Recent data shows rates of new HIV cases are on the rise in Malaysia, particularly among gay, bisexual, and other men who have sex with men (GBMSM).

This increase has been attributed in part to chemsex, which refers to the intentional use of psychoactive substances before or during sexual activity. Chemsex has been identified as a global public health issue for its likelihood to elevate HIV risk and other health issues like sexually transmitted infections (STIs), addiction, violence, and suicide and suicidal ideation, among others.

GBMSM who engage in chemsex oftentimes encounter obstacles within health care settings to accessing traditional evidence-based harm reduction services, including HIV testing, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), HIV/STI treatment, and syringe services programs. Additionally, the criminalization of drug use and same-sex sexual behavior in Malaysia further impedes access to these essential services. Moreover, even when such services are accessible, they often lack the necessary support tailored to the specific needs of GBMSM involved in chemsex.

Leveraging innovative mHealth tools could help expand access to harm reduction services for chemsex-engaged GBMSM in Malaysia.

Roman Shrestha, an assistant professor in the Department of Allied Health Sciences in the College of Agriculture, Health and Natural Resources (CAHNR), recently received a 5-year, $3.4 million grant from the National Institutes of Health (NIH) to develop JomCare, a smartphone-based just-in-time adaptive intervention (JITAI) aimed at improving access to HIV- and substance use-related harm reduction services for Malaysian GBMSM engaged in chemsex.

The study aligns with the NIH’s research goals to create innovative technologies that help prevent HIV and substance use more effectively and link people to relevant prevention and care services.

“In Malaysia, our research has indicated that harm reduction needs of GBMSM engaged in chemsex are not being adequately met. Utilizing smartphone apps and other mHealth tools presents a promising and cost-effective approach to expand access to these services for stigmatized and hard-to-reach populations,” says Roman Shrestha, who is also a principal investigator at UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP).

Shrestha and his lab, the Shrestha Lab, will work with collaborators from Yale University, the University of Michigan, the University of Texas at Tyler, and the University of Malaya in Malaysia to develop and implement an app-based chemsex harm reduction JITAI, JomCare, that uses ecological momentary assessment to monitor users’ chemsex risk in real-time. The app will then analyze participant responses to daily ecological momentary assessments (EMA) using a machine learning algorithm and deliver tailored interventions as needed. EMAs collect information about participants’ thoughts and behaviors in real time to understand elements that influence behavior.

For example, if a user reported injecting drugs, the app would provide prompts about safer drug injections and steps they can take to reduce their HIV risk. These prompts could provide information about safer drug injection, motivate participants to take action, such as ordering an at-home HIV test kit, or improve self-efficacy with behavioral skills.

The JomCare app will include on-demand features like same-day PrEP delivery, peer-based e-counseling, safer chemsex package, HIV/STI self-testing, multimedia resource library, and a medication, drug use, and mood tracker. These features align with the core features of JITAIs, which are advantageous over other mHealth approaches because they can deliver tailored interventions based on users’ fluctuating needs.

While JITAIs are being used in areas like addiction, mental health, physical activity, and obesity, there is little research on how they can be employed to address chemsex harm reduction. To the investigative team’s knowledge, JomCare will be the first app-based JITAI specifically designed to meet chemsex-involved GBMSM’s care needs.

“mHealth technology has enormous potential to effectively reach and support GBMSM involved in chemsex, offering a convenient, confidential, and less stigmatizing method of intervention. Many of these individuals already use online communication platforms, and advancements in digital health technology now allow for personalized intervention tailored to real-time, real-world situations. This is particularly important in the context of chemsex, as GBMSM have varying needs at different times of risk,” says Shrestha.

By offering a comprehensive and accessible support system, JomCare is a potential solution to remove barriers to HIV prevention and chemsex harm reduction services in Malaysia.

The project could also lead to the development of technology that makes HIV and substance use prevention services more accessible, as well as new intervention models that could apply to other health conditions and settings.