gay dating apps. Methods: The Adolescent Medicine Trials Network Comprehensive Adolescent Research and Engagement Studies is a community-based research program consisting of 3 interrelated studies testing scalable behavioral interventions to improve HIV prevention and care engagement among youth aged 12-24 years in Los Angeles and New Orleans. To supplement our in-person recruitment approaches for Comprehensive Adolescent Research and Engagement Studies, the New Orleans site formed a gay dating app recruitment team. In April 2018, the team developed a loosely structured protocol that included study-specific profiles and sample language to guide initial recruitment efforts. Two self-identified Black, gay cisgender male field recruiters field-tested the protocol on the popular gay dating app Jack'd. During the field test, the recruitment team met weekly to discuss the recruiters' experiences and user reactions. For example, we learned the importance of addressing concerns about study legitimacy and identifying appropriate ways to describe the study. We iteratively incorporated these lessons learned into the final protocol and developed a training program and tracking procedures before moving to full-scale implementation at both sites. Results: Adhering to this protocol yielded 162 enrollments in New Orleans (332 total enrollments across the two sites) throughout the recruitment period (April 2018 to August 2019). Most of these participants were sexual minority cisgender males (91\%), and the remainder were identified as members of gender minority groups. We outlined step-by-step instructions on training staff, engaging users, and scheduling and tracking recruitment activities. Conclusions: This paper provides a practical guide for researchers and community-based providers to implement a gay dating app recruitment protocol. Our experience indicates that gay dating app recruitment is feasible and fruitful when the staff members are knowledgeable, flexible, honest, and respectful to the user. Perhaps the most salient lesson we learned in approaching gay dating app users is the importance of setting clear and transparent intentions without judgment. As gay dating apps continue to increase in popularity, researchers need to stay vigilant to changing formats and develop systematic approaches to harness their potential as invaluable recruitment strategies for SGMY. International Registered Report Identifier (IRRID): RR1-10.2196/28864 ",
doi="10.2196/28864",
url="https://www.researchprotocols.org/2021/6/e28864",
url="http://www.ncbi.nlm.nih.gov/pubmed/34156342"
}


@Article{info:doi/10.2196/19114,
author="Bourdeau, Beth
and Miller, A. Brenda
and Byrnes, F. Hilary
and Woodall, Gill W.
and Buller, B. David
and Grube, W. Joel",
title="Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Jun",
day="15",
volume="4",
number="2",
pages="e19114",
keywords="adolescent",
keywords="sexual behavior",
keywords="parenting",
keywords="intervention",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation.  Objective: This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time.  Methods: A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents.  Results: Less than half (88/206, 42.7\%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations. Conclusions: Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term. Trial Registration: ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115 ",
doi="10.2196/19114",
url="https://pediatrics.jmir.org/2021/2/e19114",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128818"
}


@Article{info:doi/10.2196/24303,
author="Yang, Nancy
and Wu, Dan
and Zhou, Yi
and Huang, Shanzi
and He, Xi
and Tucker, Joseph
and Li, Xiaofeng
and Smith, M. Kumi
and Jiang, Xiaohui
and Wang, Yehua
and Huang, Wenting
and Fu, Hongyun
and Bao, Huanyu
and Jiang, Hongbo
and Dai, Wencan
and Tang, Weiming",
title="Sexual Health Influencer Distribution of HIV/Syphilis Self-Tests Among Men Who Have Sex With Men in China: Secondary Analysis to Inform Community-Based Interventions",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="1",
volume="23",
number="6",
pages="e24303",
keywords="sexual health influencer",
keywords="men who have sex with men",
keywords="HIV",
keywords="syphilis",
keywords="self-test",
keywords="sexual health",
keywords="influencer",
keywords="social network",
keywords="peers",
abstract="Background: Social network--based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. Objective: The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. Methods: In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach $\alpha$=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results: Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8\%) were sexual health influencers and 294 (79.2\%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95\% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5\% vs 67.3\%, P=.02) and were community-based organization volunteers (18.2\% vs 2.7\%, P<.001) than noninfluencers. More alters of sexual health influencers came from a rural area (45.5\% vs 23.8\%, P<.001), had below-college education (57.7\% vs 37.1\%, P<.001), and had multiple casual male sexual partners in the past 6 months (25.2\% vs 11.9\%, P<.001). Conclusions: Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage. ",
doi="10.2196/24303",
url="https://www.jmir.org/2021/6/e24303",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061035"
}


@Article{info:doi/10.2196/27262,
author="Kariithi, Edward
and Sharma, Monisha
and Kemunto, Emily
and Lagat, Harison
and Otieno, George
and Wamuti, M. Beatrice
and Katz, A. David
and Obong'o, Christopher
and Macharia, Paul
and Bosire, Rose
and Masyuko, Sarah
and Mugambi, Mary
and Levin, E. Carol
and Liu, Wenjia
and Roy Paladhi, Unmesha
and Weiner, J. Bryan
and Farquhar, Carey",
title="Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="20",
volume="10",
number="5",
pages="e27262",
keywords="implementation science",
keywords="assisted partner notification services",
keywords="HIV testing and counseling",
keywords="linkage to care",
keywords="western Kenya",
abstract="Background: Despite the effective scale-up of HIV testing and treatment programs, only 75\% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting. Objective: This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. Methods: Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases. Results: As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75\%), 6-month (1596/1641, 97.25\%), and 12-month (725/797, 90.9\%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic. Conclusions: The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery. International Registered Report Identifier (IRRID): DERR1-10.2196/27262 ",
doi="10.2196/27262",
url="https://www.researchprotocols.org/2021/5/e27262",
url="http://www.ncbi.nlm.nih.gov/pubmed/34014172"
}


@Article{info:doi/10.2196/22477,
author="Meiksin, Rebecca
and Melendez-Torres, J. G.
and Falconer, Jane
and Witzel, Charles T.
and Weatherburn, Peter
and Bonell, Chris",
title="eHealth Interventions to Address Sexual Health, Substance Use, and Mental Health Among Men Who Have Sex With Men: Systematic Review and Synthesis of Process Evaluations",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="23",
volume="23",
number="4",
pages="e22477",
keywords="eHealth",
keywords="digital health",
keywords="men who have sex with men",
keywords="sexual health",
keywords="HIV",
keywords="STI",
keywords="substance use",
keywords="mental health",
keywords="systematic review",
keywords="process evaluation",
abstract="Background: Men who have sex with men (MSM) face disproportionate risks concerning HIV and other sexually transmitted infections, substance use, and mental health. These outcomes constitute an interacting syndemic among MSM; interventions addressing all 3 together could have multiplicative effects. eHealth interventions can be accessed privately, and evidence from general populations suggests these can effectively address all 3 health outcomes. However, it is unclear how useable, accessible, or acceptable eHealth interventions are for MSM and what factors affect this. Objective: We undertook a systematic review of eHealth interventions addressing sexual risk, substance use, and common mental illnesses among MSM and synthesized evidence from process evaluations. Methods: We searched 19 databases, 3 trials registers, OpenGrey, and Google, and supplemented this by reference checks and requests to experts. Eligible reports were those that discussed eHealth interventions offering ongoing support to MSM aiming to prevent sexual risk, substance use, anxiety or depression; and assessed how intervention delivery or receipt varied with characteristics of interventions, providers, participants, or context. Reviewers screened citations on titles, abstracts, and then full text. Reviewers assessed quality of eligible studies, and extracted data on intervention, study characteristics, and process evaluation findings. The analysis used thematic synthesis. Results: A total of 12 reports, addressing 10 studies of 8 interventions, were eligible for process synthesis. Most addressed sexual risk alone or with other outcomes. Studies were assessed as medium and high reliability (reflecting the trustworthiness of overall findings) but tended to lack depth and breadth in terms of the process issues explored. Intervention acceptability was enhanced by ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM's experiences, and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race or ethnicity and educational level; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics. Conclusions: Findings suggest that eHealth interventions targeting sexual risk, substance use, and mental health are acceptable for MSM across sociodemographic groups. We identified the factors shaping MSM's receipt of such interventions, highlighting the importance of tailored content reflecting MSM's experiences and of language affirming sexual-minority identities. Intervention developers can draw on these findings to increase the usability and acceptability of integrated eHealth interventions to address the syndemic of sexual risk, substance use, and mental ill health among MSM. Evaluators of these interventions can draw on our findings to plan evaluations that explore the factors shaping usability and acceptability. ",
doi="10.2196/22477",
url="https://www.jmir.org/2021/4/e22477",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890855"
}


@Article{info:doi/10.2196/23412,
author="Silberzahn, E. Bradley
and Tomko, A. Catherine
and Clouse, Emily
and Haney, Katherine
and Allen, T. Sean
and Galai, Noya
and Footer, A. Katherine H.
and Sherman, G. Susan",
title="The EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) Study: Protocol for the Design, Implementation, and Evaluation of a Community-Based Combination HIV Prevention Intervention for Female Sex Workers in Baltimore, Maryland",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="16",
volume="10",
number="4",
pages="e23412",
keywords="sex work",
keywords="female sex worker",
keywords="recruitment",
keywords="retention",
keywords="sexually transmitted infection",
keywords="human immunodeficiency virus",
keywords="intervention",
keywords="community cohesion",
keywords="protocol design",
abstract="Background: Cisgender female sex workers (FSWs) experience high rates of HIV and sexually transmitted infections (STIs), including chlamydia and gonorrhea. Community empowerment--based responses to the risk environment of FSWs have been associated with significant reductions in HIV and STI risk and associated risk behaviors; however, evaluations of US-based interventions targeting FSWs are limited. Objective: The objective of this study is to describe the design, implementation, and planned evaluation strategy of an ongoing comprehensive community-level intervention in Baltimore City, Maryland, which aims to improve HIV and STI risk and cumulative incidence among FSWs. The two intervention components are the SPARC (Sex Workers Promoting Action, Risk Reduction, and Community Mobilization) drop-in center and the accompanying comprehensive mobile outreach program. The mission of SPARC is to provide low-barrier harm reduction services to FSWs, with a special focus on women who sell sex and use drugs. Services are provided through a harm reduction framework and include reproductive health and sexual health care; medication-assisted treatment; legal aid; counseling; showers, lockers, and laundry; and the distribution of harm reduction tools, including naloxone and sterile drug use supplies (eg, cookers, cotton, syringes, and pipes). Methods: The SPARC intervention is being evaluated through the EMERALD (Enabling Mobilization, Empowerment, Risk Reduction, and Lasting Dignity) study, which consists of a prospective 2-group comparative nonrandomized trial (n=385), a cross-sectional survey (n=100), and in-depth interviews assessing SPARC implementation (n=45). Participants enrolled in the nonrandomized trial completed a survey and HIV and STI testing at 4 intervals (baseline and 6, 12, and 18 months). Participants recruited from predefined areas closest to SPARC comprised the intervention group, and participants from all other areas of Baltimore were included in the control group. Results: We hypothesize that addressing structural drivers and more immediate medical needs, in combination with peer outreach, will improve the HIV and STI risk environment, leading to community empowerment, and reduce the HIV and STI cumulative incidence and behavioral risks of FSWs. Data collection is ongoing. A baseline description of the cohort is presented. Conclusions: In the United States, structural interventions aimed at reducing HIV and STIs among FSWs are scarce; to our knowledge, this is the first intervention of its kind in the United States. The results of the EMERALD study can be used to inform the development of future interventions targeting FSWs and other at-risk populations. Trial Registration: ClinicalTrials.gov NCT04413591; https://clinicaltrials.gov/ct2/show/NCT04413591. International Registered Report Identifier (IRRID): DERR1-10.2196/23412 ",
doi="10.2196/23412",
url="https://www.researchprotocols.org/2021/4/e23412",
url="http://www.ncbi.nlm.nih.gov/pubmed/33861210"
}


@Article{info:doi/10.2196/21082,
author="Garga, Shirali
and Thomas, Meryl
and Bhatia, Ashneet
and Sullivan, Aidan
and John-Leader, Franklin
and Pit, Sabrina",
title="Geosocial Networking Dating App Usage and Risky Sexual Behavior in Young Adults Attending a Music Festival: Cross-sectional Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="15",
volume="23",
number="4",
pages="e21082",
keywords="sexual health",
keywords="mobile apps",
keywords="young adults",
keywords="music festival",
abstract="Background: Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective: This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods: The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results: Of the respondents, 51.9\% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95\% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95\% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95\% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95\% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95\% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95\% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95\% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4\%) indicated that GNDAs should promote safe sex. Conclusions: This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices. ",
doi="10.2196/21082",
url="https://www.jmir.org/2021/4/e21082",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856354"
}


