Development of a Smartphone App-Based Messaging Intervention to Encourage HIV Self-Testing Among Men Who Have Sex with Men in Hefei, China

Introduction: Research in China has found that MSM avoid HIV testing at clinics or public health departments due in part to stigma and fear of disclosure of their MSM behaviors to professionals. HIV self-testing provides a strategic opportunity to increase rates of HIV testing among populations such as Chinese MSM that might not seek in-person testing. However, one concern of HIV self-testing is the absence of counselors to provide assistance in performing the test, interpreting the result, and seeking referrals as needed. Use of mobile health (mHealth) technology is a strategy for providing necessary timely information, assistance, and referrals to MSM who use the self-test kit. The purpose of this study was to investigate the feasibility of incorporating mobile phone app-messaging, delivered via WeChat – a popular mobile application in China – in the context of HIV self-testing for MSM in China.

Methods: Qualitative interviews were conducted with 36 men who have sex with men (MSM) aged 18 and older recruited using convenience sampling in Hefei, China. After administering the HIV self-test kit on their own, participants were interviewed about their testing experience, feasibility of incorporating WeChat messaging with HIV self-testing, and preferred WeChat message tone, content, and frequency. All interviews were audio-recorded and transcribed in Chinese and then translated into English. Thematic analysis was conducted using NVivo software.

Results: Participants believed WeChat messaging would be an acceptable way to deliver the intervention. Desired message content included: HIV prevention, transmission, and treatment information, particularly dispelling myths and local HIV epidemiology data; HIV testing locations and times; and stories from people living with HIV. Participants suggested messages should not only have fear-based appeal but should also include topics not HIV-related, such as information about LGBT friendly medical providers, gossip, and community events. Men preferred that messages combined both text and pictures, including comics or cartoons, and were a balance between professional and entertaining. Some privacy concerns were reported.

Conclusions: Combining WeChat messaging with HST was found to be an acceptable way to target behavior change among MSM in Hefei. The findings of this qualitative phase will inform message content and implementation for future pilot testing of the intervention.