mHealth Intervention Serves as Potential Tool for PrEP Uptake in MSM

Preexposure prophylaxis (PrEP) uptake improved in Spanish-speaking men who have sex with men (MSM) and transgender women who spoke either English or Spanish when using a mobile health (mHealth) intervention in the US, according to a study published in JMIR Formative Research. The feasibility and acceptability of mHealth was evaluated after adapting and tailoring 2 mHealth interventions: PrEPmate and DOT Diary.

PrEP has been used to prevent HIV through tenofovir disoproxil fumarate/emtricitabine and tenofovir alafenamide/emtricitabine being the most popular treatments prescribed in the US. However, retention of patients on PrEP has been low in the past, with 37% to 62% of patients discontinuing their treatment after 1 year. Preventive health behaviors can be encouraged using mobile technology, including mHealth interventions aimed at those most at risk. Further, 29% of new HIV diagnoses in 2021 were among Hispanic/Latino individuals, making them a group at high risk. The present study aimed to tailor mHealth interventions for MSM who primarily speak Spanish and transgender women who speak English or Spanish, as these groups are 2 of those most at risk of HIV and there is a critical need for mHealth tools tailored to Spanish-speaking populations and transgender women.

Medical technology on phone | Image credit: Production Perig - stock.adobe.com

PrEPmate and DOT Diary were the primary interventions used in this study, with PrEPmate being a text message–based intervention and DOT Diary being a mobile phone app that combines pill-taking and sexual activity tracking with real-time feedback on protection with PrEP. All content was translated into Spanish.

Cisgender men and transgender women 18 years and older who did not have HIV and were currently taking or had taken PrEP within the past year were eligible for this study. Participants also needed to own a smartphone and be willing to either receive text messages or download the DOT Diary app to their phone. All participants spoke Spanish or English, and were from the San Francisco Bay Area or the greater Miami area, with recruiting happening primarily on social media websites and through flyers and posters.

There were 3 focus groups conducted with MSM who spoke Spanish and transgender women who spoke English or Spanish. Discussion guides aimed to gather information on the preferences of the focus groups regarding content, layout, language, functionality, and usability. Qualitative methods were used to assess the data. A 1-month pilot program was conducted after implementing revisions to the interventions suggested by the focus groups.

There were 15 participants for the focus groups, of whom 56% were transgender women and 38% were cisgender men. The mean (SD) age was 37.9 (9.4) years, 43% identified as Latino or Hispanic, and 73% were currently taking PrEP.

Regarding feedback on PrEPmate, the participants liked the text messages but were unsure if they could reply and get a response from a human. They also liked the messages reminding them to take their PrEP medication and thought they would be helpful in scheduling appointments.

The tone and language of the messages aimed at transgender women were also appreciated. The adherence tracking and protection features of the DOT Diary app were recommended ,with the calendar view garnering positive feedback. However, they felt the sexual activity diary needed to be simplified. Ninety-three percent of participants would use PrEPmate and DOT Diary, with the medication reminders being the most useful part. Changes were made using this feedback before the technical pilot.

The technical pilot featured 21 participants who used the services from July 2021 to August 2021, with 11 using DOT Diary and 10 using PrEPmate; 57% were from Miami and 43% were from San Francisco. The mean age was 38.3 (7.6) years, 57% were cisgender men, and all participants tested the interventions in Spanish.

The mean System Usability Scale scores were 81.2 (13.1) and 76.4 (12.2) for PrEPmate and DOT diary respectively, which were deemed good to excellent. PrEPmate had a higher score in the assessment of how well integrated the tools were, but both scored highest on the tools being easy to use. PrEPmate had a mean Client Satisfaction Questionnaire-8 score of 28.6 (4.4), and DOT Diary had a score of 28.3 (3.2). The highest scores were given to questions asking if the participant would recommend the platform, if they were satisfied with the platform, and if the platforms helped them to take their daily PrEP.

There were some limitations to this study. There were a small number of participants included in the focus groups and the pilot, and he pilot also took place over a short amount of time, which may have limited the number of conclusions that can be drawn about long-term feasibility. Also, participants responses could have been affected by social desirability and generalizability of the study could have been limited due to participants being recruited from San Francisco and Miami alone.

The researchers concluded that acceptability and feasibility of both mHealth interventions were high after adapting them for MSM and transgender women who speak Spanish. Further evaluation is needed to test the effectiveness of PrEPmate vs DOT Diary in a larger cohort study.

Reference

Liu AY, Alleyne CD, Doblecki-Lewis S, et al. Adapting mHealth interventions (PrEPmate and DOT Diary) to support PrEP retention in care and adherence among English and Spanish-speaking men who have sex with men and transgender women in the United States: formative work and pilot randomized trial. JMIR Form Res. 2024;8:e54073. doi:10.2196/54073