@Article{info:doi/10.2196/19511,
author="Yun, Ke
and Chu, Zhenxing
and Zhang, Jing
and Geng, Wenqing
and Jiang, Yongjun
and Dong, Willa
and Shang, Hong
and Xu, Junjie",
title="Mobile Phone Intervention Based on an HIV Risk Prediction Tool for HIV Prevention Among Men Who Have Sex With Men in China: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="13",
volume="9",
number="4",
pages="e19511",
keywords="eHealth intervention",
keywords="high-risk behavior intervention",
keywords="HIV risk prediction",
keywords="men who have sex with men",
abstract="Background: eHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM). Objective: This study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China. Methods: We performed a mobile phone--based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju---an online survey platform---was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform. Results: In total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5\%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference ?2.5; 95\% CI ?5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87\%, n=66/76 vs 70\%, n=54/77 respectively; odds ratio 2.81, 95\% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90\%, n=77/86 vs 79\%, n=65/82 respectively; odds ratio 2.20, 95\% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US \$131.60 on reducing 1 sexual partner and US \$19.70 for a 1\% increment in condom usage with casual partners. Conclusions: A comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271 ",
doi="10.2196/19511",
url="https://mhealth.jmir.org/2021/4/e19511",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847597"
}


@Article{info:doi/10.2196/25107,
author="Biello, B. Katie
and Hill-Rorie, Jonathan
and Valente, K. Pablo
and Futterman, Donna
and Sullivan, S. Patrick
and Hightow-Weidman, Lisa
and Muessig, Kathryn
and Dormitzer, Julian
and Mimiaga, J. Matthew
and Mayer, H. Kenneth",
title="Development and Evaluation of a Mobile App Designed to Increase HIV Testing and Pre-exposure Prophylaxis Use Among Young Men Who Have Sex With Men in the United States: Open Pilot Trial",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="24",
volume="23",
number="3",
pages="e25107",
keywords="HIV",
keywords="men who have sex with men",
keywords="pre-exposure prophylaxis",
keywords="pilot study",
keywords="mobile apps",
keywords="mobile phone",
keywords="mHealth",
abstract="Background: HIV disproportionately affects young men who have sex with men (YMSM) in the United States. Uptake of evidence-based prevention strategies, including routine HIV testing and use of pre-exposure prophylaxis (PrEP), is suboptimal in this population. Novel methods for reaching YMSM are required. Objective: The aim of this study is to describe the development and evaluate the feasibility and acceptability of the MyChoices app, a mobile app designed to increase HIV testing and PrEP use among YMSM in the United States. Methods: Informed by the social cognitive theory, the MyChoices app was developed using an iterative process to increase HIV testing and PrEP uptake among YMSM. In 2017, beta theater testing was conducted in two US cities to garner feedback (n=4 groups; n=28 YMSM). These findings were used to refine MyChoices, which was then tested for initial acceptability and usability in a technical pilot (N=11 YMSM). Baseline and 2-month postbaseline assessments and exit interviews were completed. Transcripts were coded using a deductive approach, and thematic analysis was used to synthesize data; app acceptability and use data were also reported. Results: The MyChoices app includes personalized recommendations for HIV testing frequency and PrEP use; information on types of HIV tests and PrEP; ability to search for nearby HIV testing and PrEP care sites; and ability to order free home HIV and sexually transmitted infection test kits, condoms, and lube. In theater testing, YMSM described that MyChoices appears useful and that they would recommend it to peers. Participants liked the look and feel of the app and believed that the ability to search for and be pinged when near an HIV testing site would be beneficial. Some suggested that portions of the app felt repetitive and preferred using casual language rather than formal or medicalized terms. Following theater testing, the MyChoices app was refined, and participants in the technical pilot used the app, on average, 8 (SD 5.0; range 2-18) times over 2 months, with an average duration of 28 (SD 38.9) minutes per session. At the 2-month follow-up, the mean System Usability Scale (0-100) score was 71 (ie, above average; SD 11.8). Over 80\% (9/11) of the participants reported that MyChoices was useful and 91\% (10/11) said that they would recommend it to a friend. In exit interviews, there was a high level of acceptability for the content, interface, and features. Conclusions: These data show the initial acceptability and user engagement of the MyChoices app. If future studies demonstrate efficacy in increasing HIV testing and PrEP uptake, the app is scalable to reach YMSM across the United States. Trial Registration: Clinicaltrials.gov NCT03179319; https://clinicaltrials.gov/ct2/show/NCT03179319 International Registered Report Identifier (IRRID): RR2-10.2196/10694 ",
doi="10.2196/25107",
url="https://www.jmir.org/2021/3/e25107",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759792"
}


@Article{info:doi/10.2196/21812,
author="Wiatrek, Sarah
and Zlotorzynska, Maria
and Rai, Ramona
and Sullivan, Patrick
and Sanchez, Travis",
title="The Annual American Men's Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Key Indicators Report 2018",
journal="JMIR Public Health Surveill",
year="2021",
month="Mar",
day="4",
volume="7",
number="3",
pages="e21812",
keywords="HIV",
keywords="internet",
keywords="men who have sex with men",
keywords="sexually transmitted infections",
keywords="surveillance",
keywords="survey",
doi="10.2196/21812",
url="https://publichealth.jmir.org/2021/3/e21812",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496669"
}


@Article{info:doi/10.2196/22572,
author="Reback, J. Cathy
and Fletcher, B. Jesse
and Mata, P. Raymond",
title="A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="22",
volume="10",
number="2",
pages="e22572",
keywords="HIV",
keywords="AIDS",
keywords="methamphetamine",
keywords="mHealth",
keywords="mobile app",
keywords="ART",
keywords="mobile phone",
abstract="Background: Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content. Objective: In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence). Methods: Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n={\textasciitilde}600) who received the brick-and-mortar group-based Getting Off intervention. Results: Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023. Conclusions: By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM. Trial Registration: Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946 International Registered Report Identifier (IRRID): DERR1-10.2196/22572 ",
doi="10.2196/22572",
url="https://www.researchprotocols.org/2021/2/e22572",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616547"
}


@Article{info:doi/10.2196/22277,
author="Schuler, Miriam
and Gieseler, Hannes
and Schweder, W. Katharina
and von Heyden, Maximilian
and Beier, M. Klaus",
title="Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data",
journal="JMIR Ment Health",
year="2021",
month="Feb",
day="19",
volume="8",
number="2",
pages="e22277",
keywords="pedophilia",
keywords="hebephilia",
keywords="child sexual offenses",
keywords="child sexual abuse material",
keywords="web-based assessment",
keywords="web-based treatment",
abstract="Background: Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively). Objective: The aim of this study was to describe the characteristics of the users of the Troubled Desire app. Methods: The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire. Results: The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7\%) and the United States (474/4161, 11.4\%). Approximately 78.9\% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities. Conclusions: The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending. ",
doi="10.2196/22277",
url="http://mental.jmir.org/2021/2/e22277/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33605895"
}


@Article{info:doi/10.2196/20898,
author="Hirvonen, Maija
and Purcell, Carrie
and Elliott, Lawrie
and Bailey, V. Julia
and Simpson, Anne Sharon
and McDaid, Lisa
and Moore, Laurence
and Mitchell, Rebecca Kirstin
and ",
title="Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="16",
volume="23",
number="2",
pages="e20898",
keywords="social media",
keywords="sexual health",
keywords="sex education",
keywords="peer education",
keywords="process evaluation",
keywords="school",
keywords="feasibility studies",
keywords="adolescent",
keywords="social networking",
abstract="Background: There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective: The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods: Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results: Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to---rather than embedded in---their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions: Invitation-only social media groups formed around peer supporters' existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding. ",
doi="10.2196/20898",
url="http://www.jmir.org/2021/2/e20898/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591287"
}


@Article{info:doi/10.2196/22980,
author="Dangerfield II, T. Derek
and Wylie, Charleen
and Anderson, N. Janeane",
title="Conducting Virtual, Synchronous Focus Groups Among Black Sexual Minority Men: Qualitative Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="8",
volume="7",
number="2",
pages="e22980",
keywords="engagement",
keywords="recruitment",
keywords="sexual health",
keywords="telehealth",
abstract="Background: Focus groups are useful to support HIV prevention research among US subpopulations, such as Black gay, Black bisexual, and other Black sexual minority men (BSMM). Virtual synchronous focus groups provide an electronic means to obtain qualitative data and are convenient to implement; however, the protocols and acceptability for conducting virtual synchronous focus groups in HIV prevention research among BSMM are lacking. Objective: This paper describes the protocols and acceptability of conducting virtual synchronous focus groups in HIV prevention research among BSMM Methods: Data for this study came from 8 virtual synchronous focus groups examined in 2 studies of HIV-negative BSMM in US cities, stratified by age (N=39): 2 groups of BSMM ages 18-24 years, 5 groups of BSMM ages 25-34 years, and 1 group of BSMM 35 years and older. Virtual synchronous focus groups were conducted via Zoom, and participants were asked to complete an electronic satisfaction survey distributed to their email via Qualtrics. Results: The age of participants ranged from 18 to 44 years (mean 28.3, SD 6.0). All participants ``strongly agreed'' or ``agreed'' that they were satisfied participating in an online focus group. Only 17\% (5/30) preferred providing written informed consent versus oral consent. Regarding privacy, most (30/30,100\%) reported ``strongly agree'' or ``agree'' that their information was safe to share with other participants in the group. Additionally, 97\% (29/30)  reported being satisfied with the incentive. Conclusions: Conducting virtual synchronous focus groups in HIV prevention research among BSMM is feasible. However, thorough oral informed consent with multiple opportunities for questions, culturally relevant facilitation procedures, and appropriate incentives are needed for optimal focus group participation. ",
doi="10.2196/22980",
url="http://publichealth.jmir.org/2021/2/e22980/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427671"
}


@Article{info:doi/10.2196/26192,
author="Logie, Carmen
and Okumu, Moses
and Hakiza, Robert
and Kibuuka Musoke, Daniel
and Berry, Isha
and Mwima, Simon
and Kyambadde, Peter
and Kiera, Mimy Uwase
and Loutet, Miranda
and Neema, Stella
and Newby, Katie
and McNamee, Clara
and Baral, D. Stefan
and Lester, Richard
and Musinguzi, Joshua
and Mbuagbaw, Lawrence",
title="Mobile Health--Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other)",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="2",
volume="10",
number="2",
pages="e26192",
keywords="adolescents and youth",
keywords="implementation research",
keywords="HIV testing",
keywords="mobile health",
keywords="refugee",
keywords="Uganda",
abstract="Background: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. Trial Registration: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. International Registered Report Identifier (IRRID): DERR1-10.2196/26192 ",
doi="10.2196/26192",
url="https://www.researchprotocols.org/2021/2/e26192",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528378"
}


@Article{info:doi/10.2196/23088,
author="Shegog, Ross
and Armistead, Laura
and Markham, Christine
and Dube, Sara
and Song, Hsing-Yi
and Chaudhary, Pooja
and Spencer, Angela
and Peskin, Melissa
and Santa Maria, Diane
and Wilkerson, Michael J.
and Addy, Robert
and Tortolero Emery, Susan
and McLaughlin, Jeffery",
title="A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="27",
volume="9",
number="1",
pages="e23088",
keywords="serious game",
keywords="intervention mapping",
keywords="sexual health",
keywords="adolescents",
keywords="sexually transmitted infections",
keywords="teenage pregnancy",
keywords="parent, communication",
keywords="intergenerational",
keywords="mobile phone",
abstract="Background: Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective: This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods: We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results: SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions: The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health. ",
doi="10.2196/23088",
url="http://games.jmir.org/2021/1/e23088/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502323"
}


