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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05325476
Other study ID # R33TW011665
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date April 11, 2023
Est. completion date June 2025

Study information

Verified date May 2024
Source University of Connecticut
Contact Roman Shrestha, MPH, PhD
Phone (860) 486-2446
Email roman.shrestha@uconn.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This project will involve conducting a Type I Hybrid Implementation Science trial to assess the efficacy of the JomPrEP app while measuring contextual implementation factors to guide its future adoption and scale-up.


Description:

mHealth is a promising and cost-effective strategy to reach stigmatized and hard-to-reach populations, like MSM, and link them to care. Leveraging mHealth reduces individuals' discomfort and distrust of disclosing risk behaviors to providers, providers' low cultural competency for working with individuals of diverse sexual identities, and bypasses barriers to health care for marginalized populations, - all features crucial for HIV prevention in MSM in Malaysia. It can further guide prevention delivery and health decision-making in a confidential, less stigmatizing, and convenient manner. Results from our studies show Malaysian MSM often do not get HIV tested, initiate PrEP, or have their mental health needs addressed. Mixed methods suggest MSM want these services but prefer a streamlined system to access them that reduces interaction with clinicians where disclosure and perceived judgment occurs. mHealth may overcome these barriers by doing the screening confidentially and result in an "eligibility" output that automates HIV prevention service delivery (e.g., HIV testing, pre-exposure prophylaxis; PrEP). Overall smartphone growth in Malaysia (63% in 2015 to 89% in 2017) and our parallel work with MSM indicates that nearly all (>97%) MSM own a smartphone; Internet penetration is 89.4%, mostly through smartphones. Findings from our qualitative interviews with MSM further indicate stated preferences for interfacing with 'apps' rather than health professionals to access HIV testing, PrEP, counseling, and sexual health services as well as stakeholders indicating strong interest in using app-based platforms to deliver integrated care (e.g., HIV, mental health) align with developing culturally tailored mHealth strategies and to engage MSM in virtual communication with providers about their unmet needs for HIV testing, PrEP, and mental and sexual needs - all embedded within one app. The cross-cutting prevention strategies like the use of mHealth, particularly smartphone apps, thus hold great promise for HIV prevention in Malaysian MSM, especially when linked to HIV testing, PrEP, and co-morbid P/SUD screening and feedback, which will likely facilitate adherence and reduce HIV risk. Although mHealth has been widely applied and efficacious in promoting health outcomes in multiple patient populations and contexts, app-based platforms to improve the HIV prevention cascade are just emerging. Few apps specifically to increase uptake and adherence to PrEP are evolving and limited to high-income countries. Further, these apps do not address mental health issues that are common in those who need HIV prevention most. Given the evolving HIV epidemic among men who have sex with men (MSM) in Malaysia and their challenges with accessing prevention services, we previously proposed to adapt, expand, and refine an existing app (namely the HealthMindr app) to deliver an integrated HIV prevention intervention that will promote HIV testing and linkage to pre-exposure prophylaxis (PrEP) and that incorporates screening and support for psychiatric and substance use disorder (P/SUD) for Malaysian MSM. We have previously developed a new app (called JomPrEP) designed to improve access to HIV prevention services (i.e., HIV testing and PrEP) among Malaysian MSM. We now plan to conduct a Type 1 Hybrid Implementation Science Trial to (1) evaluate the efficacy of the JomPrEP app vs. treatment as usual (TAU) in Malaysian MSM (using a randomized controlled trial) and (2) assess contextual implementation factors (using focus groups).


Recruitment information / eligibility

Status Recruiting
Enrollment 268
Est. completion date June 2025
Est. primary completion date June 2025
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Male
Age group 18 Years and older
Eligibility Inclusion Criteria: - HIV negative or status unknown - Cis-gender men who have sex with men - Age more than or equal to 18 years - Own a smartphone (Android or IOS) Exclusion Criteria: - Unable to read or understand English or Bahasa Malaysia - Unable to provide informed consent

Study Design


Related Conditions & MeSH terms


Intervention

Other:
JomPrEP App
The JomPreP app will be ideally designed to optimize HIV prevention cascade by providing a virtual platform to access to HIV prevention (e.g., HIV testing and PrEP) and other support services (e.g., mental health). The JomPrEP app will be available on the Apple Store and the Google Play Store for the users to download. However, access to the app will be restricted to the research participant using a unique registration code.
Inactivated JomPrEP app
Participants will have access to the JomPrEP app with major intervention features inactivated. Information and resources for HIV testing, PrEP, and available mental health and addiction services will be available along with access to risk assessment tools. The RA will assist in downloading the app and provide a tutorial in using the assessment tool of the app.

