Apps are one digital tool that organizations working in HIV prevention and treatment could consider adding to their communications strategy. In order to learn more about how apps can help, HIV.gov staff down with Lisa Hightow-Weidman, M.D., M.P.H., during the summer to talk about the potential role of apps in HIV prevention and treatment, particularly for youth, who made up 21% of all new HIV diagnoses in 2016.

Dr. Hightow-Weidman uses mobile technology to address the HIV epidemic among youth. She is an associate professor of medicine and the principal investigator at the Behavior and Technology Lab at the University of North Carolina, Chapel Hill. She is also part of the NIH-funded UNC/Emory Center for Innovative TechnologyExit Disclaimer (iTech), where she is developing P3, an app that incorporates games and social activities to motivate and remind youth at risk for HIV to protect themselves by taking PrEP medications. The app has already entered field testing, which will be followed by a larger nationwide randomized controlled trial in early 2019.

Read more about our conversation below:

(This interview has been edited for length and clarity.)

HIV.gov: So what is P3?

Dr. Lisa Hightow-Weidman (LHW): P3 stands for Prepared, Protected, and Empowered. We wanted to develop an app that would help U.S. youth who are at risk for HIV to remember to take their medications. P3 is designed for young gay/bisexual men and young transwomen who have sex with men, and it focuses on PrEP adherence and persistence in PrEP care.

The biggest challenge in using apps for mobile health is keeping users engaged. The P3 app offers users intrinsic motivation to engage by giving them the chance to interact with others, do “quests,” etc. Extrinsic motivation comes in the form of rewards, which they unlock with points they earn by doing activities within the app. Those activities can include tracking their meds or posting on the app’s social wall, which offers a daily discussion question meant to facilitate discussions with peers about issues like how to live a healthy lifestyle, deal with depression or PrEP stigma, remember to take your meds, or talk to a partner about HIV testing.

Once they earn enough points, they can unlock content—like the web series we created in collaboration with OTVExit Disclaimer that focuses on the lives of primarily African American genderqueer youth and young adults as they navigate relationships, stigma, PrEP, and HIV. We hope that this kind of popular content will entice our target audience to start – and keep – using the app.

Our long-term goal for this project is to create a comprehensive HIV prevention and treatment platform that can help users remember to take their meds and remind them to get tested for HIV and STIs and build other healthy habits.

HIV.gov: How will P3 help users remember to take their meds?

LHW: The app has a medication tracker that allows you to create reminders for every med you need to take. You enter information about your meds, and then the app helps you pair each medication with a daily activity (e.g., showering, drinking your first cup of coffee, or logging on to social media) that can help you remember to take it.

For example, if you indicate you want to take PrEP every day at 9:00 a.m., the app will send you notifications based on the activity you chose. To protect your privacy, notifications don’t mention medications; instead you may see, “Did you remember to log on to Facebook today?”

You get points for logging in and tracking your meds. We don’t award points for adherence; it’s the act of tracking that we’re rewarding. But if you don’t consistently log in or track your medicines, the app recognizes this and will send you a notification that says, “Maybe this strategy isn’t working for you? Have you thought about trying something else?” Then it will give you other options and provide feedback.

HIV.gov: What will you do with the data you gather from your testing?

LHW: We’ll be looking at which components of the intervention worked, for whom, and in what way? We’ll also be looking at characteristics of individuals to better understand which components they were more likely to use and why.

We offer a lot of different engagement features because different users are engaged by different things and what engages a user one week might be different the next, based on their mood or life situation. So evaluating which activities people engaged in, and when, will provide us with more nuanced information about their motivations.

In addition, users’ current situations influence which features of the app they actually need to engage. For example, someone who has just started PrEP has very different needs than someone who hasn’t been successful at taking it in the past, but really wants to try again.

To read more about our conversation – see below.

If you’d like to learn more about using digital tools to reach various populations at risk for, or living with, HIV, consider making a Virtual Office Hours appointment today. Virtual Office Hours is HIV.gov’s no-cost, on-demand program that offers technical assistance on social media and digital tools for HIV service organizations.

In addition, check out this recent post on new media interventions for HIV from the 22nd International AIDS Conference (AIDS 2018).

For more on PrEP, check out HIV.gov’s PrEP resources page or visit CDC’s PrEP Locator to find a provider near you.

HIV.gov: What do you see as the future for mobile technology in the response to HIV?

LHW: I think there are three key questions about using mobile technology for that response. The first is “Can we take better advantage of all the work that is currently being done in silos to create better, more flexible platforms?” I think there’s a lot more we can do with Mhealth, including creating platforms that can rotate components in and out as needed and offering a higher level of tailoring for users, based on things we are learning as we move forward.

The second question, which really interests me, is “Can we deliver interventions in real time?” As we gather more information and learn what works for whom and when, can we provide folks with interventions when they need them—rather than requiring them to use an app all the time?

Finally: “How do we scale up and implement interventions so that those who need them have access to more comprehensive digital health solutions for what they may need?” For example, maybe you don’t need an intervention for PrEP adherence, but you would like reminders to take regular HIV tests. Then, while you’re getting tested, you decide taking PrEP is a good idea and want access to PrEP features in your app. How do we make those features available along the life course of the population we’re working with?