@Article{info:doi/10.2196/19384,
author="Orlando, Stefano
and Palla, Ilaria
and Ciccacci, Fausto
and Triulzi, Isotta
and Thole, Darlington
and Sangar{\'e}, Mamary Hawa
and Marazzi, Cristina Maria
and Nielsen-Saines, Karin
and Turchetti, Giuseppe
and Palombi, Leonardo",
title="Improving Treatment Adherence and Retention of HIV-Positive Women Through Behavioral Change Interventions Aimed at Their Male Partners: Protocol for a Prospective, Controlled Before-and-After Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="25",
volume="10",
number="1",
pages="e19384",
keywords="retention in care",
keywords="therapeutic adherence and compliance",
keywords="men's role",
keywords="acquired immunodeficiency syndrome",
keywords="AIDS",
keywords="HIV",
keywords="behavior",
keywords="intervention study",
keywords="health education",
keywords="community health education",
keywords="Malawi",
keywords="mother-to-child transmission",
keywords="health-related behavior",
keywords="social ecology",
abstract="Background: According to the World Health Organization, in 2018, 37.9 million people were living with HIV globally. More than two-thirds were residing in sub-Saharan Africa, where the HIV prevalence in the adult population (aged 15-49 years) was 3.9\%. This population included 1.3 million pregnant women, of whom 82\% had received antiretroviral therapy (ART) for the prevention of HIV mother-to-child transmission. In these countries, one challenge is an insufficient level of treatment adherence, particularly in HIV-positive pregnant women. Among the causes, the lack of involvement from a male partner is a significant contributor to the problem. This issue has strongly emerged in Malawi, one of the countries with the highest HIV prevalence in the world: 9.2\% of its adult population were living with HIV in 2018. Objective: This study aims to assess 3 interventions that are aimed at improving ART adherence and retention among HIV-positive women through engagement with their male partners in 4 Malawian health care centers. Methods: The prospective, controlled before-and-after study is conducted in 3 phases (total duration: 24 months): preintervention, intervention, and postintervention analyses. The number of selected clusters (clinical centers) is limited to 4: one for each intervention, plus a cluster where no intervention is performed (control arm). The interventions are as follows: opening the facility on one Saturday per month only for men, defined as a special day; testing peer-to-peer counseling among men, male champions; and providing a noneconomic incentive to all women who are accompanied by their partners to the facility, nudge. The primary outcome of the study is to evaluate the differences in retention in care and adherence to therapeutic protocols among women; the intermediate outcome is the assessment of differences in male involvement. The level of male involvement in the health of their partners (intermediate outcome) will be evaluated through a dedicated questionnaire administered at baseline and in the postintervention phase. Data will be collected at the clinical centers and stored in 2 electronic databases managed using 2 different types of software. Results: The analysis of data collected in the 4 centers during the preintervention phase is ongoing, as enrollment ended on March 31, 2020. The total number of patients enrolled was 452 (Namandanje: 133; Kapeni: 78; Kapire: 75; and Balaka: 166). Meanwhile, several meetings have been conducted to organize the intervention phase. Conclusions: The study will identify the best intervention that enhances the involvement of male partners in women's health, using an approach that considers a broad spectrum of behaviors. An important aspect is the use of educational tools focused on messages, thereby initiating a reflective discussion of stereotypes and false beliefs related to the idea of masculinity present in the Malawian culture. International Registered Report Identifier (IRRID): DERR1-10.2196/19384 ",
doi="10.2196/19384",
url="http://www.researchprotocols.org/2021/1/e19384/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33492232"
}


@Article{info:doi/10.2196/24269,
author="Zhang, Wen
and Choi, Hang Edmond Pui
and Fong, Yee-Tak Daniel
and Wong, Yuen-Ha Janet",
title="A Moderated Mediation Analysis of Condom Negotiation and Sexual Orientation on the Relationship Between Sexual Coercion and Condom Use in Chinese Young Women: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="19",
volume="7",
number="1",
pages="e24269",
keywords="sex offenses",
keywords="sex orientation",
keywords="unprotected sex",
keywords="online research",
keywords="women's health",
abstract="Background: The high prevalence of sexual coercion against young women has become a significant public health issue in China and other regions around the world. Young women are also especially vulnerable to engage in inconsistent condom use because of low sexual control. Although the relationship between sexual coercion and condom use has been widely demonstrated, the mechanism of this relationship is still unclear. Objective: The objective of this study was to test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation is a moderator. Methods: Data were collected using web-based questionnaires and a total of 402 young Chinese women were included in the analysis. Sexual coercion was measured using a subscale of the Revised Conflict Tactics Scales and condom negotiation was measured using a subscale of the UCLA Multidimensional Condom Attitudes Scale. Sexual orientation was assessed using an item adopted from a previous study and condom use was calculated by the total number of times condoms were used divided by the total number of times sexual intercourse was engaged in during the past 3 months. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator. Results: The moderated mediation analysis indicated that the relationship between sexual coercion and condom use was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect: --0.80, 95\% boot CI --1.67 to --0.36) but not in sexual minority women (indirect effect: --0.33, 95\% boot CI --0.86 to 0.31). Conclusions: The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion. ",
doi="10.2196/24269",
url="http://publichealth.jmir.org/2021/1/e24269/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464220"
}


@Article{info:doi/10.2196/17173,
author="Knox, Justin
and Chen, Yi-No
and He, Qinying
and Liu, Guowu
and Jones, Jeb
and Wang, Xiaodong
and Sullivan, Patrick
and Siegler, Aaron",
title="Use of Geosocial Networking Apps and HIV Risk Behavior Among Men Who Have Sex With Men: Case-Crossover Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="15",
volume="7",
number="1",
pages="e17173",
keywords="HIV",
keywords="case-crossover study",
keywords="dating apps",
keywords="geosocial networking apps",
keywords="men who have sex with men",
keywords="sexual risk behavior",
abstract="Background: HIV disproportionately affects men who have sex with men (MSM) in China. The HIV epidemic is largely driven by unprotected anal sex (ie, sex not protected by condoms or HIV pre-exposure prophylaxis [PrEP]). The possible association between unprotected anal sex and the use of geospatial networking apps has been the subject of scientific debate. Objective: This study assessed whether users of a gay geospatial networking app in China were more likely to use condoms when they met their partners online versus offline. A case-crossover analysis, with each person serving as his own control, was employed to address the potential bias that men looking for sex partners through an online dating medium might have inherently different (and riskier) patterns of sexual behavior than men who do not use online dating media. Methods: A cross-sectional survey was administered in 2018 to adult male users of Blued---a gay geospatial networking app---in Beijing, Tianjin, Sichuan, and Yunnan, China. A case-crossover analysis was conducted among 1311 MSM not taking PrEP who reported engaging in both unprotected and protected anal sex in the previous 6 months. Multivariable conditional logistic regression was used to quantify the association between where the partnership was initiated (offline or online) and the act of unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias. Results: We identified 1311 matched instances where a person reported having both an unprotected anal sex act and a protected anal sex act in the previous 6 months. Of the most recent unprotected anal sex acts, 22.3\% (292/1311), were initiated offline. Of the most recent protected anal sex acts, 16.3\% (214/1311), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (odds ratio 2.66, 95\% CI 1.84 to 3.85, P<.001) compared with initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted. Conclusions: Among Blued users in 4 Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared with those that they initiated offline. The relationship was strong, with over 2.5 times the likelihood of engaging in unprotected anal sex in partnerships initiated offline compared with those initiated online. These findings suggest that geospatial networking apps are a proxy for, and not a cause of, high-risk behaviors for HIV infection; these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision. ",
doi="10.2196/17173",
url="http://publichealth.jmir.org/2021/1/e17173/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33448934"
}


@Article{info:doi/10.2196/20417,
author="Lemley, M. Shea
and Klausner, D. Jeffrey
and Young, D. Sean
and Stafylis, Chrysovalantis
and Mulatya, Caroline
and Oden, Neal
and Xie, Haiyi
and Revoredo, Leslie
and Shmueli-Blumberg, Dikla
and Hichborn, Emily
and McKelle, Erin
and Moran, Landhing
and Jacobs, Petra
and Marsch, A. Lisa",
title="Comparing Web-Based Platforms for Promoting HIV Self-Testing and Pre-Exposure Prophylaxis Uptake in High-Risk Men Who Have Sex With Men: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="19",
volume="9",
number="10",
pages="e20417",
keywords="HIV",
keywords="HIV self-testing",
keywords="men who have sex with men",
keywords="web-based platforms",
keywords="online advertising",
keywords="social media",
keywords="dating apps",
keywords="informational search websites",
abstract="Background: The majority of those living with HIV in the United States are men who have sex with men (MSM), and young, minority MSM account for more new HIV infections than any other group. HIV transmission can be reduced through detection and early treatment initiation or by starting pre-exposure prophylaxis (PrEP), but rates of testing are lower than recommended among MSM, and PrEP uptake has been slow. Although promoting HIV testing and PrEP uptake by placing advertisements on web-based platforms --- such as social media websites and dating apps --- is a promising approach for promoting HIV testing and PrEP, the relative effectiveness of HIV prevention advertising on common web-based platforms is underexamined. Objective: This study aims to evaluate the relative effectiveness of advertisements placed on 3 types of web-based platforms (social media websites, dating apps, and informational websites) for promoting HIV self-testing and PrEP uptake. Methods: Advertisements will be placed on social media websites (Facebook, Instagram, and Twitter), dating apps (Grindr, Jack'd, and Hornet), and informational search websites (Google, Yahoo, and Bing) to recruit approximately 400 young (18-30 years old), minority (Black or Latino) MSM at elevated risk of HIV exposure. Recruitment will occur in 3 waves, with each wave running advertisements on 1 website from each type of platform. The number of participants per platform is not prespecified, and recruitment in each wave will occur until approximately 133 HIV self-tests are ordered. Participants will complete a baseline survey assessing risk behavior, substance use, psychological readiness to test, and attitudes and then receive an electronic code to order a free home-based HIV self-test kit. Two follow-ups are planned to assess HIV self-test results and PrEP uptake. Results: Recruitment was completed in July 2020. Conclusions: Findings may improve our understanding of how the platform users' receptivity to test for HIV differs across web-based platforms and thus may assist in facilitating web-based HIV prevention campaigns. Trial Registration: ClinicalTrials.gov NCT04155502; https://clinicaltrials.gov/ct2/show/NCT04155502 International Registered Report Identifier (IRRID): DERR1-10.2196/20417 ",
doi="10.2196/20417",
url="https://www.researchprotocols.org/2020/10/e20417",
url="http://www.ncbi.nlm.nih.gov/pubmed/33074164"
}


@Article{info:doi/10.2196/22388,
author="Wang, Hongyi
and Zhang, Jing
and Chu, Zhenxing
and Hu, Qinghai
and Dong, Willa
and Huang, Xiaojie
and Chen, Yaokai
and Wang, Hui
and He, Xiaoqing
and Zhang, Lukun
and Hu, Zhili
and Bao, Rantong
and Li, Shangcao
and Li, Hang
and Cui, Sitong
and Jin, Xia
and Ding, Haibo
and Geng, Wenqing
and Jiang, Yongjun
and Xu, Junjie
and Shang, Hong",
title="Risk-Taking Behaviors and Adherence to HIV Pre-Exposure Prophylaxis in Users of Geosocial Networking Apps: Real-World, Multicenter Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="14",
volume="22",
number="10",
pages="e22388",
keywords="men who have sex with men (MSM)",
keywords="MSM",
keywords="HIV/AIDS prevention",
keywords="Pre-exposure prophylaxis (PrEP)",
keywords="geosocial networking app",
keywords="dating app",
keywords="adherence",
keywords="regimen switch",
abstract="Background: Over half of men who have sex with men (MSM) use geosocial networking (GSN) apps to encounter sex partners. GSN apps' users have become a unique large subpopulation among MSM for interventions concerning HIV prevention and control. Pre-exposure prophylaxis (PrEP) is a promising measure for HIV prevention, especially for MSM, but its effectiveness largely depends on medication adherence. However, little is known about PrEP adherence among GSN apps' users, which is critical to addressing the overall optimization of PrEP compliance outside of clinical trials in the context of large-scale implementation. Objective: The objective of this study is to understand the correlation between GSN apps' use and medication adherence among MSM receiving PrEP, with the aim to increase their awareness about PrEP use in order to increase adherence. Methods: This study based on the China Real-world Oral intake of PrEP (CROPrEP) project, a multicenter, real-world study of Chinese MSM on daily and event-driven PrEP. Eligible participants completed a detailed computer-assisted self-interview on sociodemographic, GSN apps' use, and sexual behavior. Then participants were followed up for 12 months and assessed for various characteristics (eg, PrEP delivery, adherence assessment, PrEP coverage of sexual activities, and regimens switch). A generalized estimation equation was used to analyze the predictors of medication adherence and regimen conversion among GSN apps' users and nonusers. Results: At baseline, 756 of the 1023 eligible participants (73.90\%) reported primarily using GSN apps to seek sexual partners, and GSN apps' users are more likely to have high-risk behaviors such as multiple sex partners and condomless anal intercourse than other nonusers (all P<.05). During follow-up, GSN apps' users had a significantly low level of pill-counting adherence than nonusers (adjusted odds ratio [aOR] 0.8, 95\% CI 0.6-1.0, P=.038). In the event-driven group, GSN apps' users had marginally lower levels of self-reported adherence (aOR 0.7, 95\% CI 0.4-1.0, P=.060) and lower PrEP coverage of sexual practices (aOR 0.6, 95\% CI 0.4-1.0, P=.038). Additionally, GSN apps' users seemed more likely to switch from event-driven to daily regimen (aOR 1.8, 95\% CI 0.9-3.3, P=.084). Conclusions: GSN apps' users are highly prevalent among MSM, despite their higher sexual risk and lower adherence levels, suggesting that eHealth needs to be introduced to the GSN platform to promote PrEP adherence. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IIN-17013762; https://tinyurl.com/yy2mhrv4. International Registered Report Identifier (IRRID): RR2-10.1186/s12879-019-4355-y ",
doi="10.2196/22388",
url="http://www.jmir.org/2020/10/e22388/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33052132"
}


