Preferences for mHealth Features to Support Engagement in the HIV Preexposure Prophylaxis Cascade Among Men Who Have Sex With Men in Peru: Cross-Sectional Online Survey

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Background: Despite policy-level progress, implementation of oral HIV preexposure prophylaxis (PrEP) remains limited in Latin America. In Peru, men who have sex with men (MSM) account for most new HIV diagnoses, yet uptake remains low. Widespread smartphone ownership and the use of digital platforms present an opportunity to expand access through mobile health (mHealth) interventions. However, limited data exist on user preferences to guide the design of mHealth tools in Spanish-speaking Latin American settings. Objective: This study aimed to assess preferences for mHealth features to support PrEP engagement among Peruvian MSM and their association with PrEP cascade stages. Methods: We conducted a cross-sectional online survey (June-August 2023) among 600 HIV-negative MSM residing in Peru (median age 29, IQR 24-35 years), recruited via Facebook, Instagram, WhatsApp (Meta Platforms, Inc), and Grindr (Grindr LLC). The survey assessed communication platform use, interest in mHealth features measured on a 4-point Likert scale, and PrEP cascade stages. Exploratory factor analysis (principal axis factoring with Promax rotation) identified domains of mHealth preferences, from which median domain scores were calculated. Bivariate analyses used chi-square tests and Wilcoxon rank sum tests. Multivariable logistic regression models (α=.05), with covariates selected using stepwise procedures from candidate sociodemographic and behavioral variables, estimated associations between each domain score and PrEP cascade stages, each modeled as a separate binary outcome. Results: Nearly all participants (589/600, 98.2%) reported owning a smartphone. WhatsApp was the most frequently used and preferred platform for PrEP support, with 547 (91.2%) reporting frequent use and 302 (50.3%) ranking it first. Exploratory factor analysis identified three mHealth preference domains: informational support (Cronbach α=0.94), self-management tools (Cronbach α=0.94), and interactive communication (Cronbach α=0.91). Among participants, 483 (80.5%) had decided to use PrEP, 190 (31.7%) had sought PrEP, and 109 (18.2%) had initiated PrEP. Higher informational support was associated with the decision to use PrEP (adjusted odds ratio [aOR] 4.54, 95% CI 3.36-6.28; P<.001), seeking PrEP (aOR 1.43, 95% CI 1.10-1.89; P=.001), and PrEP initiation (aOR 1.64, 95% CI 1.16-2.44; P=.009). Self-management tools showed similar associations with the decision to use PrEP (aOR 3.23, 95% CI 2.51-4.22; P<.001), seeking PrEP (aOR 1.34, 95% CI 1.06-1.70; P=.02), and PrEP initiation (aOR 1.49, 95% CI 1.11-2.05; P=.01). Interactive communication was associated with the decision to use PrEP (aOR 2.74, 95% CI 2.15-3.53; P<.001) but not with initiation. Conclusions: Preferences for mHealth features were associated with engagement at multiple stages of the PrEP cascade among MSM in Peru. Informational support features demonstrated the most consistent associations with cascade engagement. These findings provide empirical evidence on user-prioritized digital functions that could support early engagement in HIV prevention services in a Latin American implementation context. Integrating culturally tailored mHealth tools within widely used platforms such as WhatsApp may strengthen early PrEP cascade engagement and support scalable digital strategies for HIV prevention in Peru and similar settings.

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