Developing and testing a digital harm reduction app for GBMSM engaging in chemsex: a feasibility study grounded in...

Chemsex, involving substances like methamphetamine, GHB/GBL, and mephedrone among gay, bisexual, and other men who have sex with men (GBMSM), poses HIV and health concerns. Despite existing integrated care programs, uptake remains low, highlighting a missed opportunity for self-help harm-reduction digital strategies. This study employs a collaborative design approach, integrating insights from the community on the app prototype and assessed usability to guide future interventions.

The app prototype was built on two design principles: recovery as a continuum with evolving goals like harm reduction and temporarily not using, and harm reduction dimensions on drug-, sex-, and HIV-related harms. Features were integrated into UPrEPU, a user-centered app supporting HIV PrEP adherence through flexible dosing and personalized reminders. Users could set goals, such as reducing chemsex frequency, supported by tailored feedback. The app includes an emergency alert system, local resources for clean needles and HIV testing, and myth-busting for the chemsex community. GBMSM with recent chemsex experience tested the app between January-December 2024. A one-month evaluation followed using the mHealth App Usability Questionnaire (1-7 scale, lower score indicates higher usability) and an interview to assess usability and impact. Interview transcripts were analyzed based on design themes to gather users' reflections and suggestions for enhancing harm reduction features.

Twenty GBMSM aged 23-46 in Taiwan reported a positive perception of usability (mean = 2.14, SD = 1.15). However, users indicated that HIV PrEP functions were utilized more frequently than drug-related functions. Dynamic goal setting should be more intuitive and tied to lived experiences, reflecting one's physical and mental state. Inadequate social support led individuals to adopt self-reliance strategies, such as tracking HIV PrEP uptake, setting hydration reminders, and prioritizing self-care. This extended to managing cravings, adhering to dosage limits, and achieving control over their health. Users emphasized the need for tools to go beyond drug-related features, focusing instead on helping them plan their time and set broader life goals, supporting a more holistic approach to well-being.

A collaborative, user-centered approach to app design shows promise for digital solutions addressing chemsex-related harms, including HIV prevention, with functions closely tied to lived experiences.