Resumo

O objetivo deste estudo foi analisar na literatura como os aplicativos foram elaborados e como influenciam na prevenção das Infecções Sexualmente Transmissíveis (IST). Levantou-se nas bases de dados PubMed, Periódicos da CAPES e Bireme utilizando os descritores “sexually transmitted diseases” e “mHealth” combinados pelo conector booleano AND. Considerou-se o período entre 2013 e 2017, artigos disponibilizados “on-line” em português e inglês. Os resultados dos estudos mostraram que para a elaboração do aplicativo a pesquisa formativa prevaleceu como método e o grupo focal como a técnica para a coleta de dados. Essa técnica objetiva a troca de experiencia e oportuniza a discussão de assuntos inerentes às infecções. Considera-se que os aplicativos foram construídos com rigor metodológico com a participação de usuários e com recursos instrucionais que influenciam o manejo da prevenção e o controle das infecções.

Palavras-chave
Infecção Sexualmente Transmissível; mHealth; Tecnologia

Introdução

A expansão da saúde móvel (mHealth) e da internet nos últimos anos fez com que o mercado de aplicativos relacionados à saúde evoluísse rapidamente, possibilitando novas potencialidades para este setor¹1 Xu W, Liu Y. mHealthApps: a repository and database of mobile health apps. JMIR Mhealth Uhealth 2015; 3(1):e28..

Aplicativos “apps” são programas de computador projetados para smartphones, tablets, entre outros dispositivos móveis, os quais disponibilizam jogos, serviços baseados em localização, acesso a sites de relacionamento sociais e sexuais e para os cuidados com a saúde²2 Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep 2015; 12(1):173-190.

Nesse sentido, “apps” possuem grande potencial para expandir informações sobre saúde para a população, principalmente entre os pacientes com doenças estigmatizantes, como as infecções sexualmente transmissíveis (ISTs)³3 Harding-Esch E, Jofre-Bonet M, Dhanjal JK, Burr S, Edwards T, Holland M, Sillah A, West S, Lietman T, Keenan J, Mabey D, Bailey R. Costs of testing for ocular Chlamydia trachomatis infection compared to mass drug administration for trachoma in the Gambia: application of results from the PRET study. PLoS Negl Trop Dis 2015; 9(4):e0003670.. Estima-se que, mundialmente, a cada ano, haja 357 milhões de novos casos de ISTs curáveis entre pessoas com a faixa etária de 15 a 49 anos. Dentre as infecções virais, o índice é similarmente elevado, com estimativa de 417 milhões de pessoas infectadas⁴4 World Health Organization (WHO). Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. Towards Ending STIs. 2016. [acessado 2019 Abr 11]. Disponível em: http://apps.who.int/iris/bitstream/handle/10665/246296/who-rhr-16.09-eng.pdf; jsessionid=FE6F73393DD8F8CD07A6C3E481967ADF?sequence=1
http://apps.who.int/iris/bitstream/handl... .

Esse tipo de tecnologia permite ao usuário uma série de oportunidades, a exemplo da notificação de parceiros sexuais, localização de serviços de saúde especializados, obtenção de informações sobre as modalidades de transmissão, como fazer o tratamento e medidas preventivas⁵5 Rana AI, van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.^,66 Estcourt CS, Gibbs J, Sutcliffe LJ, Gkatzidou V, Tickle L, Hone K, Aicken C, Lowndes CM, Harding-Esch EM, Eaton S, Oakeshott P, Szczepura A, Ashcroft RE, Copas A, Nettleship A, Sadiq ST, Sonnenberg P. The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis. Lancet Public Health 2017; 2(4):e182-e190..

Com a popularização dos aplicativos para a promoção da saúde sexual, houve também o crescimento dos apps gays como o Grindr® e o Tinder® criados para facilitar encontros sociais e sexuais, que podem proporcionar comportamentos sexuais de risco em determinados contextos. Por outro lado, indica um espaço no qual os profissionais podem promover ações voltadas para a saúde sexual⁷7 Grov C, Breslow AS, Newcomb ME, Rosenberger JG, Bauermeister JA. Gay and bisexual men's use of the Internet: research from the 1990s through 2013. J Sex Res 2014; 51:390-409..

Países da América Latina possuem aproximadamente 332 milhões de usuários com acesso a internet, entre os quais 114 milhões são brasileiros. Em relação ao aplicativo mais utilizados pelos brasileiros cita-se o WhatsApp®, com 46 milhões de usuários. Atualmente, as duas maiores plataformas de distribuição de aplicativos são a App Store e a Google Play⁸8 Avazu Holding. Global Internet Industry Research Brazil. 2016. [acessado 2019 Abr 11]. Disponível em: http://avazuinc.com/wordpress/wp-content/download/en/Global%20Internet%20Industry%20Research%20-%20Brazil(Full%20Edition).pdf
http://avazuinc.com/wordpress/wp-content... ^,99 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa nacional por amostra de domicílios: síntese de indicadores 2015/IBGE, Coordenação de Trabalho e Rendimento. Rio de Janeiro: IBGE; 2016. [acessado 2019 Abr 11]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv98887.pdf.

