Brief Report: PrEPTECH: A Telehealth-Based Initiation Program for HIV Pre-exposure Prophylaxis in Young Men of Color Who Have Sex With Men. A Pilot Study of Feasibility

Abstract

Background: In the United States, young men who have sex with men (YMSM) of color represent a high number of new human immunodeficiency virus (HIV) diagnoses annually. HIV pre-exposure prophylaxis (PrEP) is effective and acceptable to YMSM of color, yet PrEP uptake is low in those communities due to barriers including stigma, cost, adherence concerns, and medical distrust. A telehealth-based approach to PrEP initiation may be a solution to those barriers. This pilot study investigates one such intervention called PrEPTECH. Methods: We enrolled 25 HIV-uninfected YMSM, aged 18–25 years, from the San Francisco Bay Area into a 180-day longitudinal study between November 2016 and May 2017. Participants received cost-free PrEP services via telehealth (e.g., telemedicine visits, home delivery of Truvada® and sexually transmitted infection [STI] testing kits), except for two laboratory visits. Online survey assessments querying PrEPTECH features and experiences were administered to participants at 90- and 180-days. Results: Eighty-four percent of participants were YMSM of color. Among the 21 who completed the study, 11 of the 16 who wanted to continue PrEP were transitioned to sustainable PrEP providers. At least 75% felt that PrEPTECH was confidential, fast, convenient, and easy to use. Less than 15% personally experienced PrEP stigma during the study. The median time to PrEP initiation was 46 days. STI positivity was 20% and 19% at baseline and 90-days respectively. No HIV infections were detected. Conclusions: Telehealth programs like PrEPTECH increase PrEP access for YMSM of color by eliminating barriers inherent in traditional clinic-based models.

High acceptability of PrEP teleconsultation and HIV self-testing among PrEP users during the COVID-19 pandemic in Brazil

“…A pilot initiation program for PrEP delivery in the United States showed that teleconsultation increased access to young black MSM, as it eliminated barriers inherent in traditional clinic-based models. 11 Conversely, results from our ordinal logistic model indicate that acceptability of PrEP teleconsultation was higher among those with higher education, indicating that face-to-face consultation may not be completely replaced. Brazil faces huge social and educational disparities that may become even more profound during and after the COVID-19 pandemic.…”

Mixed-Methods Evaluation of the Incorporation of Home Specimen Self-Collection Kits for Laboratory Testing in a Telehealth Program for HIV Pre-exposure Prophylaxis

“…Direct-to-client telehealth (i.e., serving clients at home or in other non-healthcare settings using videoconferencing and related technology) is a well-accepted method for PrEP care that can overcome barriers related to distance, inconvenience, and stigma [ 7 , 11 – 13 ]. Little is known about best practices for incorporating routine laboratory monitoring in direct-to-client telehealth programs, which often serve clients who do not routinely visit healthcare settings and live far from providers.…”

<p>Pre-Exposure Prophylaxis (PrEP) in the Prevention of HIV: Strategies, Target Populations and Upcoming Treatments</p>

“…There were no HIV seroconversions during the study. 24 In another study in the state of Iowa, pharmacists employed telemedicine to conduct patient interviews, order laboratory studies, and mail PrEP medications to patients. Study results showed that 91% of video visits resulted in PrEP initiation.…”