JMIR--Mobile Phone Applications for the Care and Prevention of HIV ...

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Original Paper

Mobile Phone Applications for the Care and Prevention of HIV and Other Sexually Transmitted Diseases: A Review

Kathryn E Muessig¹, PhD; Emily C Pike¹, BS; Sara LeGrand², PhD; Lisa B Hightow-Weidman¹, MD, MPH

¹Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
²Center for Health Policy and Inequalities Research, Duke University, Durham, NC, United States

Corresponding Author:
Kathryn E Muessig, PhD

Department of Medicine
The University of North Carolina at Chapel Hill
Bioinformatics Bldg, CB #7030
130 Mason Farm Rd
Chapel Hill, NC, 27599
United States
Phone: 1 443 320 3152
Fax: 1 919 966 6714
Email:

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ABSTRACT

Background: Mobile phone applications (apps) provide a new platform for delivering tailored human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention and care.
Objective: To identify and evaluate currently available mobile phone apps related to the prevention and care of HIV and other STDs.
Methods: We searched the Apple iTunes and Android Google Play stores for HIV/STD-related apps, excluding apps that exclusively targeted industry, providers, and researchers. Each eligible app was downloaded, tested, and assessed for user ratings and functionality as well as 6 broad content areas of HIV prevention and care: HIV/STD disease knowledge, risk reduction/safer sex, condom promotion, HIV/STD testing information, resources for HIV-positive persons, and focus on key populations.
Results: Search queries up to May 2012 identified 1937 apps. Of these, 55 unique apps met the inclusion criteria (12 for Android, 29 for iPhone, and 14 for both platforms). Among these apps, 71% provided disease information about HIV/STDs, 36% provided HIV/STD testing information or resources, 29% included information about condom use or assistance locating condoms, and 24% promoted safer sex. Only 6 apps (11%) covered all 4 of these prevention areas. Eight apps (15%) provided tools or resources specifically for HIV/STD positive persons. Ten apps included information for a range of sexual orientations, 9 apps appeared to be designed for racially/ethnically diverse audiences, and 15 apps featured interactive components. Apps were infrequently downloaded (median 100-500 downloads) and not highly rated (average customer rating 3.7 out of 5 stars).
Conclusions: Most available HIV/STD apps have failed to attract user attention and positive reviews. Public health practitioners should work with app developers to incorporate elements of evidence-based interventions for risk reduction and improve app inclusiveness and interactivity.

(J Med Internet Res 2013;15(1):e1)
doi:10.2196/jmir.2301

KEYWORDS

HIV; technology; mobile phone applications

Mobile phone health interventions are increasingly being used for the prevention and care of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) [1-3]. These initiatives have been designed to promote prevention messages [4], facilitate test result notification [5,6], improve HIV medication adherence, and increase adherence to clinic appointments [7-12]. Although phone-based interventions have typically used the voice or text-based Short Message Service (SMS) features of mobile phones [1,3,13], the increasing popularity of smartphones and smartphone applications (apps) [14,15] has greatly expanded the possibilities for phone-based HIV/STD interventions [13]. These interventions are critical for reversing the HIV epidemic; 34.2 million people worldwide are living with HIV and 2.5 million people became newly infected in 2011 alone [16].

Smartphones have revolutionized mobile communication markets by offering enhanced mobile phones featuring improved Internet access and the capacity to perform more advanced computer functions. Consumer research from June 2012 estimates that 54.9% of mobile phone subscribers in the United States own a smartphone, with phones running on Apple?s iPhone operating systems (iOS) and Android?s operating systems (Android OS) representing over 86% of this market [15]. Smartphone apps are downloadable programs that run on the smartphone?s OS, which may include Web-based features. As of March 2012, Apple?s iTunes apps had received over 25 billion downloads [14] and the Android Google Play Store exceeded 15 billion app downloads in May 2012 [17]. These numbers continue to rise at over 1 billion app downloads per month for each store [17].