O resultado desse crescimento mobiliza esforços dos pesquisadores para avaliar cuidadosamente os aspectos metodológicos e científicos dos aplicativos, a fim de garantir que seus componentes possam refletir na mudança de comportamento e maximizar sua eficácia no controle de IST. Produzir pesquisas utilizando mHealth, no entanto, é um processo complexo de intervenção que envolve características especificas da área da Tecnologia da Informação e Comunicação (TIC) em todas as fases do projeto¹⁰10 Ben-Zeev D, Schueller SM, Begale M, Duffecy J, Kane JM, Mohr DC. Strategies for mHealth research: lessons from 3 mobile intervention studies. Adm Policy Ment Health 2015; 42(2):157-167.^,1111 Gibbs J, Gkatzidou V, Tickle L, Manning SR, Tilakkumar T, Hone K, Ashcroft RE, Sonnenberg P, Sadiq ST, Estcourt CS. 'Can you recommend any good STI apps?' A review of content, accuracy and comprehensiveness of current mobile medical applications for STIs and related genital infections. Sex Transm Infect 2017; 93(4):234-235..

Em razão da importância da tecnologia móvel, do uso dessa ferramenta por grande número de pessoas no Mundo, bem como da escassez de literatura sobre aplicativo para prevenção, diagnóstico, tratamento e controle das doenças infecciosas, questionou-se sobre as abordagens metodológicas utilizadas pelos autores para a elaboração dos aplicativos e quais as influências destes para a prevenção das ISTs.

Nesse contexto, procurou-se analisar na literatura os métodos usados na elaboração dos aplicativos e suas influências na prevenção das ISTs.

Metodologia

Esta é uma revisão integrativa, pois permite a síntese de múltiplos estudos publicados e possibilita conclusões gerais a respeito de uma particular área de estudo¹²12 Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm 2008; 17(4):758-764.. Para a elaboração deste estudo, optou-se pela definição de um problema, formulação de uma hipótese; estabelecimento de critérios para inclusão e exclusão; categorização dos estudos; avaliação dos estudos; interpretação dos resultados e síntese do conhecimento¹²12 Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm 2008; 17(4):758-764..

Elege-se a seguinte indagação norteadora para o estudo: Como os aplicativos são elaborados e como podem influenciar na prevenção das ISTs?

A busca eletrônica foi realizada no período de dezembro de 2017, nas bases de dados da PubMed, Periódicos da CAPES e na Bireme. Selecionaram-se artigos publicados nos últimos cinco anos (2013 a 2017), nos idiomas inglês e português, disponíveis na íntegra. Como não há descritores específicos nos Descritores em Ciências da Saúde (DeCS) sobre esse tema, foram utilizados os termos traduzidos em língua inglesa: sexually transmitted diseases e mHealth combinados pelo conector booleano AND.

Foram adotados como critérios de inclusão estudos qualitativos que abordassem o processo metodológico, as contribuições dos grupos focais de sites e aplicativos para a prevenção das ISTs, considerando a leitura dos títulos, resumos e artigos publicados na íntegra. Excluíram-se estudos quantitativos, pois estes não comtemplam a metodologia de grupos focais que analisam os ensejos dos participantes para a elaboração da tecnologia. Também foram excluídos estudos de revisão, teses, dissertações e ensaios indisponíveis na íntegra.

Para orientar a organização dos artigos, elaborou-se uma ficha contendo dados dos autores, ano da publicação, objetivo, método e resultados.

Para o nível de evidência cientifica dos artigos incluídos no estudo foi utilizado o instrumento Medicina Baseada em Evidências (MBE), pois busca obter artigos relevantes e faz uma análise crítica da qualidade publicação¹³13 Esteitie R. Fundamentos da pesquisa clínica. Porto Alegre: Artmed; 2015. e classifica em:

Grau A: são sustentados por boas evidências (nível de evidência 1- revisão sistemática de ensaios clínicos randomizados ou metanálises de estudos clínicos randomizados), favoráveis ou contrárias à intervenção recomendada.

Grau B: são sustentados por evidências razoáveis (nível de evidência 2 - estudos comparativos prospectivos, metanálises de estudos de nível 2 ou estudos de nível 1com resultados inconsistentes ou estudos do nível 3 – estudos de coorte retrospectivos, estudos de caso-controle ou estudos observacionais com controle).

Grau C: exprimem evidências conflitantes ou de baixa qualidade (nível 4 - estudos observacionais sem controle ou extrapolações de estudos de níveis 2 ou 3).