@Article{info:doi/10.2196/17191,
author="Shanks, Sarah
and Morelli, Alessandra
and Ardines, Elena
and Holdsworth, Gillian
and Baraitser, Paula",
title="Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="20",
volume="8",
number="8",
pages="e17191",
keywords="SMS",
keywords="text message",
keywords="digital health",
keywords="sexual health",
keywords="self-care",
keywords="mobile phone",
abstract="Background: Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support. Objective: The aim of this study was to quantify the number of messages generated through user interaction with a two-way SMS text messaging support service within an online sexual health service and to thematically explore the content of the messages and type of support required to facilitate self-management. Methods: The content of all SMS text messages received by an online sexual health service was analyzed from April 4, 2018, to July 5, 2018. Messages were classified as being either administrative or clinical in nature and service or user initiated. For those messages that were both clinical and user initiated, a qualitative thematic analysis was completed to fully describe the content of the interactions. Results: A total of 267 actionable messages were generated per 1000 orders requested through the service. Of the 8562 messages, 5447 (63.62\%) messages were administrative and 3115 (36.38\%) were clinical. Overall, 4306 of the 8562 messages (50.29\%) responded to service-generated queries reflecting the public health and clinical responsibilities of an online provider, and 4256 (49.71\%) were user-generated queries, demonstrating a willingness by users to proactively engage with a two-way SMS text messaging support service. Of the 3115 clinical messages, 968 (31.08\%) clinical messages were user initiated and shared personal and complex clinical information, including requests for help with the self-testing process and personalized clinical advice relating to symptoms and treatment. Conclusions: This study demonstrates the willingness of users of an online sexual health service to engage with two-way SMS text messaging and provides insight into the quantity and nature of the support required to facilitate service delivery and self-care. Further work is required to understand the range of clinical problems that can be managed within this medium. ",
doi="10.2196/17191",
url="http://mhealth.jmir.org/2020/8/e17191/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32815820"
}


@Article{info:doi/10.2196/16725,
author="Lopez, Cristina
and Gilmore, K. Amanda
and Moreland, Angela
and Danielson, Kmett Carla
and Acierno, Ron",
title="Meeting Kids Where They Are At--A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="11",
volume="22",
number="8",
pages="e16725",
keywords="adolescents",
keywords="substance use",
keywords="sexual risk reduction",
keywords="telehealth",
keywords="prevention programs",
keywords="mobile phone",
abstract="Background: Rural African American youth lack access to drug and sexual risk--taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers. Objective: This study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth. Methods: Effective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents---Sisters Informing, Healing, Living, and Empowering (SIHLE)---and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation. Results: The descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population. Conclusions: Although more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability. ",
doi="10.2196/16725",
url="http://www.jmir.org/2020/8/e16725/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32780022"
}


@Article{info:doi/10.2196/16401,
author="Hill, J. Brandon
and Motley, N. Darnell
and Rosentel, Kris
and VandeVusse, Alicia
and Garofalo, Robert
and Schneider, A. John
and Kuhns, M. Lisa
and Kipke, D. Michele
and Reisner, Sari
and Rupp, M. Betty
and Sanchez, Maria
and McCumber, Micah
and Renshaw, Laura
and West Goolsby, Rachel
and Loop, Shane Matthew",
title="An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 2): Protocol for a Single-Arm Mixed Methods Pilot Test to Assess Feasibility and Acceptability",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="10",
volume="9",
number="8",
pages="e16401",
keywords="HIV/AIDS",
keywords="YMSM",
keywords="YTW",
keywords="GNC youth",
keywords="LGBTQ",
keywords="unemployment",
keywords="homelessness",
keywords="sex work",
abstract="Background: Young cisgender men who have sex with men (YMSM), young transgender women (YTW), and gender nonconforming (GNC) youth of color face substantial economic and health disparities. In particular, HIV risk and infection among these groups remains a significant public health issue. In 2017, 17\% of all new HIV diagnoses were attributed to male-to-male sexual contact among adolescents and young adults aged 13 to 24 years. However, such disparities cannot be attributed to individual-level factors alone but rather are situated within larger social and structural contexts that marginalize and predispose YMSM, YTW, and GNC youth of color to increased HIV exposure. Addressing social and structural risk factors requires intervention on distal drivers of HIV risk, including employment and economic stability. The Work2Prevent (W2P) study aims to target economic stability through job readiness and employment as a structural-level intervention for preventing adolescent and young adult HIV among black and Latinx YMSM, YTW, and GNC youth. This study seeks to assess intervention feasibility and acceptability in the target populations and determine preliminary efficacy of the intervention to increase employment and reduce sexual risk behaviors. Objective: The goal of the research is to pilot-test a tailored, theoretically informed employment intervention program among YMSM, YTW, and GNC youth of color. This intervention was adapted from Increased Individual Income and Independence, an existing evidence-based employment program for HIV-positive adults during phase 1 of the W2P study. Methods: The employment intervention will be pilot-tested among vulnerable YMSM, YTW, and GNC youth of color in a single-arm pre-post trial to assess feasibility, acceptability, and preliminary estimates of efficacy. Results: Research activities began in March 2018 and were completed in November 2019. Overall, 5 participants were enrolled in the pretest and 51 participants were enrolled in the pilot. Conclusions: Interventions that address the social and structural drivers of HIV exposure and infection are sorely needed in order to successfully bend the curve in the adolescent and young adult HIV epidemic. Employment as prevention has the potential to be a scalable intervention that can be deployed among this group. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16401 ",
doi="10.2196/16401",
url="https://www.researchprotocols.org/2020/8/e16401",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773376"
}


@Article{info:doi/10.2196/16384,
author="Hill, J. Brandon
and Motley, N. Darnell
and Rosentel, Kris
and VandeVusse, Alicia
and Garofalo, Robert
and Schneider, A. John
and Kuhns, M. Lisa
and Kipke, D. Michele
and Reisner, Sari
and Rupp, M. Betty
and Sanchez, Maria
and McCumber, Micah
and Renshaw, Laura
and Loop, Shane Matthew",
title="An Employment Intervention Program (Work2Prevent) for Young Men Who Have Sex With Men and Transgender Youth of Color (Phase 1): Protocol for Determining Essential Intervention Components Using Qualitative Interviews and Focus Groups",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="10",
volume="9",
number="8",
pages="e16384",
keywords="HIV/AIDS",
keywords="YMSM",
keywords="YTW",
keywords="GNC youth",
keywords="LGBTQ",
keywords="unemployment",
keywords="homelessness",
keywords="sex work",
abstract="Background: HIV continues to have a disparate impact on young cisgender men who have sex with men (YMSM), young trans women (YTW), and gender-nonconforming (GNC) youth who are assigned male at birth. Outcomes are generally worse among youth of color. Experiences of discrimination and marginalization often limit educational attainment and may even more directly limit access to gainful employment. Though seemingly distal, these experiences influence young people's proximity to HIV risk by limiting their access to health care and potentially moving them toward sex work as a means of income as well as increased substance use. Work2Prevent (W2P) aims to achieve economic stability through employment as a structural-level intervention for preventing adolescent and young adult HIV infection. The study will pilot-test an effective, theoretically driven employment program (increased individual income and independence [iFOUR]), for HIV-positive adults, and adapt it to the needs of black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years who are vulnerable to HIV exposure. Objective: This paper aimed to describe the protocol for the exploratory phase of W2P. The purpose of this phase was to determine the essential components needed for a structural-level employment intervention aimed at increasing job-seeking self-efficacy and career readiness among black and Latinx YMSM, YTW, and GNC youth aged 16 to 24 years. Methods: The exploratory phase of the W2P study consisted of in-depth interviews and focus groups with members of the target community as well as brief interviews with lesbian, gay, bisexual, transgender, and queer (LGBTQ)--inclusive employers. The study team will conduct in-depth interviews with up to 12 YMSM and 12 YTW and GNC youth, up to 10 focus groups with a maximum of 40 YMSM and 40 YTW and GNC youth, and up to 40 brief interviews with LGBTQ-inclusive employers. Participants will be recruited through a community-based recruiter, passive recruitment in community spaces and on social media, and active recruitment by research staff in community spaces serving LGBTQ youth. Results: In-depth interviews were conducted with 21 participants, and 7 focus groups were conducted with 46 participants in total. In addition, 19 brief interviews with LGBTQ-inclusive employers were conducted. The analysis of the data is underway. Conclusions: Preliminary findings from the formative phase of the study will be used to inform the tailoring and refinement of the iFOUR adult-based intervention into the youth-focused W2P intervention curriculum. Perspectives from YMSM, YTW, GNC youth, and LGBTQ-inclusive employers offer a multidimensional view of the barriers and facilitators to adolescent and young adult LGBTQ employment. This information is critical to the development of a culturally appropriate and relevant youth-focused intervention. Trial Registration: ClinicalTrials.gov NCT03313310; https://clinicaltrials.gov/ct2/show/NCT03313310 International Registered Report Identifier (IRRID): DERR1-10.2196/16384 ",
doi="10.2196/16384",
url="https://www.researchprotocols.org/2020/8/e16384",
url="http://www.ncbi.nlm.nih.gov/pubmed/32773383"
}


@Article{info:doi/10.2196/16783,
author="Jongbloed, Kate
and Pearce, E. Margo
and Thomas, Vicky
and Sharma, Richa
and Pooyak, Sherri
and Demerais, Lou
and Lester, T. Richard
and Schechter, T. Martin
and Spittal, M. Patricia
and ",
title="The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="27",
volume="8",
number="7",
pages="e16783",
keywords="Indigenous",
keywords="mobile health",
keywords="mHealth",
keywords="text messaging",
keywords="substance use",
keywords="HIV/AIDS",
abstract="Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4\%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78\%). Most participants with a phone reported having an unlimited texting plan (39/55; 71\%), using the internet on their phone (44/59; 75\%), and texting daily (44/55; 80\%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3\%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9\% vs 11.7\%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population. ",
doi="10.2196/16783",
url="https://mhealth.jmir.org/2020/7/e16783",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716311"
}


