Linx La: Developing a Web-Based Mobile App to Improve Treatment Outcomes Among Sexual Minority-Identified Young Black Men Living with HIV

Background: Black/African American gay, bisexual, and other men who have sex with men are more affected by HIV than any other group in the United States (U.S.). Additionally, Black young men who have sex with men (BYMSM) living with HIV experience disparities in treatment outcomes across the HIV Care Continuum (CC). BYMSM encounter stigma and discrimination related to race, sexual orientation, poverty and disability. While mobile application (app) interventions to improve HIV treatment outcomes exist, few have been culturally tailored for and designed by BYMSM living with HIV to address the impact of systemic oppression on their health. Addressing needs arising from the many forces impacting the lives of BYMSM requires addressing issues related to equitable access to economic security, educational attainment, healthcare and social support. These are issues that can be helped by employing social workers and legal services providers. We sought to develop and test a web-based mobile app (LINX LA) to improve HIV treatment outcomes among BYMSM living with HIV by addressing their social work and legal needs.

Methods: In collaboration with community partners and BYMSM themselves, we sought to (1) identify social service and legal barriers to engagement in HIV care for BYMSM; and (2) iteratively develop and test a web-based mobile app to address those barriers. Phase 1 consisted of interviews with BYMSM (n=13) to identify technology use patterns, experiences of HIV diagnosis and engagement in care, and social service/ legal needs to create a user persona and app prototype. Phase 2 consisted of moderated interviews with BYMSM (n=20) and HIV social service providers (n=11) to refine the Phase 1 prototype. Phase 3 consisted of a one-week pilot test of LINX LA with BYMSM (n=14). Qualitative data from Phase 1 and Phase 2 along with back-end user data from Phase 3 informed the final version of LINX LA.

Results: Social service and legal needs identified included homelessness, debt, and HIV-based discrimination. Lack of social support and HIV stigma were also major barriers to engagement in care. Three core app functions were developed: (1) Community forum; (2) Informational posting; and (3) Text-based peer health navigation. Key adjectives used to describe the app were “engaging” “private” and “useful.” In Phase 3, participants initiated 31 distinct chats, posted 76 comments and 20 “likes” over the one-week pilot test. Participants agreed that the app was a “safe setting” where they could get “social support.”

Conclusions and Implications: Mobile apps have the potential to engage BYMSM living with HIV and improve treatment outcomes across the HIV CC. Iterative user-centered mobile app development resulted in the app LINX LA, which will next undergo efficacy testing in a randomized controlled trial. Open-source technology will enable LINX LA to be adapted for other practice settings and populations. We attribute positive feedback regarding LINX LA to our community-based participatory design process. Mobile health interventions to address systemic oppression and its impact on health, including HIV CC outcomes, must be developed for and by BYMSM.