mHealth for pre-exposure prophylaxis adherence by young adult men who have sex with men

Abstract

Background: Young adult men who have sex with men (YMSM) are at increased risk for HIV, especially minority YMSM. Pre-exposure prophylaxis (PrEP) is a breakthrough daily pill to prevent HIV. Consistent adherence is key to PrEP effectiveness, which is why the CDC recommends adherence support be provided to all PrEP patients. Mobile health can overcome barriers to the delivery of adherence support, particularly for YMSM who may be most in need of it due, at least in part, to their young age.Methods: We created a culturally-and developmentally-sensitive PrEP adherence mobile app (called "Dot") that was tailored for culturally-diverse young adult MSM. After formative research and usability testing, we conducted a 6-week pre-post study to evaluate the impact of Dot on self-reported PrEP adherence, PrEP treatment self-efficacy, PrEP knowledge, and intention to practice safe sex among culturally-diverse YMSM, age 20-29.Results: At 6 weeks, there were significant improvements in PrEP adherence, PrEP self-efficacy, and intention to practice safe sex. PrEP knowledge scores did not significantly change. Conclusions:The Dot app proved feasible and effective at improving PrEP adherence among culturallydiverse YMSM. Moreover, the app had a high-degree of user appeal, which is foundational to success of an mhealth intervention.

Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review

“…Two studies described successful PrEP initiation and monitoring using an online platform [ 17 , 27 ], and four studies found that telehealth for PrEP was feasible, acceptable, and effective [ 13 , 16 , 24 , 25 ]. Eight studies examined the use of apps [ 11 , 18 , 21 , 28 ] and SMS [ 15 , 19 , 22 , 26 ] for PrEP service delivery. Of note, only one study, the Enhancing PrEP in Community Settings (EPIC) study, presented results from an RCT [ 19 ].…”

Evidence and implication of interventions across various socioecological levels to address pre-exposure prophylaxis uptake and adherence among men who have sex with men in the United States: a systematic review

“…PrEP interventions for MSM were reported to implement in the US South (Florida, Georgia, Texas, Maryland, Mississippi, North Carolina and D.C.) [ 30 – 40 ], Northeast (Pennsylvania, New York, Massachusetts and Rhode Island) [ 27 , 31 – 33 , 36 , 38 , 41 – 49 ], Midwest (Illinois, Michigan, and Wisconsin) [ 24 – 26 , 32 , 33 , 36 , 47 , 50 – 52 ], West (California) [ 51 , 53 – 58 ] and nationwide [ 59 – 63 ]. Thirty-seven of the 42 studies focused solely on MSM [ 24 – 27 , 30 – 34 , 36 – 41 , 43 – 47 , 49 – 54 , 56 , 58 – 72 ], with some targeting Black, Hispanic/Latino MSM or MSM younger than 34 years old [ 24 – 27 , 30 – 34 , 36 – 40 , 44 – 46 , 49 , 50 , 52 , 56 , 58 , 60 – 63 , 70 ]. Five studies were conducted among MSM and other priority populations(e.g., transgender women or heterosexual men) [ 35 , 42 , 48 , 55 , 57 ].…”

“…Five studies were conducted among MSM and other priority populations(e.g., transgender women or heterosexual men) [ 35 , 42 , 48 , 55 , 57 ]. A RCT design was used to evaluate 37 interventions on their effect on PrEP-related outcomes [ 24 , 25 , 27 , 30 – 42 , 44 – 48 , 50 , 52 – 56 , 58 – 63 , 66 – 72 ], whereas 5 interventions were evaluated using a quasi-experimental design [ 26 , 43 , 49 , 51 , 57 ] and 4 via a pretest-posttest design [ 26 , 49 , 51 , 57 ].…”

“…Most interventions were evaluated by PrEP-related outcomes across the PrEP care continuum with PrEP uptake (n = 29) and adherence (n = 24) most commonly reported. Awareness of PrEP was measured by participants’ knowledge about PrEP including medication purpose, side effects and self-efficacy [ 25 – 27 , 31 , 33 , 39 , 40 , 43 – 45 , 49 , 56 , 60 , 63 , 70 ]. PrEP willingness/intention focused on participants’ attitudes towards PrEP use such as their likelihood of initiating PrEP across various conditions or during a future time window (e.g., within the next 3 or 6 months) [ 25 – 27 , 31 , 33 , 34 , 39 , 44 , 57 , 59 , 60 , 63 , 70 ].…”

“…The apps compiled relevant information that may influence PrEP use (e.g., education of correct HIV risk perception, medication efficacy, self-efficacy and social norms) and integrated supports from local PrEP providers to improve participants’ awareness of PrEP and facilitate linkage to PrEP care [ 30 , 37 , 45 , 47 , 61 , 62 , 70 ]. Other key features that might facilitate participants’ adherence to PrEP included medication reminder, graphical tracking of medication adherence and day-to-day strategies to counter relevant barriers (e.g., PrEP stigma) [ 32 , 49 ]. App-based interventions were found to be acceptable and feasible [ 57 , 64 , 65 ], but their efficacy remains unclear as most studies are still ongoing [ 32 , 37 , 47 , 61 , 62 , 70 , 72 ].…”