@Article{info:doi/10.2196/17894,
author="Wang, Zixin
and Yang, Xue
and Mo, H. Phoenix K.
and Fang, Yuan
and Ip, Mary Tsun Kwan
and Lau, F. Joseph T.",
title="Influence of Social Media on Sexualized Drug Use and Chemsex Among Chinese Men Who Have Sex With Men: Observational Prospective Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="24",
volume="22",
number="7",
pages="e17894",
keywords="influence of social media",
keywords="sexualized drug use",
keywords="chemsex",
keywords="men who have sex with men",
keywords="prospective observational cohort study",
abstract="Background: Sexualized drug use (SDU; the use of any psychoactive substance before or during sexual intercourse) is prevalent among men who have sex with men (MSM) and may aggravate the worsening HIV epidemic in this key population. Objective: This observational prospective cohort study investigated factors predicting the occurrence of SDU within a 6-month follow-up period among a sample of MSM in Hong Kong. We hypothesized that perceptions related to SDU would mediate the association between the influence of social media/gay social networking apps and SDU during the follow-up period. Methods: Participants were Chinese-speaking men in Hong Kong, China who had anal intercourse with at least one man in the past year. Among 600 participants who completed the baseline telephone survey, 407 (67.8\%) completed another telephone survey 6 months later. Logistic regression models and path analysis were fitted. Results: At Month 6, 6.9\% (28/407) and 4.4\% (18/407) of participants reported SDU and chemsex during the follow-up period. After adjustment for significant baseline background variables (use of pre-exposure prophylaxis; history of HIV and other sexually transmitted infections; anal intercourse with nonregular male sex partners, condomless anal intercourse with men, multiple male sex partnerships, and SDU at baseline), three constructs of the Theory of Planned Behavior (TPB) were significantly associated with SDU during the follow-up period: (1) positive attitudes toward SDU (adjusted odds ratio [AOR] 1.19, 95\% CI 1.05-1.36), (2) perceived support for SDU from significant others (AOR 1.15, 95\% CI 1.01-1.30), and (3) perceived behavioral control of refraining from SDU (AOR 0.76, 95\% CI 0.59-0.98). Exposure to information supporting SDU on social media and gay social networking apps was also significantly associated with SDU (AOR 1.11, 95\% CI 1.01-1.22). Bootstrapping analyses indicated that social media influence was indirectly associated with SDU through TPB-related perceptions of SDU ($\beta$=.04; B=.002, 95\% CI 0.001-0.01). Conclusions: Social media and gay social networking apps may be a major source of influence on MSM's perceptions and actual behaviors related to SDU. ",
doi="10.2196/17894",
url="http://www.jmir.org/2020/7/e17894/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706705"
}


@Article{info:doi/10.2196/14833,
author="Jennings Mayo-Wilson, Larissa
and Glass, E. Nancy
and Labrique, Alain
and Davoust, Melissa
and Ssewamala, M. Fred
and Linnemayr, Sebastian
and Johnson, W. Matthew",
title="Feasibility of Assessing Economic and Sexual Risk Behaviors Using Text Message Surveys in African-American Young Adults Experiencing Homelessness and Unemployment: Single-Group Study",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="17",
volume="4",
number="7",
pages="e14833",
keywords="HIV",
keywords="sexual risk behaviors",
keywords="homelessness",
keywords="text messages",
keywords="young adults",
keywords="economic",
keywords="mobile phones",
abstract="Background: Text messages offer the potential to better evaluate HIV behavioral interventions using repeated longitudinal measures at a lower cost and research burden. However, they have been underused in US minority settings. Objective: This study aims to examine the feasibility of assessing economic and sexual risk behaviors using text message surveys. Methods: We conducted a single-group study with 17 African-American young adults, aged 18-24 years, who were economically disadvantaged and reported prior unprotected sex. Participants received a text message survey once each week for 5 weeks. The survey contained 14 questions with yes-no and numeric responses on sexual risk behaviors (ie, condomless sex, sex while high or drunk, and sex exchange) and economic behaviors (ie, income, employment, and money spent on HIV services or products). Feasibility measures were the number of participants who responded to the survey in a given week, the number of questions to which a participant responded in each survey, and the number of hours spent from sending a survey to participants to receiving their response in a given week. One discussion group was used to obtain feedback. Results: Overall, 65\% (n=11/17) of the participants responded to at least one text message survey compared with 35\% (n=6/17) of the participants who did not respond. The majority (n=7/11, 64\%) of the responders were women. The majority (n=4/6, 67\%) of nonresponders were men. An average of 7.6 participants (69\%) responded in a given week. Response rates among ever responders ranged from 64\% to 82\% across the study period. The mean number of questions answered each week was 12.6 (SD 2.7; 90\% of all questions), ranging from 72\% to 100\%. An average of 6.4 participants (84\%) answered all 14 text message questions in a given week, ranging from 57\% to 100\%. Participants responded approximately 8.7 hours (SD 10.3) after receiving the survey. Participants were more likely to answer questions related to employment, condomless sex, and discussions with sex partners. Nonresponse or skip was more often used for questions at the end of the survey relating to sex exchange and money spent on HIV prevention services or products. Strengths of the text message survey were convenience, readability, short completion time, having repeated measures over time, and having incentives. Conclusions: Longitudinal text message surveys may be a valuable tool for assessing HIV-related economic and sexual risk behaviors. Trial Registration: ClinicalTrials.gov NCT03237871; https://clinicaltrials.gov/ct2/show/NCT03237871 ",
doi="10.2196/14833",
url="https://formative.jmir.org/2020/7/e14833",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706656"
}


@Article{info:doi/10.2196/14242,
author="Krishnamurti, Tamar
and Davis, L. Alexander
and Fischhoff, Baruch",
title="Inferring Sexually Transmitted Infection Risk From Attractiveness in Online Dating Among Adolescents and Young Adults: Exploratory Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="9",
volume="22",
number="6",
pages="e14242",
keywords="risk perception",
keywords="heuristics",
keywords="sexually transmitted infections",
keywords="online dating",
keywords="dating apps",
keywords="adolescents",
keywords="sexual health",
keywords="attractiveness",
keywords="halo effect",
abstract="Background: Sexually transmitted infection (STI) rates are on the rise among adolescents and young adults in the United States. With the popularity of online dating, adolescents and young adults must increasingly rely on limited cues to make initial judgments about potential sexual partners, including judgments about STI risk. Objective: This study aimed to assess whether in the context of online dating, an attractiveness heuristic would be used for STI risk assessment. We hypothesized that consistent with research on halo effects, decision makers would judge more attractive people to be less likely to have STIs. Methods: In a survey experiment, we asked participants to determine which individual in each of 20 sets of paired photographs was enrolled in a personals website for people with publicly disclosed STIs. Results: Despite financial incentives for accuracy and high levels of self-confidence in their judgments, participants performed no better than chance at identifying individuals with self-reported STIs. Contrary to our hypothesis, however, more attractive people were judged as being more likely to have an STI. This relationship appears to be mediated by inferences regarding the target individual's sexual behavior, with more attractive individuals considered to have more partners. Conclusions: On showing adolescents and young adults photographs offering no diagnostic information about STIs, they appeared to use attractiveness as a cue for sexual risk, which was mediated by the belief that attractive individuals have more sexual opportunities. Health care providers may wish to address this heuristic process among their adolescent patients in discussions about sexual health. ",
doi="10.2196/14242",
url="https://www.jmir.org/2020/6/e14242",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442128"
}


@Article{info:doi/10.2196/15964,
author="Davis, C. Angela
and Wright, JC Cassandra
and Murphy, Stacey
and Dietze, Paul
and Temple-Smith, J. Meredith
and Hellard, E. Margaret
and Lim, SC Megan",
title="A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of ``The Gist''",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="1",
volume="22",
number="6",
pages="e15964",
keywords="co-design",
keywords="pornography literacy",
keywords="sexual health",
keywords="sex education",
abstract="Background: The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy. Objective: The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people. Methods: In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team. Results: Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point. Conclusions: This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues. ",
doi="10.2196/15964",
url="https://www.jmir.org/2020/6/e15964",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348268"
}


@Article{info:doi/10.2196/15096,
author="Ampt, H. Frances
and L'Engle, Kelly
and Lim, C. Megan S.
and Plourde, F. Kate
and Mangone, Emily
and Mukanya, Mudogo Collins
and Gichangi, Peter
and Manguro, Griffins
and Hellard, Margaret
and Stoov{\'e}, Mark
and Chersich, F. Matthew
and Jaoko, Walter
and Agius, A. Paul
and Temmerman, Marleen
and Wangari, Winnie
and Luchters, Stanley",
title="A Mobile Phone--Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="29",
volume="8",
number="5",
pages="e15096",
keywords="sex work",
keywords="mobile health (mHealth)",
keywords="unintended pregnancy",
keywords="qualitative research",
abstract="Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants' responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs' lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change. ",
doi="10.2196/15096",
url="https://mhealth.jmir.org/2020/5/e15096",
url="http://www.ncbi.nlm.nih.gov/pubmed/32469326"
}


@Article{info:doi/10.2196/18043,
author="Vente, Teresa
and Daley, Mary
and Killmeyer, Elizabeth
and Grubb, K. Laura",
title="Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study",
journal="JMIR Pediatr Parent",
year="2020",
month="May",
day="26",
volume="3",
number="1",
pages="e18043",
keywords="self-harm",
keywords="social media",
keywords="nonsuicidal self-injury",
keywords="sexting",
abstract="Background: Previous studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages. Objective: This study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors. Methods: This was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used. Results: Most adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3\%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4\%) of adolescents reported sharing sexually explicit messages.  Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48). Conclusions: Results show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices. ",
doi="10.2196/18043",
url="http://pediatrics.jmir.org/2020/1/e18043/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452820"
}


@Article{info:doi/10.2196/16702,
author="Carrotte, R. Elise
and Davis, C. Angela
and Lim, SC Megan",
title="Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses",
journal="J Med Internet Res",
year="2020",
month="May",
day="14",
volume="22",
number="5",
pages="e16702",
keywords="pornography",
keywords="content analysis",
keywords="sexual media",
keywords="sexual violence",
keywords="sexual behavior",
abstract="Background: Owing to increasing access to Web-based pornography and concerns about its impact on viewers, many researchers have attempted to systematically analyze the content of pornography. Objective: We aimed to systematically review the results of quantitative content analyses of video-based pornography and identify the degree to which the following behaviors are depicted: (1) sexual behaviors and themes, (2) condom use during sexual behaviors, and (3) aggression and violence. Methods: Inclusion criteria for article eligibility were (1) peer-reviewed publications, (2) articles in the English language, (3) articles describing a quantitative content analysis of video pornography, and (4) articles quantitatively examining at least one variable of interest. Results: A total of 23 studies met the eligibility criteria. Studies varied in scope and definitions of behavioral variables. Condom use was rare, although more commonly depicted in gay male pornography (36\%-64\% videos) compared with heterosexual pornography (2\%-3\% videos). Normative sexual behaviors were most frequently depicted in pornography samples (eg, vaginal intercourse in 48\%-90\% and fellatio in 52\%-90\% of heterosexual videos; fellatio in 66\%-100\% and anal intercourse in 70\%-80\% of gay male videos). Extreme acts of violence (1\%-3\% videos) and rape (0\%-6\% videos) were relatively rare. However, more subtle forms of aggression, such as spanking (5\%-75\% videos), were more common, and unequal sexual relations (eg, domination) were also common. Although estimates varied by study, dominating and violent behaviors were nearly always directed toward women. Conclusions: Condom nonuse and gender inequalities are common in pornography, which has implications for the development of healthy sexual relationships among pornography viewers. Higher quality research, including study replication and consistent methodological choices, is needed. ",
doi="10.2196/16702",
url="https://www.jmir.org/2020/5/e16702",
url="http://www.ncbi.nlm.nih.gov/pubmed/32406863"
}


@Article{info:doi/10.2196/15888,
author="Sun, J. Christina
and Anderson, M. Kirsten
and Kuhn, Tamara
and Mayer, Liat
and Klein, H. Charles",
title="A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="12",
volume="8",
number="5",
pages="e15888",
keywords="transgender persons",
keywords="HIV",
keywords="sexual health",
keywords="minority health",
keywords="health care disparities",
keywords="health status disparities",
abstract="Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer--friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. ",
doi="10.2196/15888",
url="https://mhealth.jmir.org/2020/5/e15888",
url="http://www.ncbi.nlm.nih.gov/pubmed/32396131"
}