Grau D: não possuem evidências suficientes para que uma recomendação seja feita e são, com frequência, derivados de evidências de nível 4 ou estudos inconsistentes ou inconclusivos de qualquer nível.

Resultados

A busca dos artigos realizada no mês de dezembro de 2017, nas bases de dados selecionadas, resultou em 416 artigos (20 na Bireme, 148 na CAPES e 248 na Medline) dos quais, 20 eram duplicados e foram retirados, restando 396 para a avaliação geral. De tal modo, excluíram-se 364 artigos com base no título e com temáticas não relacionadas ao assunto, restando 32, lidos na íntegra para avaliar a elegibilidade do estudo. Após a leitura dos 32 artigos, 17 foram excluídos, pois não contemplam a abordagem qualitativa para a elaboração dos aplicativos, restando 15 para compor a análise deste estudo conforme ilustra a Figura 1.

Os estudos selecionados foram organizados e avaliados criteriosamente quanto à qualidade metodológica a relevância das informações. No Quadro 1, estão representados os 15 artigos selecionados na revisão.

Dos 15 artigos selecionados, um foi publicado no ano de 2017¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46., cinco em 2016¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.

16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.

17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.

18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^-1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6., seis em 2015²⁰20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.

21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.

22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.

23 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.

24 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^-2525 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91., um em 2014²⁶26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47. e dois em 2013²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880.. Houve concentração de estudos nos Estados Unidos¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.

15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^-1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.

19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.

20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^-2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.

24 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.

25 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91.

26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.^-2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., Reino Unido¹⁷17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,2222 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72. e na África²⁸28 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880.. Todos na língua inglesa.

No que se refere aos processos metodológicos utilizados no desenvolvimento dos 15 artigos analisados nesta revisão, observa-se que nove estudos usaram a pesquisa formativa¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.

19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^-2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2222 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880., um estudo de misto²⁵25 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91., e cinco estudos qualitativos¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1717 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^,2626 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47..

Todos os estudos empregam a técnica de grupo focal para obtenção de dados¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.

15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.

16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.

17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.

18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.

19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.

20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.

21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.

22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.

23 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.

24 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.

25 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91.

26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.

27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^-2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880., entre estes, dois aprofundam os achados com entrevistas individuais²¹21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880. e seis com dados quantitativos¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2525 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880..

Destaca-se o fato de 14 artigos abordarem apps com informações sobre a prevenção e o tratamento do HIV¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.

15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.

16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.

17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.

18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.

19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.

20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^-2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.

24 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.

25 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91.

26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.

27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^-2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880.. As intervenções de mHealth mostraram-se promissoras para melhorar a comunicação entre o paciente e os profissionais, além de fornecer educação em saúde e apoiar a autogestão do HIV²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880..

Um artigo relata a elaboração de um aplicativo para a prevenção da clamídia²²22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.. A infecção por clamídia tem maior prevalência entre a população jovem com faixa etária de 15 a 24 anos. É frequentemente assintomática em 70% das mulheres e 50% dos homens, podendo ocasionar graves morbidades na saúde reprodutiva²⁹29 O'Connell CM, Ferone ME. Chlamydia trachomatis Genital Infections. Microb Cell 2016; 3(9):390-403..

Evidencia-se que oito aplicativos são para homens que fazem sexo com homens (HSH)¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.

15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^-1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2626 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. Gays ou bissexuais e HSH estão entre os grupos no qual o HIV está descontrolado em todo o mundo. Esses são 24 vezes mais propensos à infecção pelo HIV do que os homens na população em geral, já a prevalência do HIV entre HSH é 15% maior³⁰30 Ayala G, Santos GM. Will the global HIV response fail gay and bisexual men and other men who have sex with men? J Int AIDS Soc 2016; 19(1):21098.^,3131 Programa Conjunto das Nações Unidas sobre HIV/AIDS 2017 (Unaids). [acessado 2019 Abr 11]. Disponível em: https://unaids.org.br/2017/11/homens-sao-menos-propensos-buscar-tratamento-para-hiv-e-tem-mais-chances-de-morrer-por-causas-relacionadas-aids-diz-unaids/
https://unaids.org.br/2017/11/homens-sao... .

Observa-se, também, que, entre os artigos analisados três são para a prevenção do HIV entre HSH negros¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. O HIV afeta desproporcionalmente os HSH desde o início da epidemia. Atualmente, quase 40% das pessoas vivendo com HIV nos Estados Unidos são afroamericanas³²32 Centers of Disease Control and Prevention (CDC). HIV among African American gay and bisexual men. [acessado 2019 Abr 11]. Disponível em: https://www.cdc.gov/hiv/group/msm/bmsm.html
https://www.cdc.gov/hiv/group/msm/bmsm.h... .