Locations

Country Name City State
Malaysia CERiA Kuala Lumpur
Malaysia University of Malaya Kuala Lumpur

Sponsors (4)

Lead Sponsor Collaborator
University of Connecticut National Institutes of Health (NIH), University of Malaya, Yale University

Country where clinical trial is conducted

Malaysia, 

References & Publications (24)

Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A Mobile-Based App (MyChoices) to Increase Uptake of HIV Testing and Pre-Exposure Prophylaxis by Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2019 Jan 7;8(1):e10694. doi: 10.2196/10694. — View Citation

Chawarski MC, Vicknasingam B, Mazlan M, Schottenfeld RS. Lifetime ATS use and increased HIV risk among not-in-treatment opiate injectors in Malaysia. Drug Alcohol Depend. 2012 Jul 1;124(1-2):177-80. doi: 10.1016/j.drugalcdep.2011.12.024. Epub 2012 Jan 21. — View Citation

Conserve DF, Jennings L, Aguiar C, Shin G, Handler L, Maman S. Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations. J Telemed Telecare. 2017 Feb;23(2):347-359. doi: 10.1177/1357633X16639186. Epub 2016 Jul 9. — View Citation

Cooper V, Clatworthy J, Whetham J, Consortium E. mHealth Interventions To Support Self-Management In HIV: A Systematic Review. Open AIDS J. 2017 Nov 21;11:119-132. doi: 10.2174/1874613601711010119. eCollection 2017. — View Citation

Daskalopoulou M, Rodger A, Phillips AN, Sherr L, Speakman A, Collins S, Elford J, Johnson MA, Gilson R, Fisher M, Wilkins E, Anderson J, McDonnell J, Edwards S, Perry N, O'Connell R, Lascar M, Jones M, Johnson AM, Hart G, Miners A, Geretti AM, Burman WJ, Lampe FC. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV. 2014 Oct;1(1):e22-31. doi: 10.1016/S2352-3018(14)70001-3. Epub 2014 Sep 7. — View Citation

Fendrich M, Avci O, Johnson TP, Mackesy-Amiti ME. Depression, substance use and HIV risk in a probability sample of men who have sex with men. Addict Behav. 2013 Mar;38(3):1715-8. doi: 10.1016/j.addbeh.2012.09.005. Epub 2012 Sep 24. — View Citation

Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P, Patel V, Haines A. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013;10(1):e1001363. doi: 10.1371/journal.pmed.1001363. Epub 2013 Jan 15. — View Citation

Halkitis PN, Parsons JT. Recreational Drug Use and HIV-Risk Sexual Behavior Among Men Frequenting Gay Social Venues. Journal of Gay & Lesbian Social Services. 2002;14(4):19-38.

Henny KD, Wilkes AL, McDonald CM, Denson DJ, Neumann MS. A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007-2017). AIDS Behav. 2018 Jan;22(1):43-63. doi: 10.1007/s10461-017-1923-2. — View Citation

Hirshfield S, Remien RH, Humberstone M, Walavalkar I, Chiasson MA. Substance use and high-risk sex among men who have sex with men: a national online study in the USA. AIDS Care. 2004 Nov;16(8):1036-47. doi: 10.1080/09540120412331292525. — View Citation

LeGrand S, Knudtson K, Benkeser D, Muessig K, Mcgee A, Sullivan PS, Hightow-Weidman L. Testing the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2018 Dec 18;7(12):e10448. doi: 10.2196/10448. — View Citation

Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010 Nov 27;376(9755):1838-45. doi: 10.1016/S0140-6736(10)61997-6. Epub 2010 Nov 9. — View Citation

Liu A, Coleman K, Bojan K, Serrano PA, Oyedele T, Garcia A, Enriquez-Bruce E, Emmanuel P, Jones J, Sullivan P, Hightow-Weidman L, Buchbinder S, Scott H. Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2019 Jan 25;8(1):e10659. doi: 10.2196/10659. — View Citation

Malaysian Communications and Multimedia Commission. Internet users survey: 2017. 2017; https://mcmc.gov.my/skmmgovmy/media/General/pdf/HPUS2017.pdf. Accessed May 1, 2019.

