Feasibility and Preferences to Adopt Mobile Health-Based Interventions for HIV Prevention: A Cross-Sectional Study Among High-Risk Groups In Pakistan (Preprint)

BACKGROUND HIV disproportionately affects men who have sex with men (MSM), transgender (TG) individuals, and people who inject drugs (PWID) in Pakistan, with 70.1% of cases linked to these groups, aggravated by stigma and legal constraints. Mobile health (mHealth) interventions offer potential to enhance HIV prevention, yet their acceptability remains underexplored. OBJECTIVE This study aimed to assess the feasibility, willingness to use, and preferences for mHealth-based interventions designed to improve HIV knowledge, testing uptake, and risk behavior reduction among MSM, TG individuals, and PWID in Pakistan. METHODS A cross-sectional survey was conducted from September 2024 to March 2025 with 210 participants, including MSM and TG individuals, recruited through respondent-driven sampling (RDS) in collaboration with community-based organizations (CBOs) and non-governmental organizations (NGOs). While PWID were recruited from the rehabilitation centers of trusted CBOs and NGOs, to ensure privacy and safety concerns. Participants completed a self-administered questionnaire covering demographics, HIV knowledge, access to and use of mobile technology, acceptability and preferences for mHealth interventions, and HIV-related risk behaviors. RESULTS : The majority of participants owned smartphones (76.7%; 161/210) and had daily internet access (54.8%; 115/210), spending an average of 3.14 (SD 3.10) hours online daily. High willingness (86.7%; 182/210) to use a clinic-integrated mHealth app for HIV prevention was reported. Preferred app-delivered features included educational resources (40.5%; 85/210), daily medication reminders (51.4%, 108/210), weekly HIV prevention information (52.4%; 110/210), e-consultation (75.2%; 158/210), and mental health information (63.8%; 134/210). Smartphone ownership (Odd Ratio [OR] = 4.14, 95% CI: 1.41 – 12.21) and prior experience with an mHealth app (OR 2.97, 95% CI: 1.00- 8.81) were significantly associated with willingness to adopt an mHealth app. While 80.5% (169/210) reported some knowledge of HIV, only 16.9% (29/169) rated their knowledge high, and 46.1% (97/210) were unaware of their HIV status. In terms of vulnerability, participants reported injecting drug use (58.1%; 122/210), experiences of violence (41.4%; 87/210), and police detention (61%; 128/210) were prevalent. While in terms of risky sexual behaviors, nearly half engaged in transactional sex (49.5%; 104/210) or had multiple partners (48.1%; 101/210), while consistent condom use remained low (42.9%; 90/210). CONCLUSIONS There is high acceptability and considerable potential for mHealth interventions to enhance HIV prevention efforts among MSM, TG individuals, and PWID in Pakistan. Tailored, discreet, and comprehensive mHealth platforms that include educational content, medication reminders, e-consultation, and mental health support are warranted. Addressing criminalization and ensuring user privacy will be crucial for the successful design and implementation of these interventions. Future research should focus on optimizing app design and evaluating its effectiveness in these populations.