Comparison With Prior Work
HIV or lesbian, depressive symptoms
Prior studies have demonstrated several apps for HIV prevention and treatment efforts to be promising and cost-effective strategies to reach and engage stigmatized and hidden populations, such as MSM [One of the key innovations on JomPrEP includes incorporating on-demand features, such as home-based HIVST, e-consultations, and discrete door-to-door delivery, to provide a scalable model for remote HIV prevention services delivery in the LMIC setting. Although the users would still be required to visit a laboratory for clinical testing, this would not require them to be face-to-face with their clinicians. Moreover, the platform allows users to self-assess their HIV risk, consult online with clinicians from the participant clinics, and have their medication delivered to their preferred location, thus minimizing the need for in-person interactions with the clinician. This represents a significant and much-needed innovation over traditional clinic-based and O2O models of HIV service delivery to keep at-risk individuals wedded into the virtual clinical ecosystem and boost the uptake of clinical services [Prior research has documented low user retention and a lack of sustained use after adoption as key challenges to the effectiveness of existing app-based interventions [Results from our beta testing, however, revealed that MSM were actively engaged in the app and that retention was excellent through the beta testing. Although it is possible that the perfect retention rate could be because of the shorter follow-up time, it is likely that the incorporation of additional components, such as the ability to customize profiles, personalized messages, and gaming elements (ie, the ability to “level up,” earn and redeem points), may have allowed for enhanced user engagement. In recent years, the utility of gamification features (eg, challenges, tasks, rewards, badges, leaderboards) in nontraditional gaming contexts has increased significantly, thus providing opportunities for greater user engagement in mHealth interventions [Although there was consensus on the usability and acceptability of JomPrEP, with no significant differences between different subgroups of Malaysian MSM, the app would benefit from continued refinement to address some of the shortcomings identified by men. For example, most participants who completed screening for depressive symptoms (88%) received referral letters to seek care offline (ie, outside the app). Given the focus of JomPrEP to offer holistic HIV prevention services within the online ecosystem, it would be important for the app to incorporate online consultation with mental health counselors and linkage to support groups via the app. Additionally, as part of the continued effort to ensure the safety and security of users, it would be important that JomPrEP incorporate added security measures, including 2-factor authentication and a discreet app icon (DAI). The availability of a DAI allows users to replace the default JomPrEP app log on their phone with another symbol (of their choice). This will help protect users when there is a possibility that someone may accidentally look at users’ phones and recognize that they have an app that might link them to the HIV or lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) community. A study conducted with MSM of Malaysia also highlighted the importance of privacy and confidentiality features in the mobile apps targeted for HIV prevention and treatment to minimize harm and safeguard users' privacy and confidentiality [