Harm Reduction
Conditions
Brief summary
This study is examining the usability and effectiveness of an innovative mobile app that integrates harm reduction strategies into the existing pre-exposure prophylaxis (PrEP) intake and adherence app, with an overarching goal to reduce the potentially negative consequences of problematics chemsex behavior for individuals and communities.
Detailed description
The practice of sexualized drug use is historical and has been noted across a diversity of genders and people of various sexual orientations. The term "chemsex" has been used to specifically describe the use of psychoactive substances in sexualized settings among gay, bisexual, and other men who have sex with men (GBMSM), particularly stimulants like methamphetamine and mephedrone, or other drugs like γ-hydroxybutyrate (GHB), γ-butyrolactone (GBL). Chemsex among GBMSM has coincided with the emergence of sexual-networking mobile apps, creating new opportunities for finding new partners with the intention to engage in chemsex. Harm reduction strategies for GBMSM engaging in chemsex are needed because the use of these drugs can have negative consequences for the physical and mental health of the people who use them. One of the main risks associated with chemsex is the possibility of overdose. In addition to the risk of overdose, chemsex may also increase the risk of sexually transmitted infections (STIs) and HIV transmission due to the higher possibility to engage in risky sexual behaviors. Seeking help can be difficult for GBMSM who engage in chemsex due to stigma, making the harm reduction approach equally important as clinical treatment or intervention that emphasized an abstinence approach. Harm reduction strategies recognize that drug use is a complex issue and that it is not always possible or desirable for people to stop using drugs completely. Instead, harm reduction approaches aim to reduce the harm that can result from drug use and to support people in making healthier choices. Considering also that mobile applications are another way to provide help to hard to reach population, this study aims to develop an innovative mobile app that integrates harm reduction strategies into the existing pre-exposure prophylaxis (PrEP) intake and adherence app. PrEP is a medication that can be taken daily to reduce the risk of HIV transmission. The aim of including PrEP adherence in the self-help harm reduction strategy is to ensure that participants have access to and are using an effective HIV prevention method. Behavior regulation strategies such as providing education about the risks of drug use, overdose prevention and management, and HIV prevention through correct PrEP intake, can be integrated into a mobile app that aims to minimize the negative consequences of drug use and reduce the risks associated with it, with an overarching goal to reduce the potentially negative consequences of problematics chemsex behavior for individuals and communities.
Interventions
BEHAVIORALMobile app to reduce harm of chemsex
Access to the mobile app which includes PrEP diary, demistification of chemsex urban legends, information on the location of needle and syringe services program, and alert sending to emergency contact.
Sponsors
National Cheng Kung University
Healing, Empowerment, Recovery of Chemsex (HERO) integrated care clinic
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* individuals need to have a history of drug use (ecstasy, ketamine, crystal methamphetamine, mephedrone, and/or GHB/GBL)in a sexualized context in the previous year * can read and understand chinese, * willing to communicate with the research team through the mobile messenger app Line.
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Usability of the App | 1 month | Scores on the translated version of the mHealth App Usability questionnaire (MAUQ) was used to assess usability. Responses to the statements on the questionnaire ranged from 1(strongly agree) to 7 (strongly disagree). The questionnaire is the total score of each item divided by the number of items. The closer the mean value is to 1, the higher the app's usability will be. |
Countries
Taiwan
Contacts
PRINCIPAL_INVESTIGATORCarol Strong, PhD
National Cheng Kung University
Participant flow
Recruitment details
Participants were recruited from an integrated care clinic specializing in sexual health and chemsex, from current UPrEPU users, and through online channels and word of mouth.
Pre-assignment details
No significant events occurred between enrollment and participation. Eligible participants were directly onboarded to the UPrEPU app and completed baseline assessments. No washout, run-in period, or pre-assignment exclusions were reported.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Customized Age ≥ 35 | 13 Participants |
| Age, Customized Age < 35 years | 7 Participants |
| Chemsex services utilization in the past three months Chemsex care programs affiliated with NGO | 4 Participants |
| Chemsex services utilization in the past three months Chemsex recovery therapy groups or counseling | 9 Participants |
| Chemsex services utilization in the past three months Mental health clinic/hospital or rehab center | 9 Participants |
| Chemsex services utilization in the past three months Needle Syringe Program | 2 Participants |
| Education Bachelor's degree or higher | 16 Participants |
| Education lower educational attainment | 4 Participants |
| Employment Status Employed | 18 Participants |
| Employment Status Not employed | 2 Participants |
| Preventive behaviors Doxy-PEP use experience | 2 Participants |
| Preventive behaviors HIV negative not on PrEP | 3 Participants |
| Preventive behaviors HIV negative on PrEP | 6 Participants |
| Preventive behaviors HPV vaccination uptake | 13 Participants |
| Preventive behaviors Living with HIV | 11 Participants |
| Preventive behaviors Mpox vaccination uptake | 14 Participants |
| Self-efficacy for sexual safety | 21.30 Scale scores STANDARD_DEVIATION 7.73 |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 20 Participants |
| Sexual behaviors CLAI in past 3 months | 19 Participants |
| Sexual behaviors Having a sexual partner living with HIV in past 3 months | 9 Participants |
| Sexual behaviors Numbers of male sexual partners in the past 3 months ≥ 6 | 6 Participants |
| Sexual behaviors Self-reported STI in the lifetime (any kind) | 7 Participants |
| Sexual satisfaction | 4.48 Scale scores STANDARD_DEVIATION 1.81 |
| Type of substance used for chemsex Alkyl nitrites (Rush, poppers) | 11 Participants |
| Type of substance used for chemsex GHB/GBL | 11 Participants |
| Type of substance used for chemsex MDMA | 4 Participants |
| Type of substance used for chemsex Methamphetamine | 19 Participants |
| Type of substance used for chemsex Sedative | 4 Participants |
| Type of substance used for chemsex Viagra | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 20 |
| other Total, other adverse events | 0 / 20 |
| serious Total, serious adverse events | 0 / 20 |
Outcome results
None listed