HIV Apps, Are They Fit for Purpose?

Are HIV apps fit for purpose? 

A recent study by a team of researchers from University College London and Glasgow Caledonian University looked at over 600 HIV apps to assess their functionality. They also analysed users’ reviews to see if the apps were meeting their needs.

The research, led by Aneesha Singh, was part of a 3-stage investigation into human immunodeficiency virus (HIV) smartphone apps and web tools and the results were published in 2017 (see Next Steps).

“We want to understand how online technology can deliver advances in diagnosis and prevention, and support users based on needs at different stages of the pathway,” the study authors said. 

However, they cautioned that, “using online information raises important concerns about the trustworthiness of these resources and whether they are fit for purpose.”  

Are HIV smartphone and web apps meeting the needs of their users? 

Functionality review

The second part of the study focused on assessing the functionality and features of the HIV apps. There were from the users’ perspective, according to 4 broad criteria:

  • One, HIV prevention including information/awareness and sexual behaviour change applications (risk reduction/safe sex promotions/condom use)
  • Two, HIV risk calculators and symptom checkers
  • Three, testing and links to care (including window periods for testing)
  • Four, HIV management (including pathways for people living with HIV as well as those who are at high risk of HIV). 
What they found 
  • While 87% of the smartphone apps provided some HIV-related information, “this was not clearly signposted.” App names did not always identify the aim of the app. One example was “Health is vital” which does not indicate that the app is focused on HIV information. However, given the potential embarrassment or stigma of explicit HIV icons and images, highlighted in the first stage of the study, this is clearly a dilemma for developers. One app overcame this by making it clear in the app store that it was HIV-related. They did this by removing HIV from the name and having a discreet icon when it was downloaded. 
  • In 63% of smartphone HIV apps, it was unclear whether the source of the information was medically- approved or based on medical evidence. So, there was no way of assessing if the content was reliable. Only 9% of the apps allowed interaction with healthcare professionals (HCPs). Most did not specify which type of HCP they could communicate with. 
  • The results for the web-based apps were much better: 93% did provide clearly-signposted information. These were linked to other resources, such as the NHS. 97% came from trusted sources, such as pharmacies, medical charities or healthcare providers. The web-apps also scored higher in offering home-testing options (21%) while only one of the smartphone apps did so. 
  • Many apps were also found to be poorly designed from the user perspective. For example, the back-button feature did not work on 22% of the apps reviewed and 12% of the apps did not allow the user to exit the app.
Analysis of user reviews

The final part of the study focused on user reviews of the apps. All available reviews were recorded for each app, but only those on Google Play. The iTunes App Store did not allow the copying of comments. Each review was then classified by the general sentiment expressed (whether neutral, negative or positive), and the type of review (whether a general request for new feature, new or lost functionality, or a complaint). 

In total, 345 reviews were analysed. They focused on those with specific comments about functionalities or features. 48% were in the category of functionality comments/requests (with 51% of these being complaints about functionality lost due to updates, non-working features, application crashes etc.) The remainder were positive comments about specific aspects of the app or how it had been helpful to users.

So, what did users want?

  • Firstly, information on HIV that was accurate and regularly updated
  • Secondly, transparency about how risk calculators worked and what evidence they were based on 
  • Thirdly, post-diagnosis practical and emotional support and guidance
  • Fourthly, HIV management – requests for back-up options so users could continue to access saved data when operating systems upgraded. Too often, personal data were lost
  • And lastly, usability and security – poor interfaces, difficulties with storing data, stability issues where the app froze or crashed losing data, and concerns over data privacy and security.

The researchers found that the majority of apps reviewed took a ‘one-size-fits-all’ approach. They did not address the diverse needs of people seeking HIV-related help, from pre-testing to diagnosis, psychosocial support and management. 

“There is an urgent need for trustworthy resources to support people accessing information online and to reduce barriers to care. From the person seeking information following a sexual encounter, to someone using a self-testing kit at home with no immediate access to care, to the person living with HIV, apps can provide support. This is a significant opportunity to bring together the strengths of HCI (human-computer interaction), with relevant clinical expertise, to address issues common to apps for other health conditions and those specific to sexual health/HIV,” the report authors concluded.


Read the full study

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See which HIV apps patients and patient groups have recommended on myhealthapps…

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See the related categories to HIV on myhealthapps…

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