Efficacy of Digital HIV Risk Assessment and Uptake of HIV Pre-Exposure Prophylaxis Among U.S. Military Service...

Human immunodeficiency virus (HIV) remains an important public health concern within the U.S. Armed Forces and a potential threat to force health protection and operational readiness. Within the Military Health System, a key problem is inconsistent engagement with HIV prevention services among at-risk service members despite mandated screening and universal access to pre-exposure prophylaxis (PrEP). Structural stigma, confidentiality concerns, and perceived career consequences may discourage participation in HIV prevention services, particularly when interventions rely on disclosure of sensitive behaviors during clinical encounters. Digital health strategies may provide confidential pathways for service members to assess personal risk and access prevention resources outside traditional clinical settings. This quality improvement initiative evaluated the feasibility and early system-level impact of implementing a confidential, QR-enabled mobile HIV risk self-assessment designed to increase engagement with preventive services, including HIV testing and PrEP.

A pilot quality improvement initiative was implemented at a military branch health clinic serving approximately 8,500 active-duty personnel. A confidential, mobile-accessible HIV risk self-assessment was disseminated installation-wide through QR-coded flyers placed in high-traffic nonclinical locations and reinforced through leadership-supported email communication. Monthly QR scan counts were used as a measure of engagement with the intervention. Clinical outcomes included monthly HIV testing rates and PrEP prescribing rates per 1,000 active-duty personnel derived from aggregated electronic health record reports. A Poisson generalized linear regression model with a log population offset was used to evaluate contemporaneous and 1-month-lagged associations between QR scan exposure and clinical outcomes. The project met criteria for minimal-risk quality improvement and received institutional review board exemption.

QR scan engagement was concentrated during the initial implementation month, with 24 scans recorded and minimal activity observed in subsequent months. HIV testing rates during the primary analytic window ranged from approximately 40 to 69 tests per 1,000 active-duty personnel, reflecting readiness-driven screening requirements within the military health system. PrEP prescribing rates remained relatively stable throughout the observation period. Regression analyses did not demonstrate statistically significant associations between QR scan activity and same-month HIV testing or PrEP prescribing rates. However, lagged models demonstrated an association between QR scan exposure and subsequent-month HIV testing rates (incidence rate ratio [IRR], 1.015; 95% confidence interval [CI], 1.008-1.021; P < .001). No statistically significant lagged association was observed for PrEP prescribing rates.

Implementation of a confidential mobile HIV risk screening intervention was operationally feasible within a military primary care setting but demonstrated limited short-term measurable impact on clinical utilization. In military healthcare systems where baseline HIV screening is already elevated because of readiness requirements, short-term utilization metrics may underestimate the influence of supplemental prevention interventions. Confidential digital screening tools may support gradual improvements in prevention engagement by increasing risk awareness and reducing barriers related to stigma and confidentiality concerns. Longer implementation periods, broader dissemination strategies, and integration into routine military healthcare workflows may strengthen HIV prevention engagement and support force health protection across the Military Health System.