Marcolino MS, Oliveira JAQ, D'Agostino M, Ribeiro AL, Alkmim MBM, Novillo-Ortiz D. The Impact of mHealth Interventions: Systematic Review of Systematic Reviews. JMIR Mhealth Uhealth. 2018 Jan 17;6(1):e23. doi: 10.2196/mhealth.8873. — View Citation

Mbuagbaw L, Mursleen S, Lytvyn L, Smieja M, Dolovich L, Thabane L. Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer. BMC Health Serv Res. 2015 Jan 22;15:33. doi: 10.1186/s12913-014-0654-6. — View Citation

Milward J, Lynskey M, Strang J. Solving the problem of non-attendance in substance abuse services. Drug Alcohol Rev. 2014 Nov;33(6):625-36. doi: 10.1111/dar.12194. Epub 2014 Sep 6. — View Citation

Sandfort TGM, Knox JR, Alcala C, El-Bassel N, Kuo I, Smith LR. Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review. J Acquir Immune Defic Syndr. 2017 Oct 1;76(2):e34-e46. doi: 10.1097/QAI.0000000000001462. — View Citation

Sharpe JD, Kamara MT. A systematic evaluation of mobile apps to improve the uptake of and adherence to HIV pre-exposure prophylaxis. Sex Health. 2018 Nov;15(6):587-594. doi: 10.1071/SH18120. — View Citation

Shrestha R, Lim SH, Altice FL, Copenhaver M, Wickersham JA, Saifi R, Ab Halim MA, Naning H, Kamarulzaman A. Use of Smartphone to Seek Sexual Health Information Online Among Malaysian Men Who Have Sex with Men (MSM): Implications for mHealth Intervention to Increase HIV Testing and Reduce HIV Risks. J Community Health. 2020 Feb;45(1):10-19. doi: 10.1007/s10900-019-00713-x. — View Citation

Shrestha R, Lim SH, Altice FL, Kamarulzaman A, Wickersham J. Perception and acceptability of mHealth-based intervention for HIV prevention among men who have sex with men (MSM) in Malaysia. In preparation. 2019.

Sullivan PS, Driggers R, Stekler JD, Siegler A, Goldenberg T, McDougal SJ, Caucutt J, Jones J, Stephenson R. Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study. JMIR Mhealth Uhealth. 2017 Mar 9;5(3):e26. doi: 10.2196/mhealth.7199. — View Citation

Van Tieu H, Koblin BA. HIV, alcohol, and noninjection drug use. Curr Opin HIV AIDS. 2009 Jul;4(4):314-8. doi: 10.1097/COH.0b013e32832aa902. — View Citation

WHO. mHealth: New horizons for health through mobile technologies: second global survey on eHealth. Geneva, Switzerland2011.

* Note: There are 24 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Changes in HIV testing HIV testing dates will be assessed at each follow-up time point (3, 6, and 9 months) using self-report. 3, 6, and 9 months post-randomization
Primary Changes in PrEP uptake PrEP uptake (current use of PrEP; yes/no) will be assessed at each follow-up time point (3, 6, and 9 months) using self-reported visual analogue scale. The higher the score on the scale the higher the PrEP uptake. Score (0-100). 3, 6, and 9 months post-randomization
Secondary Changes in PrEP adherence PrEP Adherence will be assessed using Dried Blood Spots at 3-, 6-, and 9-month follow-ups, which will quantify tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in RBC.TFV-DP =700 fmol/punch will be defined as optimal adherence. 3, 6, and 9 months post-randomization
See also
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Recruiting NCT05044013 - Testing of the Smartphone App to Enhance HIV Prevention Cascade Among Malaysian MSM N/A
Not yet recruiting NCT06373965 - Integrated Online-to-offline (O2O) Model of Care for HIV Prevention and Treatment Among Transgender Women (CINTAI) N/A
Not yet recruiting NCT06373952 - Integrated Online-to-offline (O2O) Model of Care for HIV Prevention and Treatment Among Men Who Have Sex With Men N/A
Completed NCT05052411 - Beta Testing of a Smartphone App for HIV Prevention in Malaysian MSM N/A
Completed NCT04531670 - Testing of the Integrated Rapid Access to HIV Prevention Program for People Who Inject Drugs Program N/A