As estratégias de prevenção e tratamento do HIV, entretanto, não retardam a epidemia, pois requerem um envolvimento significativo de um sistema de saúde que supra às necessidades dos HSH negros eliminando as barreiras, como o racismo e a homofobia durante as consultas, o desconforto e a desconfiança, associados à divulgação do comportamento sexual pelos profissionais da saúde²⁰20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,3232 Centers of Disease Control and Prevention (CDC). HIV among African American gay and bisexual men. [acessado 2019 Abr 11]. Disponível em: https://www.cdc.gov/hiv/group/msm/bmsm.html
https://www.cdc.gov/hiv/group/msm/bmsm.h... .

Discussão

Nos aplicativos em estudo observou-se métodos diversificados com informações abrangentes e convergentes que influenciam na prevenção das ISTs. Dentre os métodos destaca-se a abordagem qualitativa para o desenvolvimento dos estudos e a técnica do grupo focal para a concepção dos aplicativos. Nesse sentido a pesquisa formativa consistiu no método mais adequado para a concepção e implementação eficaz de mHealth com a participação da população e de profissionais da saúde em todas as etapas do projeto¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880..

Nas etapas iniciais do desenvolvimento da intervenção, a pesquisa formativa utilizou grupos focais e entrevistas com populações e stakeholders, para determinar as barreiras, capacidades e motivações dos usuários³³33 Donovan R, Henley N. Social marketing and social change. In: Donovan R, Henley N. Principles and Practice of Social Marketing: An International Perspective. Cambridge: Cambridge University Press; 2010. p. 1-22.. Nas etapas finais, esse método pode ser usado para avaliar a aceitabilidade do material, nível de alfabetização, conteúdo e formas de implementação³⁴34 Freimuth VS, Mettger W. Is there a hard-to-reach audience? Public Health Rep 1990; 105(3):232-238.. Essas etapas facilitam o desenvolvimento eficaz da intervenção além de permitir que especialistas analisem se a intervenção podem ser adaptada a novos cenários ou populações³⁵35 Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Schaalma H, Markham C. Planning health promotion programs: An intervention mapping approach. 2nd ed. San Francisco: Jossey-Bass; 2006..

Observou-se que todos os estudos usaram a técnica do grupo focal com a finalidade de compreender as preferências das funções e a interface¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,2222 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2626 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222. de aplicativos para a prevenção, o tratamento e a promoção do teste para o HIV¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1717 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880. e aderência a terapia antirretroviral¹⁹19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2525 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91..

Grupos focais consistem na capacidade de compartilhar vivências com outras pessoas e dessa forma, identificar as barreiras ao tratamento, além de avaliar os pontos positivos e negativos dos aplicativos para as ISTs¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1717 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.. Entretanto, considerando a natureza estigmatizante e discriminatória do tema, a falta de anonimato e o compartilhamento das experiências sexuais com membros da comunidade podem gerar desconforto que interfere nas respostas dos participantes¹⁷17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168..

Maximizar os benefícios e minimizar os danos para os participantes envolvidos no estudo é uma das responsabilidades éticas da equipe de pesquisa. Partes interessadas podem trazer contribuições valiosas sobre possíveis danos sociais da participação em ensaio clínico. Isto é de particular importância no caso de indivíduos ou grupos vulneráveis, marginalizados, estigmatizados, ou que detêm menos poder na sociedade³⁶36 Programa Conjunto das Nações Unidas sobre HIV/Aids (UNAIDS). Boas práticas de participação. Diretrizes para ensaios clínicos de prevenção biomédica do HIV 2011. [acessado 2019 Abr 6]. Disponível em: https://www.avac.org/good-participatory-practice
https://www.avac.org/good-participatory-... .

Mesmo assim, a participação dos usuários viabiliza o entendimento dos recursos e as funções necessárias para compor um aplicativo destinado à prevenção do HIV/IST¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2222 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., facilita a comunicação entre os profissionais da saúde²⁰20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191., estimula a aderência da terapia antirretroviral¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6. e informa sobre os cuidados com pacientes com HIV/SIDA²⁸28 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880..

O Community-Based Participatory Research (CBPR), o qual é embasado no construto do Modelo de Crenças em Saúde, permitiu o envolvimento da comunidade para a construção do design e o conteúdo de aplicativos para a prevenção e o tratamento do HIV de pacientes da atenção primária de saúde²¹21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106. e de jovens africanos residentes no Reino Unido¹⁷17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.. Este modelo permite abordar as vulnerabilidades ambientais para a implementação de novas tecnologias para a prevenção do HIV³⁷37 Aggleton P, Parker R. Moving Beyond Biomedicalization in the HIV Response: Implications for Community Involvement and Community Leadership among MSM and Transgender People. Am J Public Health 2015; 105(8):1552-1558..