Many of these apps are health related. A search on August 1, 2012, for apps categorized as ?health & fitness? and ?medical? yielded 13,479 apps available for iPhone consumers [18] and 15,891 apps available for Android consumers [19]. This widespread use of apps provides a promising new platform for delivering tailored HIV prevention messages and interactive care services. But are public health practitioners utilizing this new opportunity? In this paper, we review the characteristics and content of HIV- and STD-related apps that are available through the two primary online app providers: the Apple iTunes Store and the Android Google Play Store. This review describes the current landscape and content of HIV/STD apps, assesses utilization and acceptability of these apps, and provides recommendations to guide the design and development of future apps.

Search and Screening Strategy

On May 1 to 3, 2012, the following terms were used to search the Apple iTunes Store and the Android Google Play Store: HIV, human immunodeficiency virus, acquired immune deficiency syndrome, sexually transmitted diseases, STD, sexually transmitted infections, STI, sexual health, safe sex, and condom. An app was excluded if it did not include HIV/STD content; exclusively targeted industry, health care, research, or medical professionals; or was not available in English. Two researchers (KEM and ECP) searched each store and compiled lists of all identified apps. App titles and descriptions were screened for relevance and lists of apps to download were created. Lists were compared and differences resolved by a third member of the study team (LBH). Any eligible app that was identified in only one store was searched for by name in the other store to confirm its exclusive availability.

Data Extraction and App Assessment

The following data was extracted for each eligible app on May 1 to 3, 2012: name, platform (iPhone, Android, or both), category as defined by site (eg, medical, education, health and fitness, lifestyle), description of app content as provided by site, price, user star rating, number of customer downloads (available for Android only), number of customer ratings (available for iPhone only), and the date the app was last updated by the developer. For apps that were available in both the Google Play and iTunes stores, we recorded separate price and user rating information for each store. From May 7 to 24, 2012, we downloaded each eligible app (both free and fee-based) and tested all features and functions. If an app had both a free and fee-based version, only the free version was downloaded and assessed.

To evaluate the apps we identified 6 broad content areas for advancing the prevention and treatment of HIV based on the World Health Organization?s Global Health Sector Strategy on HIV/AIDS 2011-2015 [20] and the National AIDS Strategy for the United States [21]. These content areas include HIV/STD knowledge and awareness, behavior change/risk reduction/safer sex promotion, condom use/promotion, HIV/STD testing, resources and linkage to care for HIV/STD-positive persons, and intensified or focused efforts for key communities/populations. Each app was assessed for inclusion of the 5 content areas, operationalized as:

1. Does the app provide information about HIV or other STDs?

2. Does the app provide information or descriptions about ways to reduce the risk of sexually transmitting or acquiring HIV/STDs?

3. Does the app provide information about how to use or obtain male or female condoms?

4. Does the app promote or provide information or resources about HIV/STD testing?

5. Does the app provide resources specifically for HIV/STD-positive persons? (Features and resources provided through apps for HIV/STD-positive persons were tested and described.)

If the app also covered other content areas, these were listed and described. These descriptions were then compiled and grouped, resulting in the following additional 5 content categories: drug and alcohol risk, relationships, HIV/STD news, HIV/STD stigma, and an HIV/STD status verification service.

To assess whether the app fulfilled the criteria of intensified or focused efforts for key communities or populations, we reviewed the text and images used in each app. Key populations for HIV prevention vary depending on the local epidemic context. Thus, this assessment included an open-ended description of text and images used and a subjective assessment of whether the app appeared to be inclusive or tailored. For example, if an app included images of black men or women among a variety of racial and ethnic images, this app would be characterized as ?inclusive.? If an app explicitly or exclusively addressed black men or women, this app would be considered ?tailored.? Finally, we assessed whether each app included any interactive component, such as a game, quiz, diary, or goal tracker.

Search and Screening

Search queries identified 1937 apps. After screening the app titles and the site-provided app descriptions, 84 eligible apps were downloaded for full review (Figure 1). A further 15 apps were then excluded because they did not include HIV/STD-related content or were not functional (list available upon request). A total of 69 apps met the final inclusion criteria: 43 from the Apple iTunes Store and 26 from Android?s Google Play Store. Of these, 55 apps were unique with 14 apps available in both stores (29 iTunes only, 12 Google Play only, and 14 available in both stores).

Source: http://www.jmir.org/2013/1/e1/

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