@Article{info:doi/10.2196/17295,
author="Pensak, J. Meredith
and Lundsberg, S. Lisbet
and Stanwood, L. Nancy
and Cutler, S. Abigail
and Gariepy, M. Aileen",
title="Development and Feasibility Testing of a Video Game to Reduce High-Risk Heterosexual Behavior in Spanish-Speaking Latinx Adolescents: Mixed Methods Study",
journal="JMIR Serious Games",
year="2020",
month="May",
day="4",
volume="8",
number="2",
pages="e17295",
keywords="adolescent",
keywords="Latino",
keywords="Latina",
keywords="sexual activity",
keywords="video game",
abstract="Background: Similar to broader health disparities, Latinx adolescents have higher rates of high-risk sexual behavior resulting in pregnancy rates that are 2 times higher and sexually transmitted infection rates that are 5 to 8 times higher than non-Hispanic, white adolescents. Novel approaches are needed to reduce high-risk sexual behavior among Spanish-speaking Latinx adolescents who represent the fastest-growing group of US immigrants. Objective: This study aimed to partner with Spanish-speaking Latinx adolescents in a participatory design process to develop and test a Spanish-language video game intervention to decrease high-risk heterosexual behavior. Methods: This is an iterative, two-phase, mixed methods study. In phase 1, we conducted focus groups with Spanish-speaking Latinx adolescents to elicit feedback on the content and format of an existing English-language video game. Feedback was then incorporated into an expanded and culturally adapted Spanish-language video game. In phase 2, we pilot tested the feasibility, acceptability, and preliminary efficacy of the new Spanish-language video game intervention by measuring known antecedents to sexual behavior (intentions, self-efficacy, risk perception, and knowledge) assessed at enrollment and 12-week follow-up. We applied a thematic analysis to examine focus group feedback and a bivariate analysis to analyze pre- and postquantitative data. Results: In phase 1, 15 Spanish-speaking Latinx adolescents provided feedback for further video game development. A Spanish-language video game was then produced and tested in phase 2. We recruited and enrolled 24 Spanish-speaking Latinx adolescents aged 15 to 17 years. Participants played the video game for an average of 4.2 hours during monitored sessions. Pilot testing demonstrated feasibility and acceptability; 65\% (3/20) of participants stated that they would play it again, and 65\% (3/20) said they would recommend it to friends. Condom-specific knowledge did significantly increase between baseline and follow-up (P=.007). Other variables of sexual behavior antecedents did not differ significantly between baseline and 12-week follow-up. Conclusions: An iterative participatory design process in partnership with Spanish-speaking adolescents produced an innovative and acceptable Spanish-language video game intervention aimed at decreasing high-risk sexual behavior in adolescents. Pilot testing demonstrated preliminary feasibility and yielded essential information for further video game development. ",
doi="10.2196/17295",
url="http://games.jmir.org/2020/2/e17295/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32364507"
}


@Article{info:doi/10.2196/17901,
author="Gannon, Brittany
and Davis, Rindcy
and Kuhns, M. Lisa
and Rodriguez, Garibay Rafael
and Garofalo, Robert
and Schnall, Rebecca",
title="A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="7",
volume="4",
number="4",
pages="e17901",
keywords="young adults",
keywords="usability",
keywords="HIV",
keywords="mHealth",
keywords="young men",
keywords="mobile phone",
abstract="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. ",
doi="10.2196/17901",
url="https://formative.jmir.org/2020/4/e17901",
url="http://www.ncbi.nlm.nih.gov/pubmed/32254043"
}


@Article{info:doi/10.2196/16336,
author="Tzilos Wernette, Golfo
and Countryman, Kristina
and Khatibi, Kristie
and Riley, Erin
and Stephenson, Rob",
title="Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="30",
volume="22",
number="3",
pages="e16336",
keywords="adolescent",
keywords="alcohol",
keywords="sexually transmitted infections",
keywords="risky sex",
keywords="pregnancy",
abstract="Background: Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use. Objective: This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6\%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health. Methods: We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls. Results: We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls. Conclusions: Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls. ",
doi="10.2196/16336",
url="http://www.jmir.org/2020/3/e16336/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224484"
}


@Article{info:doi/10.2196/15330,
author="LeBeau, Kelsea
and Carr, Cary
and Hart, Mark",
title="Examination of Gender Stereotypes and Norms in Health-Related Content Posted to Snapchat Discover Channels: Qualitative Content Analysis",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="20",
volume="22",
number="3",
pages="e15330",
keywords="social media",
keywords="online social networking",
keywords="health behavior",
keywords="sexual health",
keywords="social norms",
keywords="gender",
keywords="gender role",
keywords="mobile applications",
abstract="Background: Snapchat has seen one of the most rapid, and unprecedented, growths in the history of social networking sites and social media with 3 billion Snapchats sent daily. In 2015, Snapchat introduced a new feature, Snapchat Discover, providing a unique way for publishers, such as magazines, to connect their content to Snapchat users. Objective: This study aimed to evaluate qualitatively the health-related content distributed among male-focused and female-focused Discover channels and to determine whether differences exist between the content posted to these channels. Methods: Magazine Discover channels with male and female target audiences were identified based on the magazine's claimed audience and a search of Snapchat Discover's magazine publishers, resulting in the selection of two male-focused and two female-focused channels. Stories were collected daily from each of the selected channels during a 4-week period. Using the constant comparative method, 406 Discover stories were collected and analyzed. Results: Differences in health content coverage existed between male- and female-focused channels. General health stories from male channels comprised 7.5\% (10/134) of total stories compared with 22.8\% (62/272) for female channels. Sexual health stories from male channels comprised 3.0\% (4/134) of total stories compared with 18.8\% (51/272) for female channels. Moreover, female-focused channels' content was more comprehensive. Female audiences were portrayed as being health information seekers, concerned with sexual health and male satisfaction, primarily responsible for contraception and pregnancy prevention, and less informed about sex. Male audiences were portrayed as being less likely to seek health information, obsessed with and driven by sex, and less concerned with sexual health. Conclusions: Understanding the content shared to social media is important, especially when considering the implications content may have for behavior. In terms of content, these findings suggest Discover channels appear to promote gender stereotypes and norms for health and sexual health through the information posted. ",
doi="10.2196/15330",
url="http://www.jmir.org/2020/3/e15330/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32196461"
}


@Article{info:doi/10.2196/16251,
author="Cordova, David
and Munoz-Velazquez, Jaime
and Mendoza Lua, Frania
and Fessler, Kathryn
and Warner, Sydni
and Delva, Jorge
and Adelman, Nicole
and 
and Fernandez, Angela
and Bauermeister, Jose",
title="Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="17",
volume="8",
number="3",
pages="e16251",
keywords="youth",
keywords="mHealth",
keywords="illicit drugs",
keywords="sex behavior",
keywords="HIV",
keywords="primary care",
abstract="Background: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (? score mean 0.36, SD 0.51) and self-efficacy (? score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95\% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95\% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95\% CI ?0.39 to 0.73), and drug use (Cohen h=1.28, 95\% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95\% CI ?0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95\% CI ?0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95\% CI ?0.39 to 0.72). Conclusions: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410. ",
doi="10.2196/16251",
url="https://mhealth.jmir.org/2020/3/e16251",
url="http://www.ncbi.nlm.nih.gov/pubmed/32181747"
}


@Article{info:doi/10.2196/15569,
author="Stephenson, Rob
and Metheny, Nicholas
and Goldenberg, Tamar
and Bakunina, Nataliia
and De Vasconcelos, Sofia
and Blondeel, Karel
and Kiarie, James
and Toskin, Igor",
title="Brief Intervention to Prevent Sexually Transmitted Infections and Unintended Pregnancies: Protocol of a Mixed Methods Feasibility Study",
journal="JMIR Res Protoc",
year="2020",
month="Mar",
day="10",
volume="9",
number="3",
pages="e15569",
keywords="brief interventions",
keywords="brief sexuality-related communication",
keywords="sexual health",
keywords="risky sexual behavior",
keywords="STIs",
keywords="unintended pregnancy",
abstract="Background: Sexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. Objective: The aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). Methods: This protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. Results: Phase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. Conclusions: This feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers. International Registered Report Identifier (IRRID): DERR1-10.2196/15569 ",
doi="10.2196/15569",
url="https://www.researchprotocols.org/2020/3/e15569",
url="http://www.ncbi.nlm.nih.gov/pubmed/32154787"
}


@Article{info:doi/10.2196/13201,
author="Zheng, Zhi-Wei
and Yang, Qing-Ling
and Liu, Zhong-Qi
and Qiu, Jia-Ling
and Gu, Jing
and Hao, Yuan-Tao
and Song, Chao
and Jia, Zhong-Wei
and Hao, Chun",
title="Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="31",
volume="22",
number="1",
pages="e13201",
keywords="affect",
keywords="men who have sex with men",
keywords="sexual behaviors",
keywords="health status",
keywords="social media",
abstract="Background: Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. Objective: This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. Methods: A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. Results: A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1\% (97/387) of negative postings were related to health and 13.4\% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=?0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=?0.8306; P<.001) and a lower positive emotion score (beta=?0.3743; P<.001). Conclusions: The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time. ",
doi="10.2196/13201",
url="http://www.jmir.org/2020/1/e13201/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012054"
}


@Article{info:doi/10.2196/14803,
author="Espinosa da Silva, Cristina
and Smith, R. Laramie
and Patterson, L. Thomas
and Semple, J. Shirley
and Harvey-Vera, Alicia
and Nunes, Stephanie
and Rangel, Gudelia
and Pines, A. Heather",
title="Stigma and Web-Based Sex Seeking Among Men Who Have Sex With Men and Transgender Women in Tijuana, Mexico: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Jan",
day="30",
volume="6",
number="1",
pages="e14803",
keywords="social stigma",
keywords="discrimination",
keywords="internet",
keywords="mobile apps",
keywords="men who have sex with men",
keywords="transgender persons",
keywords="sexual and gender minorities",
keywords="Mexico",
abstract="Background: Stigma toward sexual and gender minorities is an important structural driver of HIV epidemics among men who have sex with men (MSM) and transgender women (TW) globally. Sex-seeking websites and apps are popular among MSM and TW. Interventions delivered via Web-based sex-seeking platforms may be particularly effective for engaging MSM and TW in HIV prevention and treatment services in settings with widespread stigma toward these vulnerable populations. Objective: To assess the potential utility of this approach, the objectives of our study were to determine the prevalence of Web-based sex seeking and examine the effect of factors that shape or are influenced by stigma toward sexual and gender minorities on Web-based sex seeking among MSM and TW in Tijuana, Mexico. Methods: From 2015 to 2018, 529 MSM and 32 TW were recruited through venue-based and respondent-driven sampling. Interviewer-administered surveys collected information on Web-based sex seeking (past 4 months) and factors that shape or are influenced by stigma toward sexual and gender minorities (among MSM and TW: traditional machismo, internalized stigma related to same-sex sexual behavior or gender identity, and outness related to same-sex sexual behavior or gender identity; among MSM only: sexual orientation and history of discrimination related to same-sex sexual behavior). A total of 5 separate multivariable logistic regression models were used to examine the effect of each stigma measure on Web-based sex seeking. Results: A total of 29.4\% (165/561) of our sample reported seeking sex partners on the Web. Web-based sex seeking was negatively associated with greater endorsement of traditional machismo values (adjusted odds ratio [AOR] 0.36, 95\% CI 0.19 to 0.69) and greater levels of internalized stigma (AOR 0.96, 95\% CI 0.94 to 0.99). Web-based sex seeking was positively associated with identifying as gay (AOR 2.13, 95\% CI 1.36 to 3.33), greater outness (AOR 1.17, 95\% CI 1.06 to 1.28), and a history of discrimination (AOR 1.83, 95\% CI 1.08 to 3.08). Conclusions: Web-based sex-seeking is relatively common among MSM and TW in Tijuana, suggesting that it may be feasible to leverage Web-based sex-seeking platforms to engage these vulnerable populations in HIV prevention and treatment services. However, HIV interventions delivered through Web-based sex-seeking platforms may have limited reach among those most affected by stigma toward sexual and gender minorities (ie, those who express greater endorsement of traditional machismo values, greater levels of internalized stigma, lesser outness, and nongay identification), given that within our sample they were least likely to seek sex on the Web. ",
doi="10.2196/14803",
url="https://publichealth.jmir.org/2020/1/e14803",
url="http://www.ncbi.nlm.nih.gov/pubmed/32031963"
}


@Article{info:doi/10.2196/12917,
author="Nielsen, Anna
and B{\aa}genholm, Aspasia
and De Costa, Ayesha",
title="Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="28",
volume="4",
number="1",
pages="e12917",
keywords="mHealth",
keywords="youth",
keywords="sexual health",
keywords="condoms",
keywords="Sweden",
abstract="Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. ",
doi="10.2196/12917",
url="https://formative.jmir.org/2020/1/e12917",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012038"
}