O modelo Information, Motivation, and Behavioral Skills (IMB) utilizado na concepção de um aplicativo para HSH, permitiu identificar no conteúdo características e funções de um aplicativo para a prevenção do HIV. Essa abordagem teve o propósito de facilitar o desenvolvimento de uma tecnologia para um grupo demográfico vulnerável²³23 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237..

O IMB inclui três constituições que influenciam as mudanças de comportamento para à adesão da terapia antirretroviral: (1) informação – conhecimento sobre os medicamentos; (2) motivação – incentivos pessoais e sociais; e (3) habilidades comportamentais – capacidade da pessoa de realizar as tarefas necessárias para a aderência³⁸38 Fisher JD. Fisher WA. Amico KR. Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol 2006; 25(4):462-473..

No entanto, a construção de software integra as contribuições dos usuários para a elaboração da interface do aplicativo, isso fornece à equipe de pesquisa oportunidades para compartilhar modelos conceituais com os participantes desde o início do processo de design com o intuito de coletar o feedback e fazer as modificações necessárias²¹21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106..

Dessa forma, a avaliação qualitativa, a teoria da aprendizagem social e o desenvolvimento de software podem se complementar e são componentes importantes para o desenvolvimento de um aplicativo culturalmente personalizado e clinicamente relevante³⁹39 Whiteley L, Brown L, Lally M, Heck N, van den Berg JJ. A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model. JMIR Mhealth Uhealth 2018; 6(4):e96..

Com o intuito de obter rigor metodológico para a concepção dos aplicativos a Information Systems Research (ISR) associada à Interação Humano Computador (IHC) incorporaram o feedback de membros da população alvo às preferências do design, as barreiras e as facilidades que incentivam ou limitam o uso da tecnologia para a prevenção e o tratamento do HIV¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.. A estrutura do ISR consiste em três ciclos inter-relacionados: (1) um ciclo de relevância, (2) de rigor e (3) de projeto⁴⁰40 Hevner A. A three cycle view of design science research. Scand J Inf Syst 2007; 19(2):4..

As diretrizes do design desempenham um papel importante na IHC, pois conduz o desenvolvimento do sistema e fomenta dados para a avaliação heurística na qual especialistas em IHC eliminam falhas remanescentes do sistema²²22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.. Trata-se de uma área interdisciplinar de pesquisa e prática baseada nas tradições das Ciências Humanas, Ciências da Computação, Sistemas de Informação, Psicologia, Sociologia e Design Visual. A IHC consiste em projetar tecnologias centradas no usuário e nas suas necessidades e rotinas diárias⁴¹41 Norman D, Draper P. User centered design: new perspectives on human-computer interaction. Hillsdale: Lawrence Erlbaurn Associates; 1986..

Outro aspecto analisado foram os protótipo de baixa fidelidade, os quais permitiram explorar as preferências dos usuários no que tange ao conteúdo, o desempenho da ferramenta e fornece informações para a elaboração dos requisitos funcionais¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.. O teste de usabilidade do protótipo tem o objetivo de identificar os bugs, fornece feedback sobre a interface e a navegabilidade¹⁹19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.. Os protótipos são ferramentas essenciais no processo de design do produto e podem ajudar a minimizar os erros de projeto que podem ocorrer no início e no final do processo⁴²42 Deininger M, Daly SR, Sienko KH, Lee JC. Novice designers' use of prototypes in engineering design. Des Stud 2017; 51:25-65..

Os aplicativos apresentaram semelhanças de recursos e funções sobre prevenção e tratamento do HIV/IST¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880., interação com profissionais da saúde¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., fórum on-line com outros usuários¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., lembretes das datas para realizar o teste do HIV¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191. e os dias das consultas²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., horários da medicação¹⁹19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., efeitos colaterais da terapia antirretroviral¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,1919 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880., informações sobre sexo seguro²⁰20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2121 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2626 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., uso de substâncias ilícitas¹⁸18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222. e localizar serviços de saúde¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.

15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^-1616 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,2323 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222..

Entre os recursos destaca-se Short Message Service (SMS), caracterizada como uma intervenção interativa, rápida, fácil e personalizada¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1717 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. Os benefícios da mencionada intervenção gira em torno da conveniência e onipresença²⁴24 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168. na qual possibilita o envio de lembretes das consultas, hora da medicação, dicas para a redução de risco de contrair HIV e interação com o profissional da saúde²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. No entanto, mensagens frequentes são desnecessárias e irritantes, aumentam a probabilidade de interromper o uso do aplicativo¹⁹19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.. Dessa forma, faz-se necessário que o usuário possa ter o controle da frequência e o tipo das mensagens recebidas²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222..

