# Feasibility and Preferences to Adopt mHealth-Based Interventions for HIV Prevention Among High-Risk Groups: Cross-Sectional Study

## TL;DR

A study in Pakistan finds that mHealth apps are widely accepted by high-risk groups for HIV prevention, with features like education and e-consultation being most preferred.

## Contribution

The study provides novel insights into the feasibility and preferences for mHealth-based HIV prevention among marginalized groups in Pakistan.

## Key findings

- Most participants showed high willingness to use mHealth apps for HIV prevention.
- Preferred features included e-consultation, medication reminders, and educational resources.
- Smartphone ownership and prior mHealth app experience were key predictors of adoption.

## Abstract

HIV disproportionately affects men who have sex with men (MSM), transgender individuals, and people who inject drugs, with 70.1% of cases in Pakistan linked to these groups, aggravated by stigma and legal constraints. Mobile health (mHealth) interventions offer the potential to enhance HIV prevention, yet their acceptability remains underexplored.

This study aimed to assess the feasibility, willingness to use, and preferences for mHealth-based interventions designed to improve HIV knowledge, testing uptake, and risk behavior reduction among MSM, transgender individuals, and people who inject drugs in Pakistan.

A cross-sectional survey was conducted from February 2025 to May 2025 with 210 participants, including MSM and transgender individuals, recruited through respondent-driven sampling in collaboration with community-based organizations and nongovernmental organizations, while people who inject drugs were recruited from the rehabilitation centers of trusted community-based organizations and nongovernmental organizations, to ensure privacy and reduce safety concerns. Participants completed a self-administered questionnaire covering demographics, HIV knowledge, access to and use of mobile technology, acceptability and preferences for mHealth interventions, and HIV-related risk behaviors.

The majority of participants owned smartphones (161/210, 76.7%) and had daily internet access (115/210, 54.8%), spending an average of 3.41 (SD 3.10) hours online daily. High willingness (182/210, 86.7%) to use a clinic-integrated mHealth app for HIV prevention was reported. Preferred app-delivered features included educational resources (85/210, 40.5%), daily medication reminders (108/210, 51.4%), weekly HIV prevention information (110/210, 52.4%), e-consultation (158/210, 75.2%), and mental health information (134/210, 63.8%). Smartphone ownership (odds ratio 4.14, 95% CI 1.41‐12.21; P=.009) and prior experience with an mHealth app (odds ratio 2.97, 95% CI 1.00‐8.81; P=.05) were significantly associated with willingness to adopt an mHealth app. While 80.5% (169/210) reported some knowledge of HIV, only 17.1% (29/169) rated their knowledge high, and 46.1% (97/210) were unaware of their HIV status. In terms of vulnerability, participants reported that injected drug use (122/210, 58.1%), experiences of violence (87/210, 41.4%), and police detention (128/210, 61%) were prevalent. In terms of risky sexual behaviors, nearly half engaged in transactional sex (104/210, 49.5%) or had multiple partners (101/210, 48.1%), while consistent condom use remained low (90/210, 42.9%).

There is high acceptability and considerable potential for mHealth interventions to enhance HIV prevention efforts among MSM, transgender individuals, and people who inject drugs in Pakistan. Tailored, discreet, and comprehensive mHealth platforms that include educational content, medication reminders, e-consultation, and mental health support are warranted. Addressing criminalization and ensuring user privacy will be crucial for the successful design and implementation of these interventions. Future research should focus on implementation research to assess the real-world uptake of these findings.