@Article{info:doi/10.2196/15354,
author="Wirtz, L. Andrea
and Weir, Wilson Brian
and Mon, Hnin Sandra Hsu
and Sirivongrangson, Pachara
and Chemnasiri, Tareerat
and Dunne, F. Eileen
and Varangrat, Anchalee
and Hickey, C. Andrew
and Decker, R. Michele
and Baral, Stefan
and Okanurak, Kamolnetr
and Sullivan, Patrick
and Valencia, Rachel
and Thigpen, C. Michael
and Holtz, H. Timothy
and Mock, A. Philip
and Cadwell, Betsy
and Adeyeye, Adeola
and Rooney, F. James
and Beyrer, Chris
and ",
title="Testing the Effectiveness and Cost-Effectiveness of a Combination HIV Prevention Intervention Among Young Cisgender Men Who Have Sex With Men and Transgender Women Who Sell or Exchange Sex in Thailand: Protocol for the Combination Prevention Effectiveness Study",
journal="JMIR Res Protoc",
year="2020",
month="Jan",
day="27",
volume="9",
number="1",
pages="e15354",
keywords="HIV",
keywords="prevention",
keywords="pre-exposure prophylaxis",
keywords="men who have sex with men",
keywords="transgender persons",
keywords="sex work",
keywords="Thailand",
keywords="cost-effectiveness",
abstract="Background: Pre-exposure prophylaxis (PrEP) is highly effective in the prevention of HIV acquisition, particularly for men who have sex with men (MSM). Questions remain on the benefits of PrEP and implementation strategies for those at occupational risk of HIV acquisition in sex work, as well as on methods to support adherence among young people who initiate PrEP. Objective: The Combination Prevention Effectiveness study for young cisgender MSM and transgender women (TGW) aims to assess the effectiveness and cost-effectiveness of a combination intervention among HIV-uninfected young MSM and TGW engaged in sex work in Thailand. Methods: This open-label, nonrandomized assessment compares the relative effectiveness of a combination prevention intervention with and without daily oral emtricitabine and tenofovir disoproxil fumarate (Truvada) PrEP with SMS-based adherence support. HIV-uninfected young MSM and TGW aged 18 to 26 years in Bangkok and Pattaya who self-report selling/exchanging sex at least once in the previous 12 months are recruited by convenience sampling and peer referral and are eligible regardless of their intent to initiate PrEP. At baseline, participants complete a standard assessment for PrEP eligibility and may initiate PrEP then or at any time during study participation. All participants complete a survey and HIV testing at baseline and every 3 months. Participants who initiate PrEP complete monthly pill pickups and may opt-in to SMS reminders. All participants are sent brief weekly SMS surveys to assess behavior with additional adherence questions for those who initiated PrEP. Adherence is defined as use of 4 or more pills within the last 7 days. The analytic plan uses a person-time approach to assess HIV incidence, comparing participant time on oral PrEP to participant time off oral PrEP for 12 to 24 months of follow-up, using a propensity score to control for confounders. Enrollment is based on the goal of observing 620 person-years (PY) on PrEP and 620 PY off PrEP. Results: As of February 2019, 445 participants (417 MSM and 28 TGW) have contributed approximately 168 PY with 95\% (73/77) retention at 12 months. 74.2\% (330/445) of enrolled participants initiated PrEP at baseline, contributing to 134 PY of PrEP adherence, 1 PY nonadherence, and 33 PY PrEP nonuse/noninitiation. Some social harms, predominantly related to unintentional participant disclosure of PrEP use and peer stigmatization of PrEP and HIV, have been identified. Conclusions: The majority of cisgender MSM and TGW who exchange sex and participate in this study are interested in PrEP, report taking sufficient PrEP, and stay on PrEP, though additional efforts are needed to address community misinformation and stigma. This novel multilevel, open-label study design and person-time approach will allow evaluation of the effectiveness and cost-effectiveness of combination prevention intervention in the contexts of both organized sex work and exchanged sex. International Registered Report Identifier (IRRID): RR1-10.2196/15354 ",
doi="10.2196/15354",
url="https://www.researchprotocols.org/2020/1/e15354",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012113"
}


@Article{info:doi/10.2196/14800,
author="Hu, Maogui
and Xu, Chengdong
and Wang, Jinfeng",
title="Spatiotemporal Analysis of Men Who Have Sex With Men in Mainland China: Social App Capture-Recapture Method",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="24",
volume="8",
number="1",
pages="e14800",
keywords="HIV risk",
keywords="men who have sex with men",
keywords="MSM distribution",
keywords="migration",
abstract="Background: In China, the cases of newly diagnosed HIV/AIDS in men who have sex with men (MSM) have increased more than tenfold since 2006. However, the MSM population size, geographical distribution, and migration patterns are largely unknown. Objective: Our aim is to estimate the number, spatial distribution, and migration of MSM populations in mainland China using big data from social networking. Methods: We collected 85 days of data on online users of a social networking MSM app in mainland China. Daily online MSM users and their migration across the country were investigated during a holiday period and a nonholiday period. Using the capture-mark-recapture model, we designed an experiment consisting of two independent samples to estimate the total provincial MSM population. Results: The estimate of MSM in mainland China was 8,288,536 (95\% CI 8,274,931-8,302,141), accounting for 1.732\% (95\% CI 1.729\%-1.734\%) of adult men aged 18 to 64 years. The average daily number of MSM social networking online across mainland China was 1,198,682 during the nonholiday period. The five provinces (including municipalities) with the highest average number of daily online MSM numbers were Guangdong (n=141,712), Jiangsu (n=90,710), Zhejiang (n=72,212), Shandong (n=68,065), and Beijing (n=66,057). The proportion of daily online MSM among adult men in different cities varied from 0.04\% to 0.96\%, with a mean of 0.20\% (SD 0.14\%). Three migrating centers---Guangdong, Beijing, and the Yangtze River Delta (Shanghai-Zhejiang-Jiangsu)---accounted for 57.23\% of MSM migrants in the county. Conclusions: The percentage of MSM among adult men in mainland China is at the middle level compared with other Asia and Pacific countries. However, the number of MSM is very large, and the distribution is uneven. Both MSM distribution and migration are highly affected by socioeconomic status. ",
doi="10.2196/14800",
url="https://mhealth.jmir.org/2020/1/e14800",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012086"
}


@Article{info:doi/10.2196/14696,
author="Wambura, Mwita
and Drake, Mary
and Kuringe, Evodius
and Majani, Esther
and Nyato, Daniel
and Casalini, Caterina
and Materu, Jacqueline
and Mjungu, Deusdedit
and Nnko, Soori
and Mbita, Gaspar
and Kalage, Esther
and Shao, Amani
and Changalucha, John
and Komba, Albert",
title="Cash Transfer to Adolescent Girls and Young Women to Reduce Sexual Risk Behavior (CARE): Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Dec",
day="20",
volume="8",
number="12",
pages="e14696",
keywords="adolescent",
keywords="female",
keywords="HIV infections/epidemiology",
keywords="HIV Infections/prevention and control",
keywords="Herpesvirus 2",
keywords="humans",
keywords="incidence",
keywords="motivation",
keywords="Tanzania",
abstract="Background: The HIV epidemic in Eastern and Southern Africa is characterized by a high incidence and prevalence of HIV infection among adolescent girls and young women (AGYW) aged 15-24 years. For instance, in some countries, HIV prevalence in AGYW aged 20-24 years exceeds that in AGYW aged 15-19 years by 2:1. Sauti (meaning voices), a project supported by the United States Agency for International Development, is providing HIV combination prevention interventions to AGYW in the Shinyanga region, Tanzania. Objective: The aim of this study is to determine the impact of cash transfer on risky sexual behavior among AGYW receiving cash transfer and HIV combination prevention interventions. This paper describes the research methods and general protocol of the study. Risky sexual behavior will be assessed by herpes simplex virus type 2 (HSV-2) incidence, compensated sex (defined as sexual encounters motivated by exchange for money, material support, or other benefits), and intergenerational sex (defined as a sexual partnership between AGYW and a man 10 or more years older). Through a qualitative study, the study seeks to understand how the intervention affects the structural and behavioral drivers of the HIV epidemic. Methods: The trial employs audio computer-assisted self-interviewing, participatory group discussions (PGDs), and case studies to collect data. A total of 30 matched villages (15 intervention and 15 control clusters) were randomized to either receive cash transfer delivered over 18 months in addition to other HIV interventions (intervention arm) or to receive other HIV interventions without cash transfer (control arm). Study participants are interviewed at baseline and 6, 12, and 18 months to collect data on demographics, factors related to HIV vulnerabilities, family planning, sexual risk behavior, gender-based violence, and HSV-2 and HIV infections. A total of 6 PGDs (3 intervention, 3 control) were conducted at baseline to describe perceptions and preferences of different intervention packages, whereas 20 case studies are used to monitor and unearth the dynamics involved in delivery and uptake of cash transfer. Results: The study was funded in June 2017; enrollment took place in December 2017. A total of two rounds of the follow-up survey are complete, and one round has yet to be conducted. The results are expected in December 2019 and will be disseminated through conferences and peer-reviewed publications. Conclusions: This study will document the synergetic impact of cash transfer in the presence of HIV combination prevention interventions on risky sexual behavior among out-of-school AGYW. The results will strengthen the evidence of cash transfer in the reduction of risky sexual behavior and provide feasible HIV prevention strategies for AGYW. Trial Registration: Clinicaltrials.gov NCT03597243; https://clinicaltrials.gov/ct2/show/NCT03597243. International Registered Report Identifier (IRRID): DERR1-10.2196/14696 ",
doi="10.2196/14696",
url="https://www.researchprotocols.org/2019/12/e14696",
url="http://www.ncbi.nlm.nih.gov/pubmed/31859686"
}


@Article{info:doi/10.2196/15426,
author="Violette, R. Lauren
and Niemann, A. Lisa
and McMahan, M. Vanessa
and Katz, A. David
and Chavez, R. Pollyanna
and Clark, A. Hollie
and Cornelius-Hudson, Andy
and Ethridge, F. Steven
and McDougal, J. Sarah
and Ure II, George
and Stekler, D. Joanne
and Delaney, P. Kevin",
title="Group Sex Events Among Cisgender Men Who Have Sex With Men: Cross-Sectional and Longitudinal Survey Study to Explore Participation and Risk-Taking Behaviors",
journal="JMIR Res Protoc",
year="2019",
month="Nov",
day="27",
volume="8",
number="11",
pages="e15426",
keywords="men who have sex with men",
keywords="group sex",
keywords="HIV infection",
keywords="sexual networks",
keywords="risk",
keywords="threesomes",
keywords="four-or-more-somes",
abstract="Background: Group sex events (GSEs) are common among cisgender men who have sex with men (MSM), pose a unique risk profile for HIV and sexually transmitted disease (STD) transmission, and may be on the rise, in part because of Web-based networking platforms. However, collecting data on GSEs can be challenging, and many gaps exist in our knowledge about GSE participation among MSM. Objective: The objective of this study was to develop survey questions addressing aggregate and partner-specific group sex behaviors to measure prevalence of GSEs and associated risks in persons participating in Project Diagnostic Evaluation To Expand Critical Testing Technologies (DETECT), including MSM seeking HIV and STD testing at a public clinic in Seattle, Washington. Methods: We developed a computer self-assisted survey that included questions about participant demographics, sexual history, and risk behaviors, including group sex, as a part of Project DETECT, a Centers for Disease Control and Prevention--funded study evaluating point-of-care HIV tests. Aggregate and partner-specific questions asked about participation in all GSEs, threesomes, and four-or-more-somes including questions about number and HIV status of sex partners and condom use during the events. To evaluate question performance, we assessed the discrepancies in reporting between the aggregate and partner-specific questions, quantified question refusal rates, and calculated the additional time required to answer the GSE questions. Information about network density (number of partnerships of overlapping duration) was estimated and compared for MSM who did and did not report GSEs. Results: Among 841 visits by 690 MSM who were asked any group sex survey question, participation in a GSE of any type in the past 3 months was reported at 293 visits (293/841, 34.8\%). We found that 9.0\% (76/841) of MSM in the sample reported ?1 four-or-more-some in the partner-specific questions but did not report in the aggregate. The proportion of refusals on any given aggregate GSE-related question ranged from 0\% (0/273) to 10.6\% (15/141) (median 2.6\%) and partner-specific questions ranged from 0\% (0/143) to 22\% (5/23) (median 3.0\%), with questions about four-or-more-somes having the highest proportions of refusals. Completing the aggregate group sex questions added 1 to 2 minutes and the partner-specific questions added an additional 2 to 4 minutes per partner to the total survey length. As expected, the partner-specific GSE questions documented higher density of sexual networks that was not captured by asking about total partner counts and overlap of specific partnerships. Conclusions: We found that the Project DETECT survey was able to obtain nuanced information about GSEs. The question skip patterns and consistency checks were effective, and survey fatigue was minimal. More research is needed on GSEs, and our survey represents a promising data collection tool to help fill gaps in knowledge about the subject. ",
doi="10.2196/15426",
url="https://www.researchprotocols.org/2019/11/e15426",
url="http://www.ncbi.nlm.nih.gov/pubmed/31774403"
}