Por outro lado, mensagens com o intuito de motivar à adesão da terapia anti-retroviral podem surtir efeitos indesejados entre portadores do HIV que ainda não aceitaram o diagnóstico¹⁹19 LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men. JMIR Serious Games 2016; 4(1):e6.. Dessa forma, mensagens positivas e tranquilizadoras podem ser incluídas evitando assim foco exclusivo no HIV¹⁷17 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.. Observa-se que SMS é utilizado na África do Sul para a promoção da saúde de pacientes moradores de áreas rurais e urbanas, para aprimorar os cuidados com o HIV⁴³43 Lippman SA, Shade SB, Sumitani J, DeKadt J, Gilvydis JM, Ratlhagana MJ, Grignon J, Tumbo J, Gilmore H, Agnew E, Saberi P, Barnhart S, Steward WT. Evaluation of short message service and peer navigation to improve engagement in HIV care in South Africa: study protocol for a three-arm cluster randomized controlled trial. Trials 2016; 17:68..

O automonitoramento e o autogerenciamento do comportamento sexual via SMS oferecem novas oportunidades para envolver os pacientes com HIV no período entre as visitas clínicas e a rotina diária²⁵25 Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr 2015; 69(Supl. 1):S80-91.. No entanto esse componente deve ser considerado educacional e não apenas um registro de suas atividades sexuais¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.. O SMS oferece aos usuários uma fonte de informações sobre o HIV, adesão à terapia antirretroviral e comunicação com os profissionais da saúde⁴⁴44 Ruan Y, Xiao X, Chen J, Li X, Williams AB, Wang H. Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals. Patient Prefer Adherence 2017; 11:221-228..

A linguagem deve ser profissional, divertida e que possibilite adequações personalizadas pelos usuários. No entanto, essa opção pode não ser viável, pois exigiria o dobro do trabalho para adequar o aplicativo. Uma opção custo-efetivo pode ser a incorporação de duas linguagens formal e informal²⁶26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.. Programadores carecem compreender as limitações relacionadas à percepção da população, pois as informações apresentadas no aplicativo podem ser inteligíveis⁴⁵45 Ioannis A. Chatzipavlou , Sofia A. Christoforidou e Vlachopoulou M. A recommended guideline for the development of mHealth Apps. Mhealth 2016; 2:21..

Os estudos sinalizaram que para envolver os usuários os aplicativos devem incorporar ideias inovadoras²⁶26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47. com design visualmente atraente¹⁶16 Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health application (apps). J Biomed Inform 2016; 60:243-251.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191., ser intuitivo, conter jogos¹⁸18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82., incorporar plataformas de mídias sociais²⁶26 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.^,2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880., com textos claros¹⁸18 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82., ter baixo custo ou ser gratuito¹⁵15 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191..

Os requisitos para o download de um aplicativo consistem na gratuidade, segurança e privacidade dos dados, interface intuitiva, funcionar adequadamente, controle dos sons e outros recursos, ter boa avaliação de outros usuários e sem atualizações constantes do sistema¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1515 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. Esses achados estão em consonância com outros estudos os quais referem a gratuidade e a avaliação positiva de outros usuários como requisitos para o download de um aplicativo⁴⁶46 Pereira-Azevedo N, Osório L, Cavadas V, Fraga A, Carrasquinho E, Oliveira EC, Castelo-Branco M, Roobol MJ. Expert Involvement Predicts mHealth App Downloads: Multivariate Regression Analysis of Urology Apps. JMIR Mhealth Uhealth 2016; 4(3):e86.^,4747 Loy JS, Ali EE, Yap KY. Quality Assessment of Medical Apps that Target Medication-Related Problems. J Manag Care Spec Pharm 2016; 22(10):1124-1140..

Em relação a privacidade social, esta permite aos usuários o controle ao acesso das informações pessoais em seus dispositivos por meio de senhas, na notificação do parceiro íntimo e a identidade visual sem associação ao tema. Na privacidade institucional é a apreensão e a divulgação sem autorização dos dados pessoais dos usuários por organizações terceirizadas²²22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72..

Os pesquisadores devem proteger os dados dos participantes de possíveis violações da privacidade, incluindo a divulgação na participação no estudo ou informações pessoais de saúde, especialmente em tópicos sensíveis como o status do HIV, o comportamento e a orientação sexual⁴⁸48 White Y, Sandfort T, Morgan K, Karen Carpenter, Russell Pierre. Family relationships and sexual orientation disclosure to family by gay and bisexual men in Jamaica. Int J Sex Heal 2016; 28:306-317.. Os aplicativos devem ser projetados para terem uma interface discreta, neutra, sem vínculo com o tema e protegido por senha. Esses requisitos são necessários para evitar o estigma relacionado as ISTs e para encorajar o uso da tecnologia⁴⁹49 Goedel WC, Mitchell JW, Krebs P, Duncan DT. Willingness to Use Mobile Phone Apps for HIV Prevention Among Men Who Have Sex with Men in London: Web-Based Survey. JMIR Mhealth Uhealth 2017; 5(10):e153..

