O19.2 Limited HIV Pre-exposure Prophylaxis Uptake among Chinese Men Who Have Sex with Men– Qualitative Analysis and Potential for an App

BackgroundIn China, few gay, bisexual and other men who have sex with men (GBMSM) use HIV pre-exposure prophylaxis (PrEP), and little is known about their views of PrEP and barriers to uptake. We aimed to understand Chinese GBMSM’s limited use of PrEP and assess the potential of a new PrEP education app to address barriers.MethodsWe developed and tested a theory-informed, gay-friendly PrEP education app among GBMSM in Guangdong, China. In Phase I qualitative interviews were conducted to understand perceived barriers and facilitators toward PrEP uptake; each participant tested the app for 5 minutes and completed the System Usability Scale (SUS). Phase II included a 4-week pilot study of the app with baseline and follow-up surveys (not presented here) and qualitative exit interviews.Results41 participants completed qualitative interviews (Phase I=31, Phase II=11). GBMSM (mean age=27, SD=7.6) described numerous barriers to starting PrEP including limited access to PrEP care (e.g., few providers, high copays, medical mistrust), misinformation and low awareness about PrEP (e.g., severe side effects, ineffective), no official PrEP endorsement from providers or policymakers, and a thriving unregulated underground PrEP market. Facilitators of using PrEP included fear of HIV, seeking sexual pleasure, and freedom from stigma. 77.4% (24/31) rated the app ‘above-average’ usability on SUS. Aspects of the app enhanced usability included convenient access to gay-friendly PrEP information, a streamlined user-interface, inclusive contents addressing physical and mental health, and an asynchronous chat feature to send questions to study staff.ConclusionWe found major barriers to PrEP uptake among Chinese GBMSM including unaffordable prices, lack of GBMSM-friendly PrEP campaigns, and insufficient provision of PrEP care. Mobile health may be feasible for increasing PrEP awareness and engaging GBMSM in the health system in China. Other barriers point to the need also for health systems-level interventions to expand PrEP uptake.