@Article{info:doi/10.2196/13766,
author="Abuelezam, N. Nadia
and Reshef, A. Yakir
and Novak, David
and Grad, Hagai Yonatan
and Seage III, R. George
and Mayer, Kenneth
and Lipsitch, Marc",
title="Interaction Patterns of Men Who Have Sex With Men on a Geosocial Networking Mobile App in Seven United States Metropolitan Areas: Observational Study",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="12",
volume="21",
number="9",
pages="e13766",
keywords="men who have sex with men",
keywords="sexual behavior",
keywords="race factors",
keywords="population dynamics",
abstract="Background: The structure of the sexual networks and partnership characteristics of young black men who have sex with men (MSM) may be contributing to their high risk of contracting HIV in the United States. Assortative mixing, which refers to the tendency of individuals to have partners from one's own group, has been proposed as a potential explanation for disparities. Objective: The objective of this study was to identify the age- and race-related search patterns of users of a diverse geosocial networking mobile app in seven metropolitan areas in the United States to understand the disparities in sexually transmitted infection and HIV risk in MSM communities. Methods: Data were collected on user behavior between November 2015 and May 2016. Data pertaining to behavior on the app were collected for men who had searched for partners with at least one search parameter narrowed from defaults or used the app to send at least one private chat message and used the app at least once during the study period. Newman assortativity coefficient (R) was calculated from the study data to understand assortativity patterns of men by race. Pearson correlation coefficient was used to assess assortativity patterns by age. Heat maps were used to visualize the relationship between searcher's and candidate's characteristics by age band, race, or age band and race. Results: From November 2015 through May 2016, there were 2,989,737 searches in all seven metropolitan areas among 122,417 searchers. Assortativity by age was important for looking at the profiles of candidates with correlation coefficients ranging from 0.284 (Birmingham) to 0.523 (San Francisco). Men tended to look at the profiles of candidates that matched their race in a highly assortative manner with R ranging from 0.310 (Birmingham) to 0.566 (Los Angeles). For the initiation of chats, race appeared to be slightly assortative for some groups with R ranging from 0.023 (Birmingham) to 0.305 (Los Angeles). Asian searchers were most assortative in initiating chats with Asian candidates in Boston, Los Angeles, New York, and San Francisco. In Birmingham and Tampa, searchers from all races tended to initiate chats with black candidates. Conclusions: Our results indicate that the age preferences of MSM are relatively consistent across cities, that is, younger MSM are more likely to be chatted with and have their profiles viewed compared with older MSM, but the patterns of racial mixing are more variable. Although some generalizations can be made regarding Web-based behaviors across all cities, city-specific usage patterns and trends should be analyzed to create targeted and localized interventions that may make the most difference in the lives of MSM in these areas. ",
doi="10.2196/13766",
url="https://www.jmir.org/2019/9/e13766/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31516124"
}


@Article{info:doi/10.2196/12824,
author="Davis, C. Angela
and Wright, C. Cassandra J.
and Temple-Smith, J. Meredith
and Hellard, E. Margaret
and Lim, C. Megan S.",
title="A Health Education Website Developed to Meet Young People's Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study",
journal="JMIR Form Res",
year="2019",
month="Aug",
day="13",
volume="3",
number="3",
pages="e12824",
keywords="adolescent",
keywords="pornography",
keywords="health promotion",
keywords="internet",
keywords="sex education",
abstract="Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. ",
doi="10.2196/12824",
url="http://formative.jmir.org/2019/3/e12824/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31411140"
}


@Article{info:doi/10.2196/11165,
author="Swendeman, Dallas
and Arnold, Mayfield Elizabeth
and Harris, Danielle
and Fournier, Jasmine
and Comulada, Scott W.
and Reback, Cathy
and Koussa, Maryann
and Ocasio, Manuel
and Lee, Sung-Jae
and Kozina, Leslie
and Fern{\'a}ndez, Isabel Maria
and Rotheram, Jane Mary
and ",
title="Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Aug",
day="09",
volume="8",
number="8",
pages="e11165",
keywords="adolescents",
keywords="HIV/AIDS",
keywords="mHealth",
keywords="homelessness",
keywords="MSM",
keywords="transgender",
keywords="prevention",
abstract="Background: America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective: This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods: Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70\% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results: The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective. Trial Registration: ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9) International Registered Report Identifier (IRRID): DERR1-10.2196/11165 ",
doi="10.2196/11165",
url="https://www.researchprotocols.org/2019/8/e11165/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31400109"
}


@Article{info:doi/10.2196/13220,
author="Shafii, Taraneh
and Benson, K. Samantha
and Morrison, M. Diane",
title="Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study",
journal="J Med Internet Res",
year="2019",
month="Jul",
day="10",
volume="21",
number="7",
pages="e13220",
keywords="sexual health",
keywords="risk behaviors",
keywords="adolescent",
keywords="healthcare providers",
keywords="computer-assisted diagnosis",
keywords="teen health",
keywords="preventive care",
abstract="Background: Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. Objective: The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. Methods: At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. Results: The large majority (87.6\%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6\%) reporting they had been formally trained in MI. Despite all (195/195, 100.0\%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1\%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. Conclusions: In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents. ",
doi="10.2196/13220",
url="http://www.jmir.org/2019/7/e13220/"
}


@Article{info:doi/10.2196/13015,
author="Starks, J. Tyrel
and Robles, Gabriel
and Pawson, Mark
and Jimenez, H. Ruben
and Gandhi, Monica
and Parsons, T. Jeffrey
and Millar, M. Brett",
title="Motivational Interviewing to Reduce Drug Use and HIV Incidence Among Young Men Who Have Sex With Men in Relationships and Are High Priority for Pre-Exposure Prophylaxis (Project PARTNER): Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2019",
month="Jul",
day="04",
volume="8",
number="7",
pages="e13015",
keywords="HIV",
keywords="pre-exposure prophylaxis",
keywords="substance-related disorders",
keywords="sexual behavior",
keywords="sexual partners",
abstract="Background: Men who have sex with men (MSM) currently account for more than two-thirds of new HIV diagnoses in the United States and, among young MSM (YMSM) aged 20 to 29 years, as many as 79\% to 84\% of new infections occur between primary partners. Contributing to HIV risk, YMSM use drugs at comparatively high rates. To date, no interventions have been developed that specifically address the unique needs of partnered YMSM or incorporate a focus on relationship factors in addressing personal motivation for change. Objective: The study's primary aim is to evaluate the efficacy of the PARTNER intervention and evaluate potential moderators or mediators of intervention effects. The study's secondary aims were to gather ideographic data to inform a future effectiveness implementation study and develop a novel biomarker for pre-exposure prophylaxis (PrEP) adherence by analyzing PrEP drug levels in fingernails. Methods: PARTNER is a 4-session motivational interviewing--based intervention that integrates video-based communication training to address drug use and HIV prevention among partnered YMSM. This study utilizes a randomized controlled trial design to compare the PARTNER intervention with an attention-matched psychoeducation control arm that provides information about HIV-risk reduction, PrEP, and substance use. Participants are randomized in a 1-to-1 ratio stratified on age disparity between partners, racial composition of the couple, and relationship length. Follow-up assessments are conducted at 3-, 6-, 9-, and 12-months postbaseline. The study recruits and enrolls 240 partnered YMSM aged between 18 to 29 years at a research center in New York City. Participants will be HIV-negative and report recent (past 30-day) drug use and condomless anal sex with casual partners; a nonmonogamous primary partner (regardless of HIV status); or a serodiscordant primary partner (regardless of sexual agreement). Primary outcomes (drug use and HIV sexual transmission risk behavior) are assessed via a Timeline Follow-back interview. Biological markers of outcomes are collected for drug use (fingernail assay), sexual HIV transmission risk (rectal and urethral gonorrhea and chlamydia testing), and PrEP adherence (dried blood spots and fingernails for a novel PrEP drug level assay). Results: The study opened for enrollment in February 2018. Anticipated completion of enrollment is October 2021. Primary outcome analyses will begin after final follow-up completion. Conclusions: Existing research on partnered YMSM within the framework of Couples Interdependence Theory (CIT) has suggested that relationship factors (eg, dyadic functioning and sexual agreements) are meaningfully related to drug use and HIV transmission risk. Results pertaining to the efficacy of the proposed intervention and the identification of putative moderators and mediators will substantially inform the tailoring of interventions for YMSM in relationships and contribute to a growing body of relationship science focused on enhancing health outcomes. Trial Registration: ClinicalTrials.gov NCT03396367; https://clinicaltrials.gov/ct2/show/NCT03396367 (Archived by WebCite at http://www.webcitation.org/78ti7esTc. International Registered Report Identifier (IRRID): DERR1-10.2196/13015 ",
doi="10.2196/13015",
url="https://www.researchprotocols.org/2019/7/e13015/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31274114"
}


@Article{info:doi/10.2196/13338,
author="Milton, C. Alyssa
and Gill, A. Benjamin
and Davenport, A. Tracey
and Dowling, Mitchell
and Burns, M. Jane
and Hickie, B. Ian",
title="Sexting, Web-Based Risks, and Safety in Two Representative National Samples of Young Australians: Prevalence, Perspectives, and Predictors",
journal="JMIR Ment Health",
year="2019",
month="Jun",
day="17",
volume="6",
number="6",
pages="e13338",
keywords="youth",
keywords="sexual behavior",
keywords="cyberbullying",
keywords="mental health",
keywords="internet",
keywords="safety",
keywords="risk",
abstract="Background: The rapid uptake of information and communication technology (ICT) over the past decade---particularly the smartphone---has coincided with large increases in sexting. All previous Australian studies examining the prevalence of sexting activities in young people have relied on convenience or self-selected samples. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental health problems, suicidal thoughts and behaviors, and sexting. How sexters (including those who receive, send, and two-way sext) and nonsexters apply ICT safety skills warrants further research. Objective: This study aimed to extend the Australian sexting literature by measuring (1) changes in the frequency of young people's sexting activities from 2012 to 2014; (2) young people's beliefs about sexting; (3) association of demographics, mental health and well-being items, and internet use with sexting; and (4) the relationship between sexting and ICT safety skills. Methods: Computer-assisted telephone interviewing using random digit dialing was used in two Young and Well National Surveys conducted in 2012 and 2014. The participants included representative and random samples of 1400 young people aged 16 to 25 years. Results: From 2012 to 2014, two-way sexting (2012: 521/1369, 38.06\%; 2014: 591/1400, 42.21\%; P=.03) and receiving sexts (2012: 375/1369, 27.39\%; 2014: 433/1400, 30.93\%; P<.001) increased significantly, not sexting (2012: 438/1369, 31.99\%; 2014: 356/1400, 25.43\%; P<.001) reduced significantly, whereas sending sexts (2012: n=35/1369, 2.56\%; 2014: n=20/1400, 1.43\%; P>.05) did not significantly change. In addition, two-way sexting and sending sexts were found to be associated with demographics (male, second language, and being in a relationship), mental health and well-being items (suicidal thoughts and behaviors and body image concerns), and ICT risks (cyberbullying others and late-night internet use). Receiving sexts was significantly associated with demographics (being male and not living with parents or guardians) and ICT risks (being cyberbullied and late-night internet use). Contrary to nonsexters, Pearson correlations demonstrated that all sexting groups (two-way, sending, and receiving) had a negative relationship with endorsing the ICT safety items relating to being careful when using the Web and not giving out personal details. Conclusions: Our research demonstrates that most young Australians are sexting or exposed to sexting in some capacity. Sexting is associated with some negative health and well-being outcomes---specifically, sending sexts is linked to suicidal thoughts and behaviors, body image issues, and ICT safety risks, including cyberbullying and late-night internet use. Those who do sext are less likely to engage in many preventative ICT safety behaviors. How the community works in partnership with young people to address this needs to be a multifaceted approach, where sexting is positioned within a wider proactive conversation about gender, culture, psychosocial health, and respecting and caring for each other when on the Web. ",
doi="10.2196/13338",
url="https://mental.jmir.org/2019/6/e13338/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31210139"
}