Feasibility and Acceptability of Using a Mobile Application for HIV Symptom Monitoring, Clinical Follow Up and Peer Support Among HIV Infected MSM in Ghana, West Africa

Project Profile


Feasibility and Acceptability of Using a Mobile Application for HIV Symptom Monitoring, Clinical Follow Up and Peer Support Among HIV Infected MSM in Ghana, West Africa

Project Period:

01/01/16 - 06/30/17



Co-Principal Investigator:

LaRon Nelson, PhD, RN, FNP

Amina Alio, PhD


HIV prevalence among men who have sex with men (MSM) in Ghana is 17.5%, which is 15 times higher than that of the general population. Stigma against same-sex behaviors and identities are common in Ghana and often intertwined with symbolic HIV-related stigma beliefs, perpetuating the notion that infection is divine punishment for MSM. MSM who do not conform to local masculine gender norms are especially vulnerable to stigma. These stigmas can be major contributors to disengagement from HIV care for fear of ridicule and mistreatment. Disengagement can lead to decreased access to antiretroviral therapy and concomitant increases in HIV viral load, HIV symptoms, HIV symptom distress and HIV/AIDS related mortality. To date, there is no known study in Ghana that has identified novel patient-centered alternatives that allow HIV-infected MSM opportunities to be comprehensively evaluated for symptoms and quality of life (QOL) in less-threatening non-clinical environments of their choice. There is substantial evidence that social support from peer-groups contributes to improved care continuum outcomes for HIV-infected individuals. However, the social context in Ghana is not optimal for peer support that is centralized in “support groups” due to the potential risks from public disclosure of one’s HIV seropositive status and sexual orientation. Little is known regarding how mobile technology may be used to decentralize access to peer support. We also do not know what are HIV-infected MSMs preferences for different types (e.g., informational, emotional, affirmational) and forms (e.g., HIV status affirming; religious affirming; same-gender affirming) of mobile technology mediated peer-support that may help mitigate the negative effects of stigmas on HIV care linkage and retention. We propose two aims to narrow these knowledge gaps and support future intervention research. Our primary aim is to evaluate the feasibility and acceptability of using a mobile app to collect HIV symptom and quality of life data from HIV-infected MSM, including those who are not linked or retained in care. We will pilot the use of client-centered care continuum coordination (C5) to collect a limited set of data on HIV symptoms (frequency, severity, distress) and HIV QOL at baseline plus two 30-day follow-up time points. A convenience sample of MSM (N = 50) will be recruited using venue-based and peer-driven recruitment methods. We will determine feasibility by the number and percentage of MSM who agree to be documented in C5, percentage of follow-up visits made at 30 and 60 days, and proportion of follow-up visits where symptom and QOL data were collected. Our secondary aim is to assess the peer-support needs and concerns of HIV-infected MSM. We will interview a purposive sub-sample of MSM (n = 10) at the 60-day follow up visit. A semi-structured interview guide will be developed to assess the types and forms of peer-support that MSM may find useful for managing their HIV diagnosis. Data generated from this proposed study will inform an R34 NIH proposal to further refine and pilot test C5 in preparation for an R01 application to evaluate its implementation in public health clinics.