Quanto às informações pessoais inseridas em um aplicativo, estudos mostram a necessidade de uma fonte credível e que esclareça os termos de descrição e privacidade dos dados dos usuários, caso contrário, geram desconfiança e hesitação dos usuários para o download¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,1515 Mitchell JW, Torres MB, Joe J, Danh T, Gass B, Horvath HJ. Formative Work to Develop a Tailored HIV Testing Smartphone App for Diverse, At-Risk, HIV-Negative Men Who Have Sex With Men: A Focus Group Study. JMIR Mhealth Uhealth 2016; 4(4):e128.^,1717 Evans C, Turner K, Suggs LS, Occa A, Juma A, Blake H. Developing a mHealth intervention to promote uptake of HIV testing among African communities in the conditions: a qualitative study. BMC Public Health 2016; 16:656.^,1818 Sheoran B, Silva CL, Lykens JE, Gamedze L, Williams S, Ford JV, Habel MA. YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth. JMIR Mhealth Uhealth 2016; 4(3):e82.^,2020 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.

21 Cordova D, Bauermeister JA, Fessler K, Delva J, Nelson A, Nurenberg R, Lua FM, Alers-Rojas F, Salas-Wright CP, Youth Leadership Council. A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study. JMIR Mhealth Uhealth 2015; 3(4):e106.

22 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72.

23 Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27(6):522-237.^-2424 Broaddus MR, Marsch LA. Risks and benefits of text message-delivered and small group-delivered sexual health interventions among African American women in the Midwestern U.S. Ethics Behav 2015; 25(2):146-168.^,2626 Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men. JMIR Mhealth Uhealth 2014; 2(4):e47.

27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.^-2828 Chang LW, Njie-Carr V, Kalenge S, Kelly JF, Bollinger RC, Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: a mixed methods study. AIDS Care 2013; 25(7):874-880.. Portanto, antes de ampliar as intervenções utilizando mHealth é essencial que os pesquisadores demonstrem que os aplicativos mantenham a privacidade dos dados do paciente²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222..

Políticas de privacidade claramente definidas sobre o tratamento das informações dos usuários são importantes para salvaguardar a privacidade dos usuários⁴⁷47 Loy JS, Ali EE, Yap KY. Quality Assessment of Medical Apps that Target Medication-Related Problems. J Manag Care Spec Pharm 2016; 22(10):1124-1140.. O envolvimento dos profissionais da saúde durante o desenvolvimento dos aplicativos não garante necessariamente a sua eficácia, provavelmente forneça maior percepção das necessidades dos pacientes além de sugerir que o conteúdo seja confiável⁵⁰50 Ahmed EU, Ahmad NS, S Ali, Ali S, George A, Saleem Danish H, Uppal E, Soo J, Mobasheri MH, King D, Cox B, Darzi A. Medication Adherence Apps: Review and Content Analysis. JMIR Mhealth Uhealth 2018; 6(3):e62..

Os aplicativos podem ser integrados às rotinas assistenciais para a prevenção e o tratamento das ISTs¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,2222 Gkatzidou V, Hone K, Sutcliffe L, Gibbs J, Sadiq ST, Szczepura A, Sonnenberg P, Estcourt C. User interface design for mobile-based sexual health interventions for young people: Design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC Med Inform Decis Mak 2015; 15:72., entre as populações de difícil alcance²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222., como HSH, os quais relataram, em algumas ocasiões, julgamentos racistas e homofóbico de profissionais da saúde que atuam na atenção primária²⁰20 Levy ME, Watson CC, Wilton L, Criss V, Kuo I, Glik SN, Brewer RA, Magnus M. Acceptability of a Mobile Smartphone Application Intervention to Improve Access to HIV Prevention and Care Services for Black Men Who Have Sex with Men in the District of Columbia. Digit Cult Educ 2015; 7(2):169-191.^,1414 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46..

Combater o estigma relacionado ao HIV nos ambientes de assistência à saúde e abordar os efeitos relacionados, exigirá mais do que intervenções dirigidas a profissionais de saúde ou indivíduos com HIV. Embora as intervenções para a redução do estigma entre pessoas com HIV possam mitigar alguns efeitos individuais na saúde, estas não abordam sua inserção social que promove o estigma promulgado⁵¹51 Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, Rourke SB, Stigma Review Team. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015; 15:848..

Entre HSH, os smartphones são ferramenta requisitadas no cotidiano para conversar por SMS, bate-papo on-line por vídeo, postagens de status, blogs entre outros. Muitos homens usam a ferramenta para encontrar parceiros sexuais, bem como informações sobre HIV/IST²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. Não existe um consenso na literatura sobre a associação de encontros sexuais pelos aplicativos e o aumento de exposição ao HIV. Acredita-se que os aplicativos facilitam parcerias múltiplas e que atuam como um catalizador para um comportamento sexual de risco⁵²52 Zou H, Fan S. Characteristics of men who have sex with men who use smartphone geosocial networking applications and implications for HIV interventions: a systematic review and meta-analysis. Arch Sex Behav 2017; 46(4):885-894..

