Abstract and Introduction
Abstract
Objective: We aimed to evaluate the usability and acceptability of a co-designed mobile health (mHealth) application (PrEP-EmERGE) within a digital health pathway to support HIV pre-exposure prophylaxis (PrEP).
Methods: This was a cross-sectional study to evaluate the usability and acceptability of the PrEP-EmERGE app. Data were collected via an online survey sent to all PrEP EmERGE users in September 2021. Usability was assessed with a validated usability tool, the System Usability Scale (SUS). Acceptability was assessed using modified patient-reported experience measures (PREMs). Quantitative data were analysed using descriptive and/or inferential statistics and qualitative data (free text responses) using thematic analysis.
Results: In total, 81/133 (61%) active PrEP EmERGE users completed the online survey, which was available directly from their PrEP EmERGE app: 78/81 (96%) identified as cis-male, 74/81 (91%) reported their ethnicity as 'white', 69/81 (85%) reported daily PrEP use, 7/81 (9%) reported using an event-based dosing schedule, and 5/81 (6%) were switching between dosing schedules. Overall, the median SUS score was 78/100 (interquartile range: 70–92). There were no differences in median SUS scores by PrEP dosing schedules (p = 0.78) or months of experience of using the app (p = 0.31). Overall, 73/81 (90%) would recommend the PrEP EmERGE app to a friend and 78/81 (96%) rated their satisfaction of the app as excellent, good or satisfactory. The free text responses generated three key themes: accessibility (for results and information); autonomy [taking responsibility for their (sexual) health] and functionality (including technical recommendations for app development and the digital health pathway).
Conclusions: Innovative, co-designed digital health pathways, such as PrEP EmERGE can help sexual health services to manage increasing numbers of people accessing PrEP – ensuring that they retain access for those who need to be seen face-to-face. We report high levels of acceptability and usability during the first 4 months of this novel pathway.
Introduction
In a decade of increasing digital dependency where the proportion of the population owning a smartphone in the UK has increased from 17% to 95% among 16- to 24-year-olds, digital health mobile phone applications (mHealth) can improve access to and delivery of healthcare and are associated with improved health outcomes.[1,2] From 1 October 2020, HIV-PrEP has been freely available in England via the NHS to prevent HIV transmission.[3]
'PrEP EmERGE' is an mHealth application and digital pathway co-designed by users and clinicians to support people using HIV-PrEP and reduce the footfall of PrEP users in clinical services. The platform and pathway were adapted from existing technology co-designed and implemented as part of the EmERGE project.[4] PrEP EmERGE was developed from the original EmERGE app using similar co-design methodology and was launched in May 2021. PrEP EmERGE aims to support people using HIV-PrEP by providing users with secure access to their results (recent and historic), a diary function with medication reminders, vaccination history, details of upcoming appointments, and a one-way messaging system which facilitates communication from the clinic to the end user.
In 2021, the Brighton sexual health & contraception clinic (SHAC) provided approximately 1200 individuals with PrEP and associated monitoring. Appointment schedules are based on national PrEP surveillance guidelines with 3-monthly appointments for sexually transmitted infection (STI) and HIV testing. We co-designed the PrEP EmERGE pathway where eligible PrEP users have a co-produced mobile phone app downloaded onto their smartphone and are seen face to face every 6 months and have a virtual appointment for home STI and HIV testing every 6 months. The PrEP EmERGE users' virtual appointment is managed by the clinic administration team, which organise the postal testing kits and results using a web version of the PrEP EmERGE app in the clinic. We defined eligibility for PrEP EmERGE as any patient who is stable on PrEP, who does not require 3-monthly face-to-face clinc visits (e.g. no renal issues, no psychological or drug dependence issues which require face-to-face clinical management) and can use smartphone applications. At the time of this pilot, we were unable to perform syphilis testing appropriately using home tests so patients with previous episodes of syphilis were excluded. Patients require support from the clinic administration team to activate the PrEP EmERGE app on an android or IOS phone which can communicate encrypted data. From May 2021, all eligible PrEP users attending our clinic were offered the PrEP EmERGE digital pathway, with the aim of allowing the clinic to optimise resources and capacity while ensuring continued quality of care. In September 2021, as part of a pilot, 133 patients had enrolled into the PrEP emerge digital pathway. The aim of this study was to evaluate the acceptability and usability of the PrEP EmERGE app.
HIV Medicine. 2023;24(4):502-506. © 2023 Blackwell Publishing