Websites e aplicativos oferecem aos usuários criarem perfis com imagens em uma rede social para conversar, compartilhar arquivos de mídia e localizar parcerias sexuais usando o sistema de posicionamento global²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222.. Entre as redes sociais mais acessados listam-se o Facebook®, Twitter®¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222. e Instagram®¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.. O Jack’d®, Grind® e Adam4Adam®¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46.^,2727 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222. são aplicativos de redes geosociais. Os sites de redes sociais ou sexuais são o Craigslist®¹⁴14 Holloway IW, Winder TJ, Lea CH, Tan D, Boyd D, Novak D. Technology Use and Preferences for Mobile Phone-Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR Mhealth Uhealth 2017; 5(4):e46. e Black Gay Chat®²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222. e aplicativos de mensagens de texto e bate-papo Oovoo®, Tango® e Skype®²⁷27 Muessig KE, Pike EC, Fowler B, LeGrand S, Parsons JT, Bull SS, Wilson PA, Wohl DA, Hightow-Weidman LB. Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men. AIDS Patient Care STDS 2013; 27(4):211-222..

Recentemente, o Facebook® e o Grindr®, plataformas de mídia social, formaram parceria com pesquisadores para divulgar informações para a prevenção do HIV, promover o teste e vincular informações aos cuidados médicos entre HSH⁵³53 Cao B, Gupta S, Wang J, Hightow-Weidman LB, Muessig KE, Tang W, Pan S, Pendse R, Tucker JD. Social media interventions to promote HIV testing, linkage, adherence, and retention: systematic review and meta-analysis. J Med Internet Res 2017; 19(11):e394.^,5454 Young LE, Fujimoto K, Schneider JA. HIV prevention and sex behaviors as organizing mechanisms in a Facebook group affiliation network among young black men who have sex with men. AIDS Behav 2018; 22(10):3324-3334.. Estudos realizados nos Estados Unidos e no Reino Unido mostraram que a promoção do teste de HIV pode ser conduzida através das plataformas de aplicativos de redes geosociais⁵⁵55 Lampkin D, Crawley A, Lopez TP, Mejia CM, Yuen W, Levy V. Reaching suburban men who have sex with men for STD and HIV services through online social networking outreach: a public health approach. J Acquir Immune Defic Syndr 2016; 72(1):73-78.^,5656 Elliot E, Rossi M, McCormack S, McOwan A. Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation. Sex Transm Infect 2016; 92(6):470-473..

Considerações finais

Entre os estudos analisados observou-se a prioridade pela pesquisa formativa a qual utiliza abordagem qualitativa e quantitativa para a compreensão abrangente dos aspectos culturais, sociais, de gênero, sexualidade, fatores políticos e estruturais da população. Estabelece um planejamento importante na elaboração de aplicativos para a prevenção das ISTs e estes poderão diminuir a disseminação da infeção e orientar a busca e o tratamento dos parceiros sexuais.

A técnica mais utilizada nos estudos foi o grupo focal, que ampliou o contexto vivenciados pelos profissionais de saúde e as expectativas dos usuários. Essa técnica objetiva a troca de experiência durante a intervenção e oportuniza a discussão de assuntos inerentes ao ser humano com HIV/ISTs. Esta técnica subsidia aos pesquisadores elaborar aplicativo centrados nas necessidades dos usuários e possibilita ainda a compreensão da prevenção, acompanhamento e tratamento dos infectados.

Os estudos mostraram a importância dos aplicativos para o automonitoramento e autogerenciamento de cuidados dos portadores de HIV/IST. Os participantes identificaram as necessidades de incorporar informações sobre prevenção, terapia antirretroviral, fórum on-line com profissionais da saúde e com outros usuários, lembretes das consultas, dos testes e localizar as unidades de saúde. Além disso, os aplicativos devem conter uma interface discreta, ser interativos, gratuito ou de baixo custo, proteger a privacidade dos dados do usuário e ser de uma fonte confiável.

Pesquisadores integram recursos e informações de redes geossosiais que utilizam o Global Positioning System (GPS) para localizar parceiros sexuais com a finalidade de promover medidas de vigilância em saúde voltadas para a prevenção e o tratamento das ISTs.

Portanto, a obtenção da tecnologia mHealth como auxílio aos profissionais da saúde na prestação do cuidado aos pacientes com ISTs configura-se como um passo importante para controle, prevenção, tratamento e concepção de programas de vigilância epidemiológica das ISTs.

Referências

Datas de